Esophageal And Mediastinal Diseases Flashcards
Explain Esophageal manometry?
Test that evaluates motility and function of LES and UES
What is Achalasia?
The failure of LES relaxation when swallowing
Achalasia investigations?
Endoscopy and Barium swallow
Medical management of Achalasia?
Nitrates to relax the LES
What does Botulinum toxin do to treat Achalasia?
Weakens the LES when injected into it
What is the surgical treatment for Achalasia SHOULD, balloon dilation fail.
Esophagocardiomyotomy (Heller Myotomy )
What should we do to treat Achalasia, should the Heller procedure fail?
Esophageal resection and reconstruction
First line treatment for Esophagitis?
Oral and parental broad spectrum antibiotics
In Esophagitis, what do we give to relive Laryngeal edema?
Corticosteroids
How do we treat First Degree burn esophagitis?
Continue Antibiotics for 10 Days.
How do we treat Second/Third Degree burn esophagitis?
Install silicon catheter down esophagus for feeding, until the patient heels, which takes 1-4 months.
What is the surgical resection procedure for Esophageal cancer?
Esophagectomy with gastric pull up
What is Barrett’s esophagus?
The lining of lower esophagus with columnar epithelium
How to diagnose Barrett’s esophagus?
Endoscopy
What is Barrett’s believed to result from?
Chronic GERD
What is Barrett’s importance?
Predisposes to esophageal cancer
How is Barrett’s treated?
Control the GERD
Where does Squamous cell carcinoma arise?
Upper and middle thirds. For black people
Where does Adenocarcinoma arise?
In the Lower third. Predominantly white males
Esophageal tumors are are diagnosed via?
Barium swallow initially, then confirmed is endoscopy or biopsy
How do we assess esophageal cancer staging?
Via endoscopic ultrasonography
What’s the approach for tumor resection?
Right or left thoracotomy
Which esophageal tumor could be treated via radiotherapy, should resection fail?
Squamous cell carcinoma
What is Barrett’s esophagus believed to pre-dispose?
adenocarcinoma
Clinical features of GERD?
Heart burn, regurgitation
GERD treatment generally, and surgical
Lifestyle modification, Fundoplication
What is the indication to do surgery for GERD?
When medical therapy (more than 6 months) fails.
What is the approach for Nissen Fundoplication
Trans-abdominal
What is an Esophageal Diverticulae?
A sack or pouch protruding from the esophagus, like a ball sack
Esophageal divertiucalae treatment?
Larger ones are excised, Cricopharyngeal myotomy is essential
What is a Hiatal Hernia?
An abdominal protrusion into the esophagus, from the stomach
Most common type of Hiatal Hernia?
Sliding hernia I.e Type 1
Commonest sign of Hiatal Hernia?
Regurgitation obviously, due to the hernia being there
How do we know if the hernia is para-esophageal?
Chest X-ray confirms its position
Surgical treatment of para-esophageal hernia?
Fundoplication
What is the most common tumor of the anterior mediastinum?
Thymoma
Thymoma treatment if stages 1/2?
Total resection
Thymoma treatment if stage 3
Resection and post op chemotherapy
Thymoma treatment if stage 4a and b?
Chemo
How do we treat Pericardial cysts?
Percutaneous drainage and resection
How do we treat an enteric cyst?
Resection
How do we treat mediastinitis?
Surgical debridement
Where do we find teratomas?
Anterior mediastinum
What is a rare cause of posterior mediastinal mass?
Meningocele
What is Collis Gastroplasty?
The lengthening of the esophagus, done for GERD in case of short esophagus.
Complications of Anti-Reflux surgery?
Technical failures, dysphagia (difficulty swallowing)
