| Chapter 5 Workbook |
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LEARNER OBJECTIVES
At the completion of this chapter, the learner will be able to:
Section 1: Introduction
1.1 Define the esophagus and describe its primary function.
Section 2: Anatomy
2.1 Describe the anatomy of the normal esophagus and esophagogastric
junction,
including:
2.2 Motor innervation
2.3 Blood supply
2.4 Lymphatic drainage
2.5 Histology
Section 3: Physiology
3.1 Describe the process of deglutition.
3.2 Describe the function of the upper esophageal sphincter.
3.3 Discuss esophageal body peristalsis, including the difference in
the control
mechanisms between the upper
striated-muscle esophagus and distal
smooth-muscle esophagus.
3.4 Describe the function of the lower esophageal sphincter.
Section 4: Symptoms and Signs of Esophageal Diseases
4.1 Describe the symptoms of esophageal disease, including:
4.1.1 Dysphagia
4.1.2 Odynophagia
4.1.3 Heartburn or pyrosis
4.1.4 Regurgitation
4.1.5 Nonheartburn chest pain
4.1.6 Waterbrash
4.1.7 Bleeding
4.1.8 Respiratory/laryngeal symptoms
Section 5: Investigations Used in the Diagnosis of Esophageal
Disease
5.0 Define the following investigations:
5.1 Barium x-ray
5.2 Endoscopy with mucosal biopsy and brush cytology
5.3 Bernstein (acid perfusion) test
5.4 Esophageal manometry
5.5 pH reflux studies
5.6 Radionuclide studies
Section 6: Anatomic Variants
6.1 Define esophageal atresia and tracheoesophageal fistula,
including how
they present.
6.2 Define hiatus hernia with regard to anatomic type (sliding
versus paraesophageal).
Section 7: Gastroesophageal Reflux Disease (GERD)
7.1 Describe the anatomic and physiological factors predisposing to
GERD.
7.2 Outline the clinical features of GERD.
7.3 Discuss the procedures used in diagnosing GERD.
7.4 Discuss the management of GERD, including medical and surgical
treatment.
7.5 Define the complications of GERD, including peptic stricture,
Barrett's
esophagus, and respiratory
complications.
Section 8: Nonreflux-Induced Esophagitis
8.1 Describe the major infectious causes of esophagitis, including
how
they present.
8.1.1 Candida esophagitis
8.1.2 Herpes simplex esophagitis
8.3 Discuss chemical-induced esophagitis, including:
8.3.1 Caustic chemical ingestion
8.3.2 Pill-induced esophagitis
8.4 Describe radiation-induced esophagitis.
Section 9: Disorders of the Oropharyngeal Phase of Deglutition
9.1 List the major causes of oropharyngeal deglutition.
9.2 Describe how oropharyngeal dysphagia can be differentiated from
esophageal
dysphagia based on history.
9.3 Describe the investigations required in assessing oropharyngeal
dysphagia.
9.4 Discuss the complications of oropharyngeal dysphagia.
Section 10: Motor Disorders of the Esophagus and Lower
Esophageal Sphincter
10.0 Describe the major primary and secondary motor disorders of the
esophagus,
including clinical
symptoms.
10.1 "Nutcracker" esophagus
10.2 Diffuse esophageal spasm
10.3 Achalasia
10.4 Scleroderma esophagus
Section 11: The Esophagus as a Cause of Angina-Like Chest Pain
11.1 Discuss the management of angina-like chest pain of esophageal
origin,
including presenting
symptoms, initial investigations, and treatment.
Section 12: Esophageal Neoplasms
12.0 Discuss the different types of tumors which can involve the
esophagus,
including:
12.1 Benign tumors (leiomyoma, squamous cell papillomas,
fibrovascular polyps,
granular cell
tumors)
12.2 Malignant tumors
12.2.1 Adenocarcinoma
12.2.2 Squamous cell carcinoma
Section 13: Miscellaneous Disorders of the Esophagus
13.0 Describe the presenting symptomatology and typical x-ray
findings of:
13.1 Webs and rings
13.2 Diverticula
13.3 Describe the clinical presentation and management of patients
presenting with
esophageal trauma.
13.4 Describe the clinical presentation and management of patients
presenting with
food-bolus
obstruction or foreign bodies.
13.5 Demonstrate the ability to read a barium swallow in patients
with sliding and
paraesophageal
hiatus hernia, esophageal cancer, Zenker's diverticulum,
esophageal
diverticulum, and achalasia.
13.6 Develop an approach for the diagnostic evaluation of a patient
with dysphagia.
LEARNER WORKBOOK
EXERCISE 1
1.1 Briefly describe the esophagus, including its primary function.
EXERCISE 2
2.1 Describe the anatomy of the esophagus, including the UES and
LES.
2.2.1 Motor innervation of the esophagus is via the
__________________.
2.2.2 Describe motor innervation of the esophagus.
2.3.1 Arterial blood supply to the UES and cervical esophagus is via
_________________.
2.3.2 Most of the thoracic esophagus is supplied by which arteries?
2.3.3 The LES and the most distal segment of the esophagus are
supplied by which
arteries?
2.3.4 Venous drainage is via ____________________.
2.4 Briefly describe lymphatic drainage as it relates to the
esophagus.
2.5.1 The wall of the esophagus consists of ___ ________, ___
_______, and___
________.
2.5.2 Briefly describe the histology of the esophagus.
EXERCISE 3
3.1 Briefly describe the process of deglutition.
3.2 What is the function of the upper esophageal sphincter?
3.3 What is the difference in the control mechanisms between the
upper
striated-muscle esophagus and
distal smooth-muscle esophagus?
3.4 What is the function of the lower esophageal sphincter?
EXERCISE 4
4.1 The most commonly used method of investigating the esophagus is
a
______________.
4.2 Match the following investigations with the correct measurement.
| Investigation |
|
Measurement |
1.
pH reflux studies
2. Esophageal manometry
3. Bernstein test
4. Barium x-ray
5. Radionuclide studies
6. Fiberoptic endoscopy
|
_____
_____
_____
_____
_____
_____
|
a.
evaluates both structural lesions &
motor disorders
b. identifies structural & neurologic
abnormalities
c. records intraluminal pressures at
multiple sites
d. assesses gastroesophageal reflux or
esophageal transit
e. tests sensitivity of the esophagus to
acid perfusion
f. measures acid reflux events
g. visualizes the esophageal mucosa
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EXERCISE 5
5.1 Briefly describe tracheoesophageal fistula with esophageal
atresia.
5.2 Treatment of esophageal fistulas (with or without atresia) is by
means of
_________________.
5.3 Hiatus hernias can be divided into two types: _____________,
_____________.
5.4 Describe each type of hiatus hernia.
EXERCISE 6
6.1 Describe the anatomic and physiological factors predisposing to
GERD.
6.2 The most important barrier to gastroesophageal reflux is the
_______________.
6.3 List five clinical features of GERD.
6.4 What tests are used in diagnosing GERD?
6.5 Outline the medical therapies used in GERD.
6.6 Define the following complications of GERD:
EXERCISE 7
7.1 The two most common forms of infectious esophagitis are
_________________
and _________________.
7.2 Briefly describe caustic chemical ingestion and its effects on
the esophagus.
7.3 Briefly describe pill-induced esophagitis.
EXERCISE 8
8.1 List two causes of oropharyngeal deglutition for each of the
following categories:
a. Central nervous system disease
b. Peripheral nervous system disease
c. Muscle disease
d. Local disorders
e. Idiopathic
8.2 Briefly discuss the treatment for oropharyngeal motor disorders.
EXERCISE 9
9.1 Motor disorders of the esophagus can be classified as either
primary or
secondary. Briefly describe the
following and identify if they are primary or
secondary.
EXERCISE 10
10.1 Describe the management of angina-like chest pain of esophageal
origin,
including:
a. Presenting symptoms
b. Initial investigations
c. Treatment
EXERCISE 11
11.1 A large number of different tumors can involve the esophagus.
Briefly describe
the following benign
tumors:
a. Leiomyoma
b. Squamous cell papillomas
c. Fibrovascular polyps
d. Granular cell tumors
11.2 Briefly describe the following malignant tumors:
a. Adenocarcinoma
b. Squamous cell carcinoma
EXERCISE 12
12.1 Webs are ________________________.
12.2 Schatzki's ring is ___________________.
12.3 Pharyngoesophageal diverticula are _________________________.
12.4 Briefly describe Zenker's diverticulum, including clinical
presentation and
medical management.
12.5 Briefly discuss the differences between midesophageal
diverticula,
epiphrenic diverticula, and intramural diverticulosis.
12.6 Describe the clinical presentation and management of patients
presenting with:
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