Chapter 5 - Objectives: First Principles of Gastroenterology

Chapter 5:
Esophagus

Sections:

1. Introduction

2. Anatomy

3. Physiology

4. Symptoms and Signs of Esophageal Disease

5. Investigations Used in the Diagnosis of Esophagael Disease

6. Anatomic Variants

7. Gastroesophagael Reflux Disease (GERD)

8. Nonreflux-Induced Esopagitis

9. Disorders of the Orpharyngeal Phase of Deglutition

10. Motor Disorders of the Esophagus and Lower Esophagael Sphincter

11. The Esophagus as a Cause of Angina-Like Chest Pain

12. Esophageal Neoplasms

13. Miscellaneous Disorders of the Esophagus

Suggested Reading List

Objectives

Workbook

Index

Acknowledgement

Disclaimer

OBJECTIVES

Anatomy and Physiology

1. Know the anatomy and physiology of the normal esophagus and
esophagogastric junction.

2. Describe the process of deglutition and esophageal peristalsis.

3. Understand the different physiological control mechanisms between the upper
striated-muscle esophagus and distal smooth-muscle esophagus.

4. Understand the mechanisms underlying LES tone and relaxation.

Congenital and Anatomic Abnormalities

1. Define esophageal atresia and tracheoesophageal fistula, and describe
how they present.

2. Define hiatus hernia with regard to anatomic type (sliding versus
paraesophageal).

Gastroesophageal Reflux Disease (GERD)

1. Outline the clinical symptoms of GERD.

2. Describe the anatomic and physiological factors predisposing to GERD.

3. Discuss the procedures used in the diagnosis of GERD.

4. Discuss medical management of GERD.

5. List the indications for operative management of GERD and discuss the
physiological basis for the antireflux procedures.

6. List the complications of gastroesophageal reflux disease.

Nonreflux-Induced Esophagitis

1. List the major infectious causes of esophagitis (Candida, herpetic)
and describe how they present.

2. List other causes of esophagitis.

Disorders of the Oropharyngeal Phase of Deglutition

1. Categorize the major causes of oropharyngeal deglutition.

2. Describe how oropharyngeal dysphagia can be differentiated from esophageal
dysphagia based on history.

3. Describe the investigations required in the assessment of oropharyngeal
dysphagia.

4. What are the complications of oropharyngeal dysphagia?

Motor Disorders of the Esophagus

1. List the major primary and secondary esophageal motor disorders.

2. Describe the clinical symptoms typically associated with different esophageal
motor disorders.

Esophageal Tumors

1. List the symptoms suggestive of an esophageal malignancy.

2. Outline a diagnostic plan for evaluating a patient with suspected esophageal
tumor.

3. Describe the natural history of malignant esophageal neoplasms.

4. List the common types of benign esophageal tumors.

Miscellaneous Esophageal Disorders

1. Be able to describe the presenting sympomatology and typical x-ray
findings of esophageal webs, and Zenker's and esophageal diverticula.

2. Outline the clinical presentation and management of patients presenting
with (a) Boerhaave's syndrome and (b) esophageal foreign body or
food-bolus obstruction.

Skills

1. Demonstrate the ability to read a barium swallow in patients with sliding and
paraesophageal hiatus hernia, esophageal cancer, Zenker's diverticulum,
esophageal diverticulm and achalasia.

2. Describe the motility abnormalities in achalasia, diffuse esophageal spasm,
"nutcracker" esophagus and scleroderma esophagus.

3. Develop an approach for the diagnostic evaluation of a patient with dysphagia.