Upper GI Integrative Cases

Question 1

What is the most common form of esophageal congenital anomaly?

What is its most common form?

Answer 1

Tracheoesophageal fistula.

Blind upper segment with distal fistula.

Question 2

How would a blind upper segment with distal fistula present? (symptoms)

Answer 2

Vomiting without bile, food intolerance, air in the stomach.

Question 3

What are esophageal webs?

How do they occur?

What symptoms do they cause?

Answer 3

Thick bands of tissues, usually in the upper esophagus, that form obstructive margins.

May be congenital or acquired (eg response to severe GERD)

Dysphagia.

Question 4

What syndrome, seen in postmenopausal women, is associated with esophageal webs?

What are its other associations?

Answer 4

Plummer-Vinson syndrome.

Iron deficiency anemia, atrophic glossitis, as well as an increased risk of esophageal squamous cell carcinoma.

Question 5

What is the other name for an esophageal ring?

What is the difference between an A or B ring?

Distinguish it from an esophageal web.

Answer 5

Schatzki ring.

A rings are above GEJ, B rings are at them.

Thicker and full-circumference. Also produces dysphagia.

Question 6

Name 4 possible complications of achalasia.

Answer 6

1. Squamous cell carcinoma
2. Candida esophagitis
3. Diverticula formation
4. Aspiration pneumonia

Question 7

Name the esophageal diverticula that correspond to the upper, middle, and lower segments of the esophagus.

What causes these to form

Answer 7

Upper: Zenker

Middle: Traction

Lower: Epiphrenic

Formed from motor dysfunction which applies force/stress to that part of the esophagus (alternately, weakened wall eg in GERD, mediastinal lymphadenitis)

Question 8

What is the diagnosis for painful hematemesis?

What causes it?

Answer 8

Mallory-Weiss tears (longitudinal tears at the GEJ)

Alcoholics experience a loss of the inhibitory function that limits the strength of vomiting; this allows the tearing to occur.

Question 9

What causes an esophageal varix?

What is the outlook?

Answer 9

Portal hypertension (usually due to alcoholism) causes porto-caval anastomosis through the veins in the lower esophagus.

Not good; 40-50% mortality rate with massive bleeding.

Question 10

An esophageal biopsy taken from Steve-O (a daredevil known for vomiting on-camera) shows presence of blue-staining mucin goblets. What type of epithelium is this, and what is this condition known as?

Answer 10

Intestinal-type epithelium (simple columnar); Steve-O has Barrett’s esophagus.

(no really, the guy actually does have Barrett’s esophagus)