Esopagus Flashcards
Blood supply to cervical esophagus
Inferior thyroid artery
Blood supply thoracic esophagus
Bronchial arteries
Blood supply abdominal esophagus
Aorta- left gastric and splenic
Muscle composition of upper esophageal sphincter
Cricopharyngeus mm
Most common site of perf with egd
Layers of esophagus
Squamous epithelium
Circular mm layer
Outer longitudinal layer
NO SEROSA–> spread to other organs
Resting pressure of UES
Swallowing pressure of UES
Resting: high- remains closed
Swallow: 0 - allows food bolus to come through
Resting pressure of LES
6-24mmHg
GERD with abnormal relaxation
Reflux more commonly occurs when….
LES is less than 2cm
Intra abdominal LES less than 1cm
LES pressure less than 6
Angle of entry into stomach
Tightness of diaphragmatic crura
Zenkers boundaries
Killians triangle
Thyrophargeal m oblique
Cricopharngeus m transverse
Treatment for zenkers diverticulim
False divertic
Left cervical incision
Diverticulectomy or diverticopexy
Crico phayngeal myotomy
Leave drains
Pod #1: esophagogram
True diverticulim of esophagus
Usually lateral
Traction diverticulim
Mid-esophagus
Tx: excision and primary closure
Diverticulim associated with motility disorders
Epi phrenic divertic
Tx: diverticulectomy myotomy opposite side of diverticulectomy
Seen as cork screw esophagus on esophagram
Diffuse esophageal spasm
Retro sterna losing to back
Tx: ccb, antispasmodic, nitrates
Heller myotomy - cut upper and lower spincters
Heller myotomy is used to treat what condition?
Achalasia
Seen with achalasia
No peristalsis
High LES pressure
No LES relaxation
Achalasia is caused by
Loss of ganglion cells in auerbachs plexus in esophagus
Seen on Xray with achalasia
Bird beak
Treatment for achalasia
Ccb
LES dilation
Nitrates
Heller myotomy
Steps in heller myotomy
Left thoracotomy
Mm of LES cut and partial fundiplication with stomach
Only cut outer layer of mm- leave mucosal layer intact
Dx of GERD
Egd
pH probe -24hrs
Manometry- resting LES less than 6
Treatment for GERD
Ppi x 6 months
Nissen: Divide short gastrics Pull esophagus into abdomen Repair defect in phrenoesophageal membrane Gastric fundus wrap
Identify left crura
Alkali ingestion causes
Acid ingestion causes
Liquefaction necrosis
Coagulation necrosis
Alkali worse
Tx caustic ingestion
Npo
Cxr- free air
Endoscopy - do not go past site of injury
Burn classifications for caustic injury
Primary: hyperemia
Tx: conservative, abx
Secondary: ulcers, exudate
Tx: only Sx if sepsis, peritonitis
Tertiary: deep charring, lumen narrowed
Usually Sx
Need gastrograffin followed by thin barium study
Common site for esophagus perf
Cricopharyngeus m
Dx: gastrograffin followed by barium
Treatment for esophagus perf
Non-Sx: contained, no systemic effects
Ivf, npo, abx
Sx: non- contained
Less than 24hrs: primary closure , drains, intercostal m flap
Sick: diversion with esophagostomy, washout mediastinum, chest tubes, feeding tubes
Esophagectomy
Prox: right thoracotomy
Distal: left
Dx of esophagus tumors is with?
Egd
EUS- can determine depth and lymph node involvement
Cancer spreads along….
Submucosal lymphatic channels
Esophageal CA is unresectable when…
Any mets, nerve involvement, airway invasion, mal pleural effusions
Types of esophageal CA
AdenoCA- most common- lower esophagus
Squamous - upper
Xrt and chemo can be used to downstage
Esophagectomy surgery details
Transhiatal:
Abd and neck incisions
Ivor Lewis: abd incisional right thoracotomy - exposes all of esophagus, intrathoracic anastomoses
Most common benign tumor of esophagus
Leiomyoma
No bx
Resect with enuclation
Prox/mid: right thoracotomy
Distal: left
