Chapter 12: Esophagus Flashcards
A 20 year old man is brought to the emergency room after attempting suicide by ingesting a bottle of drain cleaner. The patient is delirous and tachypneic and tachycardic, with hypoxia and fever. The initial priority for this patient is:
Endotracheal intubation
An 80 year old man comes into clinic because of difficulty swallowing solids and frequent regurgitation of undigested food for the past three month. A barium swallow demonstrated a Zenker’s diverticulum. The best treatment for this man is:
A diverticulectomy with cricopharyngeal and lower esophageal mytomy.
A 50 year old man is being evaluated because or chronic gastroesophageal reflux symptoms. On endoscopy he is found to have barretts esophagus with low grade dysplasia on biopsy. Management of this patient should be to:
Repeat endoscopy in 6 months with repeat 4-quadrant biopsy of the Barretts
A 40 year old man is referred to the office because of a large type II paraesophageal hernia that was found on a routine screen chest radiograph. He denies any symptoms of chest pain, dyspnea, abdominal pain, or other GI symptoms. He is otherwise healthy and very active. The most appropriate approach at this time is:
Observant management
A 53-year-old woman comes to clinic because of dysphagia to liquids and solids for the past three weeks. She has been on proton pump inhibitors for treatment of heartburn. A barium swallow show prominent proximal esophageal dilation with a stricture of the distal esophagus (Birds’ beak appereance). Endoscopy shows no distal esophageal lesion. Manometry shows elevated lower esophageal sphincter tone with swallowing. What is the most appropriate surgical treatment for her?
A Combined Heller myotomy and Nissen fundoplication**
A 62-year-old-man is found to have early Stage I esophageal adenocarcinoma. His past medical history is significant for severe bilateral pulmonary emphysematous disease and is s/p bilateral thoracotomy for lung reduction therapy. His is on chronic home oxygen. The best treatment plan for this patient is:
A transhiatal esophagectomy with gastric pull-up
A 30-year-old woman comes to clinic because of dysphagia to solids for the past month. A barium swallow shows a mass lesion in the mid-esophagus. Upper endoscopy demonstrates a smooth, submucosal lesion. Endoscopic ultrasound confirms a smooth delineated mass in the muscularis layer. The best approach to relieve this patient from her symptoms of dysphagia is:
Enucleation of the lesion with reapproximation of the muscle layer
A 62-year-old woman is seen in the office to discuss further management of gastroesophageal reflux that is not well controlled with medications. She wants to undergo surgical relief of her reflux symptoms. Workup confirms reflux disease on pH study with a shortened esophagus on upper GI study. The best surgical approach for treating the patient is:
A Collis gastroplasty with a Nissen fundoplication
A 75 year old man comes into the Emergency room complaining of a fish bone stuck in his throat. With difficulty the bone is removed endoscopically, and the patient is sent home. He returns 2 days later with fever, chills, and chest pain. The most likely cause of the symptom is:
Posterior Mediastinum
A 58-year-old man was seen in clinic because of dysphagia for 3 weeks. Barium swallows shows a distal esophageal stricture. He undergoes upper endoscopy, with biopsy showing adenocarcinoma. The most useful diagnostic procedure to T stage this patients tumor is:
Endoscopic ultrasound
