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First Aid ABSITE > Chapter 4: Esophagus > Flashcards

Chapter 4: Esophagus Flashcards

1
Q

Esophageal development occurs primarily during what week of gestation?

A

4th week of gestation

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2
Q

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

A

Tracheoesophageal fistula

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3
Q

Failure of recanalization of tubular lumen

A

Esophageal atresis, web, stenosis

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4
Q

Extends 18-25cm from the pharynx to the stomach

A

Esophagus

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5
Q

5-6cm and extends from the cricopharyngeus muscle (C6) to thoracic inlet (T1)

A

Cervical Esophagus

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6
Q

15cm and extends from the thoracic inlet (T1) to esophageal hiatus of the diaphragm (T10)

A

Thoracic Esophagus

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7
Q

5-6cm and may be absent in patients with a hiatal hernia or esophageal shortening

A

Abdominal esophagus

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8
Q

Created by the cricopharyngeus and innervated by recurrent laryngeal nerve

A

Upper esophageal sphincter

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9
Q

Narrowest region of the esophagus

A

At level of cricopharyngeus

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10
Q

Anatomic sites of esophageal narrowing

A

Aortic arch
Bronchus (left main stem)
Cricopharyngeus
Diaphragm

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11
Q

Mucosa of the esophagus

A

Nonkeratinizing, stratified squamous epithelium

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12
Q

Esophageal wall is made up of:

A

Mucosa
Submucosa
Muscularis

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13
Q

Provides parasympathetic innervation to the esophagus

A

Vagus nerve

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14
Q

Innervates the cricopharyngeus and cervical esophagus

A

Recurrent laryngeal nerve

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15
Q

Site of cricopharyngeal weakness

A

Killian’s triangle

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16
Q

Most common location to find pseudodiverticula or iatrogenic perforation

A

Killian’s triangle

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17
Q

UES pressure at rest

A

50-70 mmHg

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18
Q

UES pressure with bolus

A

12-14 mmHg

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19
Q

Also referred as the high-pressure zone which prevents reflux of gastric contents into the esophagus

A

LES

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20
Q

Resting LES pressure

A

10-20 mmHg

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21
Q

Characterized by aperistalsis and failure of LES relaxation during swallowing

A

Achalasia

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22
Q

Arterial supply of cervical esophagus

A

Inferior thyroid artery

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23
Q

Arterial supply of thoracic esophagus

A

Aorta and bronchial arteries

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24
Q

Arterial supply of abdominal esophagus

A

Left gastric artery

Inferior phrenic artery

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25
Q

Most common esophageal motility disorder

A

Achalasia

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26
Q

Manometry result in achalasia

A

Lack of peristalsis

Failure of LES relaxation

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27
Q

Bird’s beak tapering of distal esophagus with dilation of proximal segment in barium swallow

A

Achalasia

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28
Q

Definitive therapy for achalasia

A

Heller myotomy

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29
Q

Rare disorder characterized by degeneration of smooth muscle, resulting in LES failure and disordered peristalsis of distal esophagus

A

Scleroderma

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30
Q

Primary motility disorder characterized by disordered, high-amplitude motility

A

Diffuse esophageal spasm

31
Q

Predominant symptom of Diffuse esophageal spasm

A

Substernal chest pain

32
Q

Barium swallow reveals corkscrew esophagus and segmentation

A

Diffuse esophageal spasm

33
Q

Manometry reveals frequent, high-amplitude, simultaneous contractions of esophageal body. LES is typically normal

A

Diffuse esophageal spasm

34
Q

Most common primary esophageal disorder

A

Nutcracker esophagus

35
Q

Manometry reveals characteristic continuous, high-amplitude (>2 SD above normal) peristalsis

A

Nutcracker esophagus

36
Q

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

A

Pharyngoesophageal or Zenker’s diverticula

37
Q

Ulcer in a sliding hiatal hernia commonly found on the lesser curvature

A

Cameron’s ulcer

38
Q

Sliding hiatal hernia

39
Q

Rolling paraesophageal hernia

40
Q

Type of hernia where GEJ remains intra-abdominal

A

Type II/Rollling paraesophageal hernia

41
Q

Borchardt’s triad of an incarcerated paraesophageal hernia

A

Severe chest pain
Painful retching without emesis
Inability to pass a NGT

42
Q

Longitudinal tears in the esophageal mucosa near the GEJ following repeated retching which commonly occur in alcoholics

A

Mallory-Weiss tears

43
Q

Definitive diagnosis of mallory-weiss tears

44
Q

Most common cause of esophageal perforation

A

Iatrogenic

45
Q

Spontaneous rupture of the esophagus resulting from increased intraabdominal pressure against a closed glottis

A

Boerhaave’s syndrome

46
Q

Most common location of Boerhaave’s syndrome

A

Distal thoracic esophagus

47
Q

Type of necrosis caused by alkali agents

A

Liquefactive necrosis

48
Q

Type of necrosis caused by acids

A

Coagulation necrosis

49
Q

Premalignant condition characterized by intestinal metaplasia of the normal esophageal squamous mucosa

A

Barrett’s esophagus

50
Q

Primary risk factor of Barrett’s esophagus

51
Q

Most common esophageal malignancy

A

Adenocarcinoma

52
Q

What layer is essential to esophageal anastomoses?

53
Q

Which layer is absent in the esophagus?

54
Q

A 50-year old man develops an esophageal perforation. Where is the most common site of esophageal perforation during endoscopy?

A

Killian’s triangle

55
Q

Where is the most common site of esophageal perforation after repeated vomiting?

A

Distal thoracic esophagus

56
Q

What are the risk factors for SCC of the esophagus?

A

Tobacco use, alcohol, caustic injury, Plummer-Vinson syndrome

57
Q

What are the risk factors of Adenocarcinoma of the esophagus?

A

Chronic GERD, Barrett’s esophagus, obesity

58
Q

A 45-year old man presents with progressive dysphagia to solids. What is the first diagnostics study?

A

Barium swallow

59
Q

What is the indication for esophagectomy in a patient with Barrett’s esophagus?

A

Severe (high-grade) dysplasia on biopsy

60
Q

What are manometric hallmarks of achalasia?

A

Aperistalsis and failure of LES relaxation

61
Q

What are manometric hallmarks of DES?

A

Disordered, high amplitude contractions

62
Q

What are long-term complications of caustic injury to esophagus?

A

Stricture

SCC

63
Q

What determines resectability of esophageal malignancy?

A

Freedom from distant mestastases or distant nodal involvement
Ability to resect any adjacent, involved structures

64
Q

A 77-year old female presents with severe chest pain, intractable retching, and inability to pass a NGT. What is the diagnosis?

A

Incarcerated or stangulated paraesophageal hernia

65
Q

A 77-year old female presents with severe chest pain, intractable retching, and inability to pass a NGT. What is the treatment?

A

Emergent surgical repair

66
Q

An 80-year old man with dysphagia presents with aspiration pneumonia. For his esophageal study, what is the contrast agent of choice?

A

Nonionis (water soluble) agent to minimize the risk of pneumonitis

67
Q

A 30-year old male has chest pain and dyspnea after upper endoscopy. What CXR findings suggest esophageal perforation?

A

Pneumomediastinum
Subcutaneous emphysema
Hydropneumothorax
Pleural effusion

68
Q

What are the benefits of laparoscopic Heller myotomy with partial fundoplication compared to left thorascopic myotomy for the treatment of achalasia?

A

Decreased length of stay

Decreased of postoperative reflux

69
Q

A 30-year old male is incidentally found to have a Zenker’s diverticulum. What is the appropriate treatment?

A

None if asymptomatic

If symptomatic, surgical excision via neck or transoral stapling

70
Q

What is the normal LES resting pressure?

A

10-20 mmHg

71
Q

What is the normal UES resting pressure

A

50-70 mmHg

72
Q

A 58-year old man with long history of GERD undergoes endoscopy with biopsy. Pathology reveals mild dysplasia. What is the recommended follow up?

A

Endoscopic surveillance with biopsies at least every 2 years

73
Q

A 35-year old female presents with progressive hearburn and regurgitation of undigested food. She has a barium swallow that reveals a bird’s beak tapering of the distal esophagus. What will her manometry studies show?

A

Lack of peristalsis and failure of LES relaxation

First Aid ABSITE (3 decks)

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