Comlex Patients: Gi System, Esophageal Pathology

Front 1

Infant presents with regurgtation after feeding and is dx with aspiration pneumonia.
X-ray shows air in the stomach (air is coming from the trachea)
What is the congenital abnormality?

Back 1

Tracheoesophageal fistula
What is the most common type of TE Fistula?

Hint 1

Blind pouch at the proximal esophagus
Anastomoses with the trachea at the bifurcation

Front 2

Middle-aged female presents with dysphagia and iron deficiency anemia.
What is the abnormality?

Back 2

Plummer-Vinson syndrome
Esophageal web
Increased risk for what?

Hint 2

squamous cell carcinoma

Front 3

Pt presents with progressive dysphagia
Barium swallow shows "bird-beak"sign and esophagus dilated proximal to the LES

Back 3

Achalasia: failure of the LES to relax
Pt states recent trip to South America
What disease caused this? Pt at increased risk?

Hint 3

Chagas dz (loss of ganglion cells in myenteric plexus)
Squamous cell carcinoma

Front 4

Pt presents with hematemesis; hx alcoholic (or bulemic);
You find linear lacerations to the esophagus.
What is your dx?

Back 4

Mallory-Weiss syndrome
What if the tear leads to perforation of esophagus?

Hint 4

Boerhaave syndrome

Front 5

Pt is an alcoholic with hx of cirrhosis/portal HTN
You find dilated submucosal veins in the lower 1/3 of esophagus. Pt at risk for what type of emergency?

Back 5

Esophageal varices to rupture
(worse prognosis than mallory-weiss syndrome)
Pt now has massive hematemesis, what is the Rx?

Hint 5

Band ligation, sclerotherapy, or balloon tamponade

Front 6

Pt presents with heartburn and regurgitation
What is the most common cause of esophagitis?

Back 6

Gastroesophageal Reflux Dz
What do you need to see on biopsy to make dx and what are some complications to GERD?

Hint 6

Must see eosinophils on mucosal biopsy (think: body has an allergy to the acid)
Bleeding, stricture, bronchosphasm, asthma, Barrett esophagus

Front 7

Pt hx chronic GERD
Endoscopy shows red granular mucosa at the GE junction
Path report: metaplasia of squamous esophageal mucosa -> columnar epithelium (intestinal metaplasia)

Back 7

Barrett esophagus
Pt increased risk of what (especially in Caucasians)?

Hint 7

Columnar Metaplasia -> Dysplasia -> Esophageal Adenocarcinomas

Front 8

African American male, >50 y/o presents with progressive dysphagia, hx of ETOH, smoking, achalasia, prior lye exposure, Plummer-Vinson syndrome
You find a mid-esophageal leision. What would you expect the biopsy to show?

Back 8

Squamous cell carcinoma of esophagus
What is the pt's prognosis?

Hint 8

poor b/c good chance it's already metastasized