Chapter 4 - Esophagus

Question 1

Failure of separation of the dorsal foregut from the laryngeotracheal tree during development

Answer 1

tracheoesophageal fistula

Question 2

Majority of the esophagus arises from the

Answer 2

foregut

Question 3

The most proximal portion of esophagus is derived from the

Answer 3

pharyngeal apparatus

Question 4

Level of the esophageal hiatus in the diaphragm

Answer 4

T10

Question 5

The upper esophageal sphincter (UES) is created by what muscle? Innervated by?

Answer 5

cricopharyngeus; recurrent laryngeal nerve

Question 6

Narrowest region of the esophagus

Answer 6

At the cricopharyngeus

Question 7

Esophagus lacks what tissue layer

Answer 7

Serosa

Question 8

Esophageal landmarks by endoscopic distances (from incisors):
UES?
Thoracic inlet? 
Aortic arch/Left mainstem bronchus?
LES/gastroesophagealjunction (GEJ)?

Answer 8

UES—15 cm
Thoracic inlet—18 cm
Aortic arch/Left mainstem bronchus—25 cm
LES/gastroesophageal junction (GEJ)—40 cm

Question 9

Submucosal plexus?

Answer 9

Meissner’s

Question 10

Myenteric plexus?

Answer 10

Auerbach’s plexus

Question 11

Primary peristalsis in the esophagus is initiated by

Answer 11

Bolus and initiation of swallowing

Question 12

Secondary peristalsis occurs due to

Answer 12

Esophageal distension

Question 13

Site of cricopharyngeal weakness and the most common location to find pseudodiverticula or iatrogenic perforation.

Answer 13

Killian’s triangle

Question 14

The strongest layer of the esophagus and of 1° importance for surgical repair.

Answer 14

Esophageal submucosa

Question 15

Most common esophageal motility disorder.

Answer 15

Achalasia

Question 16

UES pressure (resting):

Answer 16

50–70mmHg

Question 17

UES pressure (bolus):

Answer 17

12–14mmHg

Question 18

LES pressure (resting):

Answer 18

10–20mmHg

Question 19

Surgical treatment of achalasia that yields symptomatic improvement but high recurrence

Answer 19

Pneumatic dilation

Question 20

Definitive therapy for achalasia

Answer 20

Heller myotomy

With concurrent fundoplication

Question 21

Rare disorder characterized by degeneration of smooth muscle, resulting in LES failure and disordered peristalsis of distal esophagus. Proximal striated muscle is spared.

Answer 21

Scleroderma

Question 22

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.

Answer 22

Diffuse Esophageal Spasm

Question 23

Barium swallow demonstrates corkscrew esophagus and segmentation

Answer 23

Diffuse Esophageal Spasm

Question 24

Pulsion diverticulum usually found at Killian’s triangle as a result of discoordination of UES relaxation and swallowing.

Answer 24

Pharyngoesophageal (Zenker’s)

Question 25

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.

Answer 25

Epiphrenic

Question 26

Esophageal web associated with iron deficiency

Answer 26

Plummer-Vinson syndrome

Question 27

Sliding hiatal hernia is what type of hernia?

Answer 27

Type 1

Question 28

Majority of paraesophageal hernia is

Answer 28

Type 1 (sliding hiatal)

Question 29

Type of paraesophageal hernia wherein the GEJ remains intraabdominal and only the fundus js herniated

Answer 29

Type 2 (rolling paraesophageal)

Question 30

Ulcer in a sliding hiatal hernia and is commonly found on the lesser curve.

Answer 30

Cameron’s ulcer

Question 31

Borchardt’s triad

Answer 31

severe chest pain
painful retching without emesis
inability to pass a nasogastric tube [NGT]

Seen in hernia

Question 32

Longitudinal tears in esophageal mucosa near the GEJ following repeated retching or other episodes of high intraluminal pressure. Commonly occur in alcoholics.

Answer 32

Mallory-Weiss Tears

Question 33

Most common cause of esophageal perforation is

Answer 33

iatrogenic

Question 34

The spontaneous rupture of the esophagus resulting from ↑ intraabdominal pressure against a closed glottis, often during bouts of retching.

Answer 34

Boerhaave’s syndrome

Question 35

Ingested alkali agents causes what type of necrosis

Answer 35

Liquefactive

Question 36

Ingested acidic agents causes what type of necrosis

Answer 36

Coagulation necrosis

Question 37

Barrett’s esophagus is a precursor of what malignancy

Answer 37

Adenocarcinoma

Question 38

Most common esophageal malignancy worldwide

Answer 38

SCC

Adenocarcinoma in the US

Question 39

Most common complication of esophagectomy

Answer 39

Pulmonary

Question 40

What is the order of preference of conduit for esophageal reconstruction?

Answer 40

Stomach > colon > jejunum

Question 41

Most common primary esophageal motility

Answer 41

Nutcracker esophagus

Substernal chest pain, dysphagia