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Esophagus > All Esophagus > Flashcards

All Esophagus Flashcards

1
Q

Best test to distinguish oropharyngeal dysphagia from a Zenker diverticulum?

A

modified barium swallow

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2
Q

Surveillance regimen for Barrett’s esophagus with low grade dysplasia:

A

follow endoscopically every 6 months

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3
Q

True or false. Metastatic esophageal cancer has an almost zero 5 year survival rate.

A

true

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4
Q

surgical approach for esophageal perforation in middle third of esophagus

A

right posterolateral thoracotomy

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5
Q

surgical approach for esophageal perforation to distal third of esophagus (intrathoracic)

A

left posterolateral thoracotomy

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6
Q

True or false. Neoadjuvant chemoradiotherapy significantly prolongs disease free interval and survival in patient’s with esophageal SCC and adenocarcinoma.

A

true

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7
Q

Neoadjuvant chemoradiotherapy for esophageal cancer consists of:

A

5 FU plus cisplatinum concomitantly with 40-60 cGy to the mediastinum

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8
Q

Which patients with esophageal cancer should be offered neoadjuvant therapy prior to surgery?

A

those with T2 or T3 lesions

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9
Q

management of esophageal leiomyomas based on size:

A

endoscopic removal for tumors <5cm size; tumor >5cm in size should be excised with VATS or laparoscopy depending on location

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10
Q

Dysmotility disorder of the esophagus and LES defined by absent peristalsis (aperistalsis) and lack of LE sphincter relaxation:

A

achalasia; has an elevated integrated relaxation pressure of the LES that is >15mmHg on manometry

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11
Q

term for the measure of vigor of the esophageal contraction on manometry

A

distal contractile integral (DCI)

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12
Q

DCI >8000 mmHg-s-cm is characteristic of whta?

A

hypercontractile esophagus

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13
Q

Diffuse esophageal spasm has a distal latency time of ____

A

<4.5 sec

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14
Q

Most common site of iatrogenic esohageal perforation:

A

cricopharyngeus

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15
Q

Most common site of spontaneous esophageal perforation:

A

distal 1/3 of the esophagus

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16
Q

blood supply to cervical esophagus:

A

inferior thyroid artery

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17
Q

When should endoscopic surveillance begin after caustic ingestion?

A

15-20 years after, due to risk of SCC

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18
Q

Blood supply to thoracic esophagus:

A

branches of bronchial arteries and branches off aorta

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19
Q

Blood supply to abdominal esophagus:

A

branches of left gastric and inferior phrenic artery

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20
Q

T1 esophageal cancer that does not invade past the ____ can be treated with endoscopic resection

A

submucosa

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21
Q

Neoadjuvant chemoradiotherapy is recommended for what T stage esophageal cancers before surgery?

A

all T3 and T4 lesions

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22
Q

traction diverticula location and layers of wall:

A

occurs in mid esophagus and contains all layers of the esophageal wall

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23
Q

pulson diverticula location and layers of wall:

A

occurs in very proximal or distal esophagus; only contains mucosa and submucosa

24
Q

treatment & surveillance of Barrett’s without dysplasia:

A

start PPI; consider antireflux surgery for patients with continued symptoms after PPI

random 4 quadrant biopsies every 2cm;Surveillance every 3-5 years

25
Q

treatment and surveillance of Barrett’s with low grade dysplasia:

A

start PPI;
if low grade dysplasia persists on repeat EGD, RFA should be used

random 4 quadrant biopsies every 1 cm; EGD every 6-12 months with bx

26
Q

treatment of Barrett’s with high grade dysplasia:

A

start PPI; endoscopic resection of mucosal irregularities followed by RFA

27
Q

True or false. Endoscopic resection is an appropriate surgical management for T1a esophageal adenocarcinoma

A

True

28
Q

Motility disordered characterized by corkscrew appearance on UGI

A

diffuse esophageal spasm

29
Q

Components of truncal vagotomy:

A

main trunks of vagus divided; needs a drainage procedure

30
Q

Components of selective (total gastric) vagotomy:

A

anterior and posterior nerves of latarjet are ligated after take off of celiac/hepatic branches; pyloric drainage procedure is needed b/c pylorus is denervated

31
Q

Components of highly selective (parietal cell) vagotomy:

A

nerve fibers that innervate parietal cells within the serosa of the body and fundus of the stomach only are divided; preserves nerve supply to antrum and pylorus (nerves of Latarjet) and no drainage procedure needed

32
Q

timing and mechanism of early dumping syndrome:

A

within 30 minutes of eating; hyperosmotic load causes a large fluid shift

33
Q

timing and mechanism of late dumping syndrome:

A

2-3 hours after eating; due to large insulin release from large food bolus hitting duodenum and causing hypoglycemia

34
Q

first line pharmacotherapy for esophageal variceal hemorrhage

A

octreotide

35
Q

first line endoscopic intervention for esophageal variceal hemorrhage

A

endoscopic variceal ligation or endoscopic sclerotherapy

36
Q

management of Zenker diverticulum <1cm:

A

observation

37
Q

management of Zenker diverticulum <2cm:

A

diverticulopexy alone or myotomy alone

38
Q

management of Zenker diverticulum 2-5 cm:

A

myotomy plus diverticulopexy or diverticulectomy

39
Q

Where do Zenker diverticula arise?

A

between the inferior pharyngeal constrictor and cricopharyngeus

40
Q

How many lymph nodes are needed for adequate staging of esophageal cancer during esophagectomy?

A

15 nodes

41
Q

Where do abdominal esophageal lymph nodes drain?

A

drain to celiac and cardiac nodes which eventually drain to the cisterna chyli or thoracic duct

42
Q

Most effective nonsurgical treatment of achalasia:

A

pneumatic dilation

43
Q

Manometry in hypertensive LES syndrome:

A

> 45mm Hg; may have incomplete LES relaxation

44
Q

manometry findings for nutcracker esophagus:

A

increased mean distal amplitude > 18mm Hg; normal peristalsis; increased distal duration

45
Q

manometry findings for diffuse esophageal spasm:

A

premature/simultaneous contractions with swallow, intermittent peristalsis, repetitive multipeak contractions, contraction amplitude >30mm Hg; normal LES

46
Q

Treatment of diffuse esophageal spasm:

A

calcium channel blockers, PPI, and/or TCAs

47
Q

Achalasia is characterized by degeneration of _____

A

the myenteric plexus

48
Q

Most effective treatment of achalasia:

A

laparoscopic heller myotomy

49
Q

Steps of Peroral endoscopic myotomy (POEM):

A

submucosal space entered and allowed to dissect submucosa distally along the muscular layer using spray coagulation to create a submucosal tunnel that extends beyond the GEJ; myotomy of circular esophageal and gastric bundles performed and mucosal incision closed with hemostatic clips

50
Q

True or False. Patients with severe or absent esophageal dysmotility benefit from a complete fundoplication over a partial.

A

false. they benefit more from partial fundoplication

51
Q

In what patients is a partial fundoplication contraindicated

A

achalasia or scleroderma

52
Q

Most commonly used organ for esophageal substitution in children?

A

colon

53
Q

low amplitude or absent peristalsis and normal or decreased LES pressures

A

scleroderma

54
Q

low amplitude simultaneous contractions with high LES pressures

A

achalasia

55
Q

high amplitude contractions with normal LES pressures

A

nutcracker esophagus

56
Q

normal amplitude contractions with high LES pressures

A

hypertensive esophagus

Esophagus (1 decks)

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