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ABSITE Review > ABSITE Review - Esophagus > Flashcards

ABSITE Review - Esophagus Flashcards

1
Q

What are the muscle layers of the esophagus?

A

Squamous epithelium, circular inner muscle layer, outer longitudinal muscle layer; no serosa

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2
Q

What is the blood supply to the cervical, thoracic and abdominal esophagus?

A

Cervical - inferior thyroid artery
Thoracic - Aorta
Abdominal - Left gastric artery and inferior phrenic arteries

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3
Q

What is the lymphatic drainage pathway of the esophagus?

A

Upper 2/3 drains cephalad

Lower 1/3 drains caudad

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4
Q

What is the type of muscle in the upper and lower esophagus?

A

Upper - striated muscle

Lower - smooth muscle

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5
Q

Where travels the right vagus nerve as it exits the chest and what structure it forms?

A

Travels posterior portion of stomach and becomes celiac plexus

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6
Q

Where travels the left vagus nerve as it exits the chest and where it goes?

A

Travels anterior portion of stomach; goes to liver and biliary tree

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7
Q

Where is the criminal nerve of Grassi contained and was happens if it is left undivided?

A

Contained in the R vagus nerve; can cause persistently high acid levels postoperatively if left undivided

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8
Q

Where is the UES located with respect to the incisors? What are the normal pressures with food and at rest?

A

Located 15cm from incisors
Normal UES pressure with food bolus: 12-14 mmHg
Normal UES pressure at rest: 50-70mmHg

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9
Q

What is the main muscle at the UES?

A

Cricopharyngeus muscle (circular muscle, prevents air swallowing)

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10
Q

Where is the MC site of esophageal perforation during EGD?

A

Cricopharyngeus muscle

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11
Q

Where is the LES located with respect to the incisors? What are the normal pressures at rest?

A

Located 40cm from incisors

Normal UES pressure at rest: 10-20mmHg

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12
Q

What are the anatomic areas of narrowing of the esophagus?

A

Cricopharyngeus muscle
Compression by the left mainstem bronchus and aortic arch
Diaphragm

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13
Q

What is the recommended surgical approach for the cervical, upper and lower esophagus?

A

Cervical - Left
Upper 2/3 - Right (avoids aorta)
Lower 1/3 - Left (left-sided course in this region)

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14
Q

What is a Zenker’s diverticulum? What is the cause?

A

Is a FALSE posterior diverticulum between the cricopharyngeus and pharyngeal constrictors
Caused by increased pressure during swallowing.

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15
Q

What is the diagnostic study of choice for Zenker’s and what is the treatment?

A

Dx - Barium Swallow Studies, Manometry
Tx - Cricopharyngeal myotomy, removal of diverticulum not necessary
Left cervical incision; leave drains; esophagogram POD 1

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16
Q

What is a traction diverticulum? What is the cause? What is the treatment?

A

Is a TRUE diverticulum - usually lies lateral in midesophagus
Due to granulomatous disease, inflammation, tumor
Tx - excison and primary closure

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17
Q

What is the cause of an epiphrenic diverticulum? Where it is usually located? What is the treatment?

A

Rare; associated with esophageal motility disorders
MC in distal 10cm of the esophagus
Tx - diverticulectomy and long esophageal myotomy on the side opposite to the diverticulectomy

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18
Q

What is the cause of achalasia?

A

Caused by failure of peristalsis and lack of LES relaxation after food bolus
Secondary to neuronal degeneration in muscle wall

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19
Q

What is the study of choice for diagnosing achalasia?

A

Manometry - increase LES pressure, incomplete LES relaxation, no peristalsis

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20
Q

What is the treatment for achalasia?

A

CCBs, LES dilation –> effective in 60%
If medical tx and dilation fails –> Heller myotomy - left thorscotomy, transect circular layer of muscle lower esopagus; also need partial Nissen fundoplication

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21
Q

Which agent can produce similar symptoms to achalasia?

A

Tympanosoma cruzi

22
Q

What are the manometric findings of diffuse esophageal spasm?

A

Frequent strong body contractions of increase amplitude and duration, normal LES tone, strong unorganized contractions

23
Q

What is the treatment of diffuse esophageal spasm?

A

CCBs, nitrates, antispasmodics, Heller myotomy

24
Q

What are the normal anatomic protection from GERD?

A

Need LES competence, normal esophageal body, normal gastric reservoir

25
Q

What is the usual work up for GERD?

A

Endoscopy, pH probe (best test), manometry (resting LES < 6mmHg), histology

26
Q

What is the medical therapy for GERD?

A

Omeprazole for 12 weeks

27
Q

What are the surgical indications for GERD?

A

GERD on pH monitoring, failue of medical tx, complications of GERD (stricture, Barret’s esophagus, cancer)

28
Q

The phrenoesophageal membrane is an extension of ____ fascia.

A

Transversalis

29
Q

What is Collis gastroplasty?

A

When not enough esophagus exists to pull down into abdomen, can staple along stomach and create a new esophagus.

30
Q

What is the MCC of dysphagia following a Nissen?

A

Wrap is too tight

31
Q

What are the 4 types of hiatal hernia?

A

Type I - sliding hernia from dilation of hiatus (MC)
Type II - paraesophageal; hole in the diaphragm alongside the esophagus, normal GE junction
Type III - combined
Type IV - entire stomach in the chest plus another organ

32
Q

Which type of hiatal hernia, you should always repair and why?

A

Type II due to risk of incarceration

33
Q

What is treatment for a Schatzki’s ring?

A

Dilatation of the ring usually sufficient; may need antireflux procedure

34
Q

What is Barret’s esophagus? What is the cause?

A

Squamous metaplasia to columnar epithelium

Occurs with long standing exposure to gastric reflux

35
Q

What is the cancer risk of Barret’s esophagus?

A

Increases by 50 times

36
Q

What is the treatment of uncomplicated and severe Barret’s?

A

Uncomplicated Barret’s can be treated like GERD - surgery will decrease esophagitis and further metaplasia but will not prevent cancer or cause regression - need carefull follow up with EGD for lifetime
Severe Barret’s - indication for esophagectomy

37
Q

How the esophageal cancer spreads quickly?

A

Along the submucosal lymphatic channels

38
Q

What are signs of unresectable esophageal cancer?

A

Hoarseness (RLN), Horner’s syndrome, phrenic nerve involvement, malignant pleural effusion, malignant fistula, airway invasion, vertebral invasion

39
Q

What is the #1 type of esophageal cancer?

A

Adenocarcinoma

40
Q

Which cancer most likely occurs in upper and lower esophagus?

A

Upper 2/3 - squamous cell

Lower 1/3 - adenocarcinoma

41
Q

What is the primary blood supply to stomach after replacing esophagus?

A

Right gastroepiploic artery

42
Q

What is the Ivor-Lewis esophagectomy?

A

Abdominal incision and right thoracotomy; intrathoracic anastomosis

43
Q

How many anastomosis are present in a colonic interposition?

A

Three

44
Q

What is the MC benign tumor of the esophagus? Which layer it is located?

A

Leiomyoma; submucosal

45
Q

What is the treatment for a leiomyoma?

A

Do not biopsy bc can form scar and make subsequent resection difficult
Tx - > 5cm or symptomatic –> excision (enucleation) via thoracotomy

46
Q

What is the 2nd MC benign tumor of the esophagus?

A

Esophageal polyps; usually in the cervical esophagus

47
Q

What are the degree of injury and specific treatment in caustic esophageal injury?

A

No NGT with caustic injuries
Primary burn - hyperemia - observation, IVFs, spitting, Abx
Secondary burn - ulcerations, exudates, and sloughing - prolonged observation, esophagogram in HOD 2-3
Tertiary burn - deep ulcers, charring, and lumen narrowing - esophagectomy, esophagogram in HOD 2-3

48
Q

What is the treatment of a noncontained esophageal perforation diagnosed in < 24 hours?

A

try primary repair with drainsand intercostal muscle pedicle flap

49
Q

What is the treatment of a noncontained esophageal perforation diagnosed in a sick patient or more than 24 hours?

A

Cervical esophagostomy for diversion, washout of the mediastinum, place chest tubes, and later placement of a feeding G or J tube

50
Q

What is Boerhaave’s syndrome?

A

Forceful vomiting followed by chest pain - perforation most likely to occur in the left lateral wall of esophagus at the level of T8, 3-5 cm above the GE junction

ABSITE Review (32 decks)

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