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*OldSurgery > Esophageal Disorders > Flashcards

Esophageal Disorders Flashcards

1
Q

atypical symptoms of GERD

A

noncardiac chest pain
pulmonary problems (asthma, cough)
laryngeal symptoms (hoarseness and aspiration)
loss on dental enamel

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2
Q

when do you do a barium swallow for GERD?

A

considering surgery

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3
Q

only test to give you the length of the esophagus

A

barium swallow

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4
Q

is a barium swallow diagnostic of GERD

A

no

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5
Q

what can diagnose GERD

A

upper endoscopy with
barrett esophagus
stricture
excludes other dz that can mimic GERD (PUD)

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6
Q

Defines the function of the LES and the esophageal body (peristalsis)
Rules out esophageal motility disorder
Essential for correctly positioning the probe for the 24-hour pH monitoring

A

Esophageal manometry

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7
Q

Quantifies the gastroesophageal reflux and allows a correlation between the symptoms of reflux and the episodes of reflux
they push a button everytime they have a symptom

A

ambulatory 24-hour pH monitoring

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8
Q

does someone w/ endoscopically confirmed esophagitis, stricture or Barrett’s need pH monitoring

A

No

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9
Q

Indications for esophageal manometry and prolonged pH monitoring

A

peristance of symptoms while taking adequate PPI or other pharms
recurernce of sx after discontinuation of drugs
atypical symptoms
confirmation in prep for antireflex surgery

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10
Q

lifestyle modication for GERD

A 
Weight lose if overweight
Avoid foods that worsen symptoms
Avoiding large meals
Waiting 3 hours after a meal before lying down
Elevating the head of the bed 8 inches
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11
Q

pharm tx stepwise for GERD

A

Histamien H2-receptor antagonists

PPIs

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12
Q

ADRs w/ long term PPIs

A

Can interfere with calcium homeostasis and aggravate cardiac conduction defects
Responsible for hip fracture in postmenopausal women

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13
Q

surgical indications for GERD

A 
symptoms not completely controlled by PPI
symptoms that are controlled by PPI but dont' want to take forever
Barrett esophagus
extraesophageal manifestations
young patients
poor patient compliance
postmenopausal w/ osteoporosis
pts. w/ cardiac conduct defects
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14
Q

who has the best results w/ antireflex surgery

A

well controlled on PPI and has typical symptoms

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15
Q

most frequently preformed surgery for GERD

A

Laparoscopic Nissen fundiplication (360° wrap)

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16
Q

complications with GERD

A

Esophagitis
Esophageal ulcer
Esophageal stricture
Barrett’s esophagus

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17
Q

The esophagus is lined with columnar epithelium
Represents advanced GERD
Salmon-pink mucosa that lines the esophagus

A

Barret’s Esophagus

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18
Q

what type cells are found in Barrett’s Esophagus

A

Specialized intestinal metaplasia of the esophageal mucosa due to replacement of squamaous epithelium by columnar epithelium
goblet cells

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19
Q

is there malignant potential w/ barrett’s esophagus

A

yes

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20
Q

Do PPIs prevent bile reflex?

A

No

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21
Q

what do prevent bild reflex?

A

antireflex surgery

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22
Q

patient’s with long-standing GERD (>5 years) espeically those >50 should have what to screen for Barett esophagus?

A

upper endoscopy and biopsy in 4 quadrants

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23
Q

Patients with persistent low-grade dysplasia on repeat endoscopy should undergo surveillance how often

A

every 6 months for 2 cycles (can then be yearly if no progression)

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24
Q

2 ways to manage high-grade syplasia w/ Barett’s esophagus

A

Surveillance endoscopy, with intensive biopsy at 3-month intervals until cancer is detected
Surgical resection

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25
Q

what type is a sliding hiatal hernia (GE junction is intrathoracic)

A

Type 1

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26
Q

what type hiatal hernia is rolling where only the fundus is intrathoracic

A

Type II

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27
Q

what is the only hiatal hernia where the GE junction is intraperitoneal

A

Type II

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28
Q

Fundus and body and other abdominal organs

are intrathoracic

A

Type IV hiatal hernia

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29
Q

type of hiatal hernia that can be associated w/ life-threatening complications. should be repaired if symptomatic

A

paraesophageal hernia (II, III, IV)

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30
Q

symptoms of paraesophageal hernias

A 
only 50% are symptomatic
epigastric abdominal pain
postprandial fullness
chest discomfort
heart burn
dyphagia
vomiting 
weight loss
dyspnea
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31
Q

complications from paraesophageal hernias

A

Anemia from Cameron ulcers from erosions of the gastric mucosa
incarceration w/ obstruction, strangulation, perf

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32
Q

what is Borchardt’s triad indicative of?

A

an incarcerated intrathoracic stomach – Surgical emergency

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33
Q

what are the three aspects of Borchardt’s triad?

A

chest pain
retching w/ inability to vomit
inability to pass an NGT

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34
Q

diagnosis for non-ermegency hiatal hernia

A

CXR (retrocardiac air bubble)
barium swallow
upper endoscopy
often found incidentaly on CT

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35
Q

before hiatal hernia what needs to be done?

A

esophageal motility study

pH probe not needed

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36
Q

Present with dysphagia, regurgitation, chest pain and heartburn

A

esophageal motility disorders

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37
Q

what must be done w/ eosphageal motility disorder

A

esophageal manometry

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38
Q

Failure of esophageal body peristalsis and incomplete relaxation of the LES
All have dysphagia
Most have regurgitation
Late in disease – weight loss

A

Achalasia

39
Q

what is a tumor at cardia, tight NIssen or angelchik

A

pseudoachalasia

40
Q

what too look for on barium esophagram w/ achalasia

A

barium esophgram will show a bird beak (later)

late signs- toruous, sigmoid esophagus, epiphrenic diverticulum

41
Q

on endoscopy w/ achalsia what will you seen

A

Residual liquid or food in esophagus

Scope can pass the narrowing at distal esophagus with popping sensation

42
Q

Tx for achalasia

A

CCB
endoscopic botulinum toxic
balloon dilation of LES (high risk of perf)
surgery

43
Q

what surgery is done for achalsia

A

Heller myotomy w/ partial fundoplication

44
Q

Substernal chest pain or dysphagia

Barium swallow shows tertiary contractions (corkscrew esophagus) An epiphrenic diverticulum is sometimes present

A

diffuse esophageal spasm

45
Q

what will manometry show with diffuse esophageal spasm

A

simultaneous contractions of normal or low amplitude

46
Q

tx for diffuse esophageal spasm

A

Meds- CCB and nitreates

sx- myotomy (not as effective as it is for achalasia)

47
Q

central crushign chest pain is dominant symptoms
dysphagia and heartburn may also be present
barium swallow is normal

A

nutrcrack esophagus

48
Q

what will manometry show w/ nutcracker esophagus

A

Manometric abnormality where the amplitude of esophageal body > 2 standard deviations above normal

49
Q

Tx for nutcracker esophagus

A

muscle relaxants such as CCB and nitrates

50
Q

2 types of esophageal diverticuale

A

traction (true)

pulsion (false)

51
Q

diverticula contain only the submucosa and mucosa

A

pulsion (false)

52
Q

diverticula contain all layers of the esophageal wall

A

traction (true) esophageal diverticulae

53
Q

what causes a true esophageal diverticulaue

A

Result from an adjacent inflammatory process, like a lymph node, that pulls the entire esophageal wall

54
Q

cause of pulsion diverticula

A

Most are due to elevated intraluminal pressure that causes the mucosa and submucosa to herniate through the muscle layer

55
Q

most common esophageal diverticulae

A

Pharyngoesophageal – Zencker’s

56
Q

location of Pharyngoesophageal – Zencker’s

A

Killian’s triangle - the point of transition between the thyropharyngeus muscle and the cricopharyngeus muscle represents an area of potential weakness

57
Q

symptoms of pharyngoesophageal -zencker’s diverticulae

A

Cervical dysphagia, effortless regurgitaiton of undigested food, halitosis, choking and aspiration

58
Q

main diagnostic for Pharyngoesophageal – Zencker’s

A

barium esophagram

59
Q

Tx for Pharyngoesophageal – Zencker’s

A

surgical- exicision of diverticulum and mytomy of the circopharyngeus muscle and upper 3 cm of teh esopahgeal wall

60
Q

what usually causes a traction midesophageal diverticula

A

granulomatous disease such as TB

61
Q

tx of traction midesophageal diverticulae

A

tx underlying inflammation

62
Q

what causes a pulsion midesophageal diverticula

A

motility disoders

63
Q

tx for pulsion midesophgeal diverticula

A

tx underlying motility disorder

Surgery if symptomatic or > 5cm – diverticulectomy and myotomy

64
Q

what esophageal diverticulae has a high association w/ GERD

A

Epiphrenic diverticula

65
Q

tx for symptomatic or enlarging esophageal diverticuale

A

Diverticulectomy, esophagomyotomy, +/- partial fundiplication

66
Q

what are benign tumors of the esophagus usually

A

leiomyomas

67
Q

where are leiomyomas usually

A

smooth muscle layer
lower 2/3
narrow the lumen
smooth muscles surronded by a capsule of fibrous tissue

68
Q

symptoms of esophageal leiomyoas

A

dysphagia, retrosternal presure and pain

69
Q

what will a leiomyoa look like on barium swallow

A

Characteristic smooth, concave submucosal defect with sharp borders on barium swallow

70
Q

do you need to biopsy a leiomyoma

A

no

71
Q

when do you treat a leiomyos

A

Excise if symptomatic or > 5cm

by Enucleation

72
Q

squamous cell carcinoma of esophagus risk factors

A 
smoking
tobacco
Chronic ingestion of hot liquids or foods
Poor oral hygiene 
Nutritional deficiencies
Achalasia
Caustic injury
73
Q

adenocarcinoma of the esophagus risk factor

A

GERD

74
Q

where does esophageal CA start?

A

mucosa and invades adjacent structure

75
Q

number one symptom of carcinoma of espohagus

A

dysphagia
also heartburn, weight loss
hoarseness
respiratory symptoms

76
Q

dx for carcinoma of esophagus

A

barium esophagram then endoscopy w/ biopsy

77
Q

used for carcinoma of esophagus and shows Depth of mural penetration and invasion to periesophageal tissue and adjacent lymph nodes

A

endoscopic US (EUS)

78
Q

if you suspect trachel or bronchial invasion with carcinoma of the esophagus what should be done?

A

bronchoscopy

79
Q

paliative tx for carcinoma of esophagus

A

CT, RT
laser
endoscopic stent placement

80
Q

what is theonly cure for carcionma of the sophagus

A

surgery

81
Q

causes of esophageal bleeding

A 
Esophageal ulcers
Esophageal varices
Esophagitis 
Mallory-Weiss tear?
Esophageal tumors
82
Q

presentation of esophageal bleeding

A

Hematemesis
Coffee-ground emesis
Melena
Shock

83
Q

tx for esophageal bleeding

A 
2 large bored IVs
volume resuscitation
possible pRBC (start if 2 L didn't help) 
draw blood for testing
NGT
EGD (only imaging needed) 
hemodynamic monitoring
84
Q

if you can order one blood test on an upper GI bleeding patient what would you order?

A

type and cross

85
Q

Tx for esophageal varices

A 
sclerotherapy
somatostatin or vasopressin
balloon tamponade
TIPS
emergency esophagectomy
portosystemic shunts
86
Q

causes of esophageal perf

A 
iatrogenic- endoscopy
bougienage
dilation
NGT
intraop- mediastinoscopy, fundoplication
87
Q

syndrome caused by retching that causes perforation of esophagus at GE junction

A

Boerhaave’s syndrome

88
Q

when does moratlity increase w/ esophageal perf

A

if diagnosed after 24 hours

89
Q

symptoms of esophageal perf

A 
fever, tachy, leukocytosis
subQ emphysema
dyspnea
on x-ray mediastinal emphysema, pleural effusion
peritonitis
90
Q

what will you see on plain filem w/ esophageal perf

A 
Plain X-ray
Mediastinal emphysema
Pleural effusion 
Mediastinal widening
PTX
hydropneumothorax
91
Q

how do you do esophagography w/ esophageal perf

A

water soluble first if no leak then use barium

92
Q

what may worsen a performation

A

upper endoscopy

93
Q

non operative management of esophageal perf

A

broad spectrum and NPO
must have no signs of sepsis, minimal pleural soilage into esophagus
minimal symptoms and diagnosed days after injury

94
Q

operative tx for esophageal perf

A 
broad spectrum abx
drainage
primary repair
esophageal exclusion
esophageal resection
consult surgeon early

*OldSurgery (22 decks)

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