Esophagus Flashcards
What is a diag ostic finding in Barretss esophagus?
Goblet Cells (normal eso squamous replaced by insetinal columnar epi)
Esophageal motility disorders (achalasia, HTN LES) can be treated with (3)
CCBs, nitrates, Heller myomotomy
T2N0 EC, tx?
neoadjuvant chemorads then transhiatal esophagectomy
EC: adeno and squamous. Adeno related to Barretts/GERD and MC in US, but SCC is related to _ and more common _
EC SCC is related to smoking and drinking; more common worldwide
If concern for eso perf and CXR shows pleural effusion and gastrogaffin shows no leak, what to do next?
Barium esophogram
Near complete occlusion of distal eso with malignancy, how to feed?
J tube!
EGD for achalasia causes eso perf? how to approach surgically
Distal (bc the achalasia) so Left posteriolateral thoracotomy
Scleroderma with sis of dysphagia, first line tx?
CCB
Spooning of fingernails, IDA, and esophageal web. Whats the dx?
Plummer Vinson
Techinical aspects of transthoracic Heller myotomy
- Right lat decb
- Enter at the 7th intercostal space
- Incise the pulmonary ligament
- retract lung medial and cephalic
- incise the pleura
- Encircle eso with penrose
- ID the vagus nerves
- do the esophagomyomotomy
Classic v Alarm sx GERD
Classic GERD - heartburn, regard
Alarm = Dysphagia
Zenker loaction
Killian triangle
Inferior pharyngeal constrictor and cricopharyngeus in upper esophagus
(False diverticulum)
GEJ tumor classification; which class requires esogastrectomy?
Siwert classification
Class II treated with esogastrectomy to achieve R0 resection
where is a Heller dissection done?
5-6 cm on the eso and 2 cm on stomach below the GEJ
mallory weiss tear bleeding txs?
Endoscopy w banding,etc
If rebleaeed Endoscopy AGAIN
Achalasia presentation
Dysphagia to both liquid and solids
3 points of narrowing in esophagus
Narrowest=cricopharyngeus 14mm Aortic arch (15) Left main(17)
Surveillance for BARRETTS
No dysplasia - EGD 3-5 years
Low grade - EDG every 6 MONTHS +/- endoscopic eradication
HIGH grade - endoscopic eradication
s/p Nissen PO 1 month with gastropaeresis, what are you considering?
vagus nerve injury
what is the minimum amount of intra-abdomen esophagus required for adequate surgical management of reflux?
what if this can’t be achieved?
2-3 CM without tension is required
Can do Collis gastroplasty which creates 4-5 cm of Neo-esophagus
ph testing after Heller is DeMeester.
DeMester score > ____ indicates signicant reflux and what is the tx?
14.72
Tx= PPI fo life!
EC, what stage does a patient benfit from JUST esophagectomy (not neo chemo rads)?
Early stage T1b or T2 if no nodes, low risk pt, no lymphavasc invasion and lesion well differentiated
Mandatory pre-op w/u for patients being considered for operative mgmt of GERD? (4)
- EGD to r/o CA
- 24 hour ph monitoring to get DeMeester score
- Esophogram to motility disorders
- Manometry to r/o motility disorders
