Caustic injuries to esophagus

Q) Which of the following is not true about reconstruction in caustic injuries to esophagus

a) Caustic injuries to esophagus have 1000 times more risk of developing malignancy

b) Right colon replacement is definately better than left colon

c) The only indication for elective surgery is refractory strictures and possibility of malignancy

d) Most of the surgeons prefer bypass over resection of esophagus

Premium Answer

Nutcracker esophagus

Q) Which of the following is the least common symptom of nutcracker esophagus?

a) Pain in chest

b) Dysphagia

c) Odynophagia

d) Regurgitation

Answer d

 Nutcracker esophagus is a hyper contractile disorder of the  esophagus in which there is excessive contractility of the esophagus. There are high amplitude peristaltic contractions in the body of esophagus.

It is the most common motility disorder of the esophagus.

It can occur in all age groups and is of equal distribution in both sex.

Nutcracker esophagus symptoms

  1. Chest pain
  2. Dysphagia
  3. Painful deglutition (Odynophagia)

Acording to the Chicago classification 

 There is  subjective complaint of chest pain with at least one swallow showing a distal contractile integral greater than 8000 mm  Hg with single or multi­peaked contractions on HRM. The LES pressure is normal, and relaxation occurs with each wet swallow

Manometry shows

  1. High amplitude peristaltic contractions in distal 10 cm of esophagus
  2. After ten 5 ml swallows average amplitude is more than 220 mmHg

Management

  1. Avoid trigger inducing foods such as caffeine
  2. Calcium channel blockers, Nitrates, Antispasmodics
  3. Esophageal dilatation in some cases

 

Traction diverticula

traction diverticulum esophagus

Q) What is true about traction diverticula of the esophagus?

a) It is a common diverticulum at the lower end of esophagus

b)Most  of these diverticula are symptomatic and require surgery

c) Mediastinal fibrosis is a common etiologial factor

d) They are most common on the left side

 

Answer 

c) Mediastinal fibrosis

Most of the traction diverticula are in mid esophagus on the right side. The common etiological factors are mediastinal infections, tuberculosis, mediastinal fibrosis and histoplasmosis.

These are true traction diverticula and have all the walls of esophagus.

They are mostly discovered incidentally during the workup of other diseases. Most of these are asymptomatic but can present with dysphagia, chest pain and regurgitation.