All Esophagus Flashcards
Best test to distinguish oropharyngeal dysphagia from a Zenker diverticulum?
modified barium swallow
Surveillance regimen for Barrett’s esophagus with low grade dysplasia:
follow endoscopically every 6 months
True or false. Metastatic esophageal cancer has an almost zero 5 year survival rate.
true
surgical approach for esophageal perforation in middle third of esophagus
right posterolateral thoracotomy
surgical approach for esophageal perforation to distal third of esophagus (intrathoracic)
left posterolateral thoracotomy
True or false. Neoadjuvant chemoradiotherapy significantly prolongs disease free interval and survival in patient’s with esophageal SCC and adenocarcinoma.
true
Neoadjuvant chemoradiotherapy for esophageal cancer consists of:
5 FU plus cisplatinum concomitantly with 40-60 cGy to the mediastinum
Which patients with esophageal cancer should be offered neoadjuvant therapy prior to surgery?
those with T2 or T3 lesions
management of esophageal leiomyomas based on size:
endoscopic removal for tumors <5cm size; tumor >5cm in size should be excised with VATS or laparoscopy depending on location
Dysmotility disorder of the esophagus and LES defined by absent peristalsis (aperistalsis) and lack of LE sphincter relaxation:
achalasia; has an elevated integrated relaxation pressure of the LES that is >15mmHg on manometry
term for the measure of vigor of the esophageal contraction on manometry
distal contractile integral (DCI)
DCI >8000 mmHg-s-cm is characteristic of whta?
hypercontractile esophagus
Diffuse esophageal spasm has a distal latency time of ____
<4.5 sec
Most common site of iatrogenic esohageal perforation:
cricopharyngeus
Most common site of spontaneous esophageal perforation:
distal 1/3 of the esophagus
blood supply to cervical esophagus:
inferior thyroid artery
When should endoscopic surveillance begin after caustic ingestion?
15-20 years after, due to risk of SCC
Blood supply to thoracic esophagus:
branches of bronchial arteries and branches off aorta
Blood supply to abdominal esophagus:
branches of left gastric and inferior phrenic artery
T1 esophageal cancer that does not invade past the ____ can be treated with endoscopic resection
submucosa
Neoadjuvant chemoradiotherapy is recommended for what T stage esophageal cancers before surgery?
all T3 and T4 lesions
traction diverticula location and layers of wall:
occurs in mid esophagus and contains all layers of the esophageal wall
pulson diverticula location and layers of wall:
occurs in very proximal or distal esophagus; only contains mucosa and submucosa
treatment & surveillance of Barrett’s without dysplasia:
start PPI; consider antireflux surgery for patients with continued symptoms after PPI
random 4 quadrant biopsies every 2cm;Surveillance every 3-5 years
treatment and surveillance of Barrett’s with low grade dysplasia:
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
treatment of Barrett’s with high grade dysplasia:
start PPI; endoscopic resection of mucosal irregularities followed by RFA
True or false. Endoscopic resection is an appropriate surgical management for T1a esophageal adenocarcinoma
True
Motility disordered characterized by corkscrew appearance on UGI
diffuse esophageal spasm
Components of truncal vagotomy:
main trunks of vagus divided; needs a drainage procedure
Components of selective (total gastric) vagotomy:
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
Components of highly selective (parietal cell) vagotomy:
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
timing and mechanism of early dumping syndrome:
within 30 minutes of eating; hyperosmotic load causes a large fluid shift
timing and mechanism of late dumping syndrome:
2-3 hours after eating; due to large insulin release from large food bolus hitting duodenum and causing hypoglycemia
first line pharmacotherapy for esophageal variceal hemorrhage
octreotide
first line endoscopic intervention for esophageal variceal hemorrhage
endoscopic variceal ligation or endoscopic sclerotherapy
management of Zenker diverticulum <1cm:
observation
management of Zenker diverticulum <2cm:
diverticulopexy alone or myotomy alone
management of Zenker diverticulum 2-5 cm:
myotomy plus diverticulopexy or diverticulectomy
Where do Zenker diverticula arise?
between the inferior pharyngeal constrictor and cricopharyngeus
How many lymph nodes are needed for adequate staging of esophageal cancer during esophagectomy?
15 nodes
Where do abdominal esophageal lymph nodes drain?
drain to celiac and cardiac nodes which eventually drain to the cisterna chyli or thoracic duct
Most effective nonsurgical treatment of achalasia:
pneumatic dilation
Manometry in hypertensive LES syndrome:
> 45mm Hg; may have incomplete LES relaxation
manometry findings for nutcracker esophagus:
increased mean distal amplitude > 18mm Hg; normal peristalsis; increased distal duration
manometry findings for diffuse esophageal spasm:
premature/simultaneous contractions with swallow, intermittent peristalsis, repetitive multipeak contractions, contraction amplitude >30mm Hg; normal LES
Treatment of diffuse esophageal spasm:
calcium channel blockers, PPI, and/or TCAs
Achalasia is characterized by degeneration of _____
the myenteric plexus
Most effective treatment of achalasia:
laparoscopic heller myotomy
Steps of Peroral endoscopic myotomy (POEM):
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
True or False. Patients with severe or absent esophageal dysmotility benefit from a complete fundoplication over a partial.
false. they benefit more from partial fundoplication
In what patients is a partial fundoplication contraindicated
achalasia or scleroderma
Most commonly used organ for esophageal substitution in children?
colon
low amplitude or absent peristalsis and normal or decreased LES pressures
scleroderma
low amplitude simultaneous contractions with high LES pressures
achalasia
high amplitude contractions with normal LES pressures
nutcracker esophagus
normal amplitude contractions with high LES pressures
hypertensive esophagus
