Chapter 4 - Esophagus Flashcards
Failure of separation of the dorsal foregut from the laryngeotracheal tree during development
tracheoesophageal fistula
Majority of the esophagus arises from the
foregut
The most proximal portion of esophagus is derived from the
pharyngeal apparatus
Level of the esophageal hiatus in the diaphragm
T10
The upper esophageal sphincter (UES) is created by what muscle? Innervated by?
cricopharyngeus; recurrent laryngeal nerve
Narrowest region of the esophagus
At the cricopharyngeus
Esophagus lacks what tissue layer
Serosa
Esophageal landmarks by endoscopic distances (from incisors): UES? Thoracic inlet? Aortic arch/Left mainstem bronchus? LES/gastroesophagealjunction (GEJ)?
UES—15 cm
Thoracic inlet—18 cm
Aortic arch/Left mainstem bronchus—25 cm
LES/gastroesophageal junction (GEJ)—40 cm
Submucosal plexus?
Meissner’s
Myenteric plexus?
Auerbach’s plexus
Primary peristalsis in the esophagus is initiated by
Bolus and initiation of swallowing
Secondary peristalsis occurs due to
Esophageal distension
Site of cricopharyngeal weakness and the most common location to find pseudodiverticula or iatrogenic perforation.
Killian’s triangle
The strongest layer of the esophagus and of 1° importance for surgical repair.
Esophageal submucosa
Most common esophageal motility disorder.
Achalasia
UES pressure (resting):
50–70mmHg
UES pressure (bolus):
12–14mmHg
LES pressure (resting):
10–20mmHg
Surgical treatment of achalasia that yields symptomatic improvement but high recurrence
Pneumatic dilation
Definitive therapy for achalasia
Heller myotomy
With concurrent fundoplication
Rare disorder characterized by degeneration of smooth muscle, resulting in LES failure and disordered peristalsis of distal esophagus. Proximal striated muscle is spared.
Scleroderma
Rare, 1° motility disorder characterized by disordered, high-amplitude motility with predominant symptom of substernal chest pain that may radiate to the neck or upper extremities and dysphagia with both solids and liquids.
Diffuse Esophageal Spasm
Barium swallow demonstrates corkscrew esophagus and segmentation
Diffuse Esophageal Spasm
Pulsion diverticulum usually found at Killian’s triangle as a result of discoordination of UES relaxation and swallowing.
Pharyngoesophageal (Zenker’s)
Esophageal diverticulum that is most commonly caused by motility disorders, particularly achalasia; Commonly associated with gastroesophageal reflux disease (GERD) and occurs within 10 cm of the GEJ.
Epiphrenic
Esophageal web associated with iron deficiency
Plummer-Vinson syndrome
Sliding hiatal hernia is what type of hernia?
Type 1
Majority of paraesophageal hernia is
Type 1 (sliding hiatal)
Type of paraesophageal hernia wherein the GEJ remains intraabdominal and only the fundus js herniated
Type 2 (rolling paraesophageal)
Ulcer in a sliding hiatal hernia and is commonly found on the lesser curve.
Cameron’s ulcer
Borchardt’s triad
severe chest pain
painful retching without emesis
inability to pass a nasogastric tube [NGT]
Seen in hernia
Longitudinal tears in esophageal mucosa near the GEJ following repeated retching or other episodes of high intraluminal pressure. Commonly occur in alcoholics.
Mallory-Weiss Tears
Most common cause of esophageal perforation is
iatrogenic
The spontaneous rupture of the esophagus resulting from ↑ intraabdominal pressure against a closed glottis, often during bouts of retching.
Boerhaave’s syndrome
Ingested alkali agents causes what type of necrosis
Liquefactive
Ingested acidic agents causes what type of necrosis
Coagulation necrosis
Barrett’s esophagus is a precursor of what malignancy
Adenocarcinoma
Most common esophageal malignancy worldwide
SCC
Adenocarcinoma in the US
Most common complication of esophagectomy
Pulmonary
What is the order of preference of conduit for esophageal reconstruction?
Stomach > colon > jejunum
Most common primary esophageal motility
Nutcracker esophagus
Substernal chest pain, dysphagia
