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Esophagus > Esopagus > Flashcards

Esopagus Flashcards

1
Q

Blood supply to cervical esophagus

A

Inferior thyroid artery

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2
Q

Blood supply thoracic esophagus

A

Bronchial arteries

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3
Q

Blood supply abdominal esophagus

A

Aorta- left gastric and splenic

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4
Q

Muscle composition of upper esophageal sphincter

A

Cricopharyngeus mm

Most common site of perf with egd

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5
Q

Layers of esophagus

A

Squamous epithelium
Circular mm layer
Outer longitudinal layer

NO SEROSA–> spread to other organs

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6
Q

Resting pressure of UES

Swallowing pressure of UES

A

Resting: high- remains closed
Swallow: 0 - allows food bolus to come through

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7
Q

Resting pressure of LES

A

6-24mmHg

GERD with abnormal relaxation

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8
Q

Reflux more commonly occurs when….

A

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

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9
Q

Zenkers boundaries

A

Killians triangle

Thyrophargeal m oblique
Cricopharngeus m transverse

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10
Q

Treatment for zenkers diverticulim

A

False divertic

Left cervical incision
Diverticulectomy or diverticopexy

Crico phayngeal myotomy

Leave drains

Pod #1: esophagogram

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11
Q

True diverticulim of esophagus

Usually lateral

A

Traction diverticulim

Mid-esophagus
Tx: excision and primary closure

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12
Q

Diverticulim associated with motility disorders

A

Epi phrenic divertic

Tx: diverticulectomy myotomy opposite side of diverticulectomy

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13
Q

Seen as cork screw esophagus on esophagram

A

Diffuse esophageal spasm

Retro sterna losing to back

Tx: ccb, antispasmodic, nitrates
Heller myotomy - cut upper and lower spincters

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14
Q

Heller myotomy is used to treat what condition?

A

Achalasia

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15
Q

Seen with achalasia

A

No peristalsis
High LES pressure
No LES relaxation

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16
Q

Achalasia is caused by

A

Loss of ganglion cells in auerbachs plexus in esophagus

17
Q

Seen on Xray with achalasia

A

Bird beak

18
Q

Treatment for achalasia

A

Ccb
LES dilation
Nitrates

Heller myotomy

19
Q

Steps in heller myotomy

A

Left thoracotomy
Mm of LES cut and partial fundiplication with stomach

Only cut outer layer of mm- leave mucosal layer intact

20
Q

Dx of GERD

A

Egd
pH probe -24hrs
Manometry- resting LES less than 6

21
Q

Treatment for GERD

A

Ppi x 6 months

Nissen:
Divide short gastrics
Pull esophagus into abdomen
Repair defect in phrenoesophageal membrane
Gastric fundus wrap

Identify left crura

22
Q

Alkali ingestion causes

Acid ingestion causes

A

Liquefaction necrosis

Coagulation necrosis

Alkali worse

23
Q

Tx caustic ingestion

A

Npo
Cxr- free air
Endoscopy - do not go past site of injury

24
Q

Burn classifications for caustic injury

A

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

25
Q

Common site for esophagus perf

A

Cricopharyngeus m

Dx: gastrograffin followed by barium

26
Q

Treatment for esophagus perf

A

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

27
Q

Dx of esophagus tumors is with?

A

Egd

EUS- can determine depth and lymph node involvement

28
Q

Cancer spreads along….

A

Submucosal lymphatic channels

29
Q

Esophageal CA is unresectable when…

A

Any mets, nerve involvement, airway invasion, mal pleural effusions

30
Q

Types of esophageal CA

A

AdenoCA- most common- lower esophagus

Squamous - upper

Xrt and chemo can be used to downstage

31
Q

Esophagectomy surgery details

A

Transhiatal:
Abd and neck incisions

Ivor Lewis: abd incisional right thoracotomy - exposes all of esophagus, intrathoracic anastomoses

32
Q

Most common benign tumor of esophagus

A

Leiomyoma

No bx
Resect with enuclation
Prox/mid: right thoracotomy
Distal: left

Esophagus (1 decks)

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