1. Esophageal Disorders Quiz

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Questions and Answers

Which of the following is a first-line treatment for eosinophilic esophagitis?

Proton pump inhibitors (correct)

Corticosteroids

H2 receptor antagonists

Antacids

Dietary restrictions for eosinophilic esophagitis often involve eliminating which of the following?

Fruits and vegetables

Dairy, eggs, soy, and wheat (correct)

Grains and nuts

Artificial sweeteners and preservatives

The classic triad of achalasia includes all of the following, EXCEPT:

Increased lower esophageal sphincter pressure

Incomplete lower esophageal sphincter relaxation

Esophageal hypermotility (correct)

Aperistalsis of the esophagus

Primary achalasia is most commonly caused by:

Degeneration of nitric oxide-producing neurons Signup and view all the answers

Which of the following is a cause of secondary achalasia (pseudoachalasia)?

Chagas disease Signup and view all the answers

Which of the following symptoms is commonly associated with achalasia?

Progressive difficulty swallowing both solids and liquids Signup and view all the answers

What is the typical appearance of the esophagus on a barium swallow study in a patient with achalasia?

A dilated esophagus with a distal area of stenosis having a 'bird's beak' appearance Signup and view all the answers

What is the primary reason that the esophageal epithelium is susceptible to injury in GERD?

The epithelium's sensitivity to gastric acid. Signup and view all the answers

The pathophysiology of achalasia involves the degeneration of inhibitory neurons in which location?

Myenteric (Auerbach) plexus Signup and view all the answers

What is the most frequently observed endoscopic finding associated with damage to the esophageal mucosa due to GERD?

Reflux esophagitis Signup and view all the answers

Which esophageal manometry finding is most consistent with the diagnosis of achalasia?

Uncoordinated or absent peristalsis along with high LES resting pressure Signup and view all the answers

In achalasia, the increased resting pressure of the lower esophageal sphincter (LES) is directly related to which of the following?

Degeneration of inhibitory neurons Signup and view all the answers

Which of the following is considered a major cause of GERD due to transient lower esophageal sphincter relaxation?

Vagal pathway activity Signup and view all the answers

What is the primary characteristic of esophagitis?

Inflammation of the esophageal mucosa Signup and view all the answers

Which of the following is a common feature of achalasia?

Esophageal dilation proximal to the LES Signup and view all the answers

What is the primary surgical goal in the treatment of achalasia?

To relieve the functional obstruction of the lower esophageal sphincter while preventing reflux Signup and view all the answers

Besides surgery, which endoscopic procedure is indicated for achalasia?

Botulinum toxin injection into the LES Signup and view all the answers

Which of the following is NOT a direct cause of esophagitis?

Hiatal hernia Signup and view all the answers

What can cause gastroesophageal reflux due to an increase in intra-abdominal pressure?

Coughing, straining or bending Signup and view all the answers

In mild cases of GERD, what is the common observable change in the esophageal morphology?

Simple hyperemia Signup and view all the answers

Eosinophilic esophagitis is most strongly associated with which of these?

Allergic conditions and atopy Signup and view all the answers

What is the most frequent cause of esophagitis?

Reflux of gastric contents into the lower esophagus Signup and view all the answers

What is a morphological change that is commonly found with more severe gastric reflux?

Erosions Signup and view all the answers

Which of the following is a common symptom of eosinophilic esophagitis?

Food bolus impaction Signup and view all the answers

Which of the following is NOT a listed disorder affecting the esophagus?

Gastritis Signup and view all the answers

Barrett's esophagus is a complication of chronic GERD characterized by what cellular change?

Glandular metaplasia Signup and view all the answers

What is a common observation during esophageal manometry specifically related to the lower two thirds of the esophagus in patients with achalasia?

Absent or uncoordinated peristalsis Signup and view all the answers

What is the key diagnostic finding in eosinophilic esophagitis?

Intraepithelial accumulation of eosinophils Signup and view all the answers

Which demographic group is most commonly affected by eosinophilic esophagitis?

Young males Signup and view all the answers

In Barrett's esophagus, if the cause of reflux is not removed what may the metaplasia lead to?

Dysplasia Signup and view all the answers

Which of the following best describes the nature of eosinophilic esophagitis?

A chronic immune-mediated inflammatory condition Signup and view all the answers

What can exacerbate symptoms of eosinophilic esophagitis?

Ingestion of food containing allergens Signup and view all the answers

Which of the following is a typical symptom of bleeding esophageal varices?

Sudden onset of severe gastrointestinal bleeding Signup and view all the answers

What is the primary diagnostic procedure for esophageal varices?

Esophagogastroduodenoscopy (EGD) Signup and view all the answers

Which of the following is a typical treatment for esophageal varices?

Endoscopic variceal ligation Signup and view all the answers

What is the underlying cause of a Zenker diverticulum?

Inadequate relaxation of the upper esophageal sphincter and increased intraluminal pressure Signup and view all the answers

Which of the following is a common presenting symptom of Zenker diverticulum?

Dysphagia and gurgling Signup and view all the answers

What is the diagnostic procedure of choice for Zenker diverticulum?

Barium swallow with videofluoroscopy Signup and view all the answers

At which location does a Zenker diverticulum typically arise?

Above the upper esophageal sphincter at the junction of the esophagus and pharynx Signup and view all the answers

What is the main treatment for symptomatic Zenker diverticula?

Surgery Signup and view all the answers

A patient presents with hematemesis after a bout of severe vomiting. Which of the following conditions is most likely?

Mallory-Weiss syndrome Signup and view all the answers

Which of these is a predisposing condition for Mallory-Weiss syndrome?

Hiatal hernia Signup and view all the answers

What is the primary mechanism behind the development of a Mallory-Weiss tear?

Severe retching or vomiting Signup and view all the answers

A patient with suspected Mallory-Weiss syndrome is undergoing diagnostic testing. Which procedure is considered the gold standard?

Esophagogastroduodenoscopy (EGD) Signup and view all the answers

What is a defining characteristic of Mallory-Weiss syndrome?

Partial thickness lacerations at the gastroesophageal junction Signup and view all the answers

When is surgical ligation indicated in cases of Mallory-Weiss syndrome?

When EGD or angiographic treatment fails and bleeding is ongoing Signup and view all the answers

A hiatal hernia is characterized by:

The abnormal protrusion of an abdominal structure into the thoracic cavity Signup and view all the answers

Which of the following is least specific for Mallory-Weiss syndrome?

Hematemesis Signup and view all the answers

Study Notes

School of Medicine - Diseases of the Esophagus

The School of Medicine at Universidad Autónoma de Guadalajara focuses on diseases of the esophagus.
The faculty includes Ximena Paredes Limon, MD, and Emily Paez Morales, MD.

Objectives

Students will apply knowledge of GI anatomy, histology, and physiology to explain clinicopathologic features, diagnostic criteria, and therapies for disorders like inflammation, abnormal GI motility, and gastrointestinal tract obstruction.
The pathophysiology and clinicopathological features of specific esophageal disorders will be described, including Zenker diverticulum, achalasia, esophagitis, esophageal reflux, Mallory-Weiss syndrome, and hiatal hernias.
Treatment and management options, including lifestyle modifications, pharmacological interventions, and surgical procedures, will be explored.

Esophagus

The esophagus is a hollow, highly distensible muscular tube.
It spans from the epiglottis in the pharynx to the gastroesophageal junction.
Its length ranges from 18 to 26 cm.
It acts as a conduit for food transport from the oral cavity to the stomach.
The esophageal walls are made up of four layers: mucosa, submucosa, muscularis propria, and adventitia.

Esophageal Constrictions

The esophagus has three constrictions: Upper, Middle, and Lower.
These constrictions are located at different anatomical regions (C6-C7, T3-T4, and T10-T11).

Esophagus Layers

Mucosa:
- Stratified squamous epithelium (non-keratinized).
- Muscularis mucosa (smooth muscle within mucosa).
Submucosa: Contains blood vessels, Meissner's plexus, and glandular epithelium.
Muscularis externa: Contains inner circular and outer longitudinal muscle fibers, with the proximal 1/3 mostly striated muscle and distal 2/3 mostly smooth muscle. The Auerbach's plexus lies between these layers.
Adventitia: Consists of dense connective tissue and elastic fibers, attaching the esophagus to the rest of the body.

Esophageal Mucosa

Lined by non-keratinizing stratified squamous epithelium transitioning to columnar epithelium at the gastroesophageal junction.

Esophageal Disorders

Esophagitis: inflammation of the esophageal mucosa due to direct mucosal injury, inflammatory processes, or substance-induced damage.
Eosinophilic esophagitis: Chronic immune-mediated inflammation predominantly caused by eosinophils, often associated with allergic diseases. Symptoms can include dysphagia, food bolus impactions, and food allergen-related symptoms. Diagnosis is confirmed by histopathology showing intraepithelial eosinophil accumulation. Treatment involves restricting exposure to food allergens and using PPI's for 8 weeks.
Achalasia: Characterized by an incomplete or absent lower esophageal sphincter relaxation and peristaltic dysfunction leading to dysphagia, regurgitation, retrosternal pain, and weight loss. Diagnosis involves esophageal manometry which reveals uncoordinated peristalsis with an elevated resting LES pressure. Treatment options include Heller myotomy and partial fundoplication or botulinum toxin injections. The etiology can be primary (unknown) or secondary (related to various disorders including Chagas disease).
Reflux esophagitis: Reflux of gastric contents into the lower esophagus leads to esophagitis, often due to gastroesophageal reflux disease (GERD) with esophageal mucosa susceptible to acid damage, but resists abrasive injury. Endoscopic findings include reflux esophagitis. Grading (A-D) is based upon the degree of mucosal injury.
Barrett's esophagus: A complication of chronic GERD. Results from the replacement of squamous esophageal epithelium with glandular metaplasia, increasing risk of esophageal adenocarcinoma and has recognizable mucosal tongues of red, velvety mucosa extending upward from the gastroesophageal junction. Diagnosis requires endoscopic evidence of metaplastic columnar mucosa. Microscopically, intestinal-type metaplasia is recognized in tissue samples where goblet cells are characteristic of Barrett's condition.
Esophageal varices: Dilated veins within the lower esophagus, caused by portal hypertension.
Zenker diverticulum: An outpouching of the lower pharyngeal mucosa and submucosa, often in older men and caused by inadequate relaxation of the upper esophageal sphincter. It is diagnosed via barium swallow with videofluoroscopy and treatment is often surgical, depending on the extent of the pouch.
Mallory-Weiss Syndrome: Longitudinal mucosal lacerations of the gastroesophageal junction, commonly caused by severe vomiting, often associated with acute alcohol intoxication or bulimia, and characterized by hematemesis. Diagnostically, using EGD is helpful in ruling out other reasons for upper GI bleeding. Surgical ligation of bleeding vessels may be a treatment option for advanced cases.

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Description

Test your knowledge on various esophageal disorders, including eosinophilic esophagitis and achalasia. This quiz covers key symptoms, diagnostic criteria, and treatment options. Challenge yourself with detailed questions related to esophageal conditions and their management.