Esophagus

Question 1

What is a diag ostic finding in Barretss esophagus?

Answer 1

Goblet Cells (normal eso squamous replaced by insetinal columnar epi)

Question 2

Esophageal motility disorders (achalasia, HTN LES) can be treated with (3)

Answer 2

CCBs, nitrates, Heller myomotomy

Question 3

T2N0 EC, tx?

Answer 3

neoadjuvant chemorads then transhiatal esophagectomy

Question 4

EC: adeno and squamous. Adeno related to Barretts/GERD and MC in US, but SCC is related to _ and more common _

Answer 4

EC SCC is related to smoking and drinking; more common worldwide

Question 5

If concern for eso perf and CXR shows pleural effusion and gastrogaffin shows no leak, what to do next?

Answer 5

Barium esophogram

Question 6

Near complete occlusion of distal eso with malignancy, how to feed?

Answer 6

J tube!

Question 7

EGD for achalasia causes eso perf? how to approach surgically

Answer 7

Distal (bc the achalasia) so Left posteriolateral thoracotomy

Question 8

Scleroderma with sis of dysphagia, first line tx?

Answer 8

CCB

Question 9

Spooning of fingernails, IDA, and esophageal web. Whats the dx?

Answer 9

Plummer Vinson

Question 10

Techinical aspects of transthoracic Heller myotomy

Answer 10

1. Right lat decb
2. Enter at the 7th intercostal space
3. Incise the pulmonary ligament
4. retract lung medial and cephalic
5. incise the pleura
6. Encircle eso with penrose
7. ID the vagus nerves
8. do the esophagomyomotomy

Question 11

Classic v Alarm sx GERD

Answer 11

Classic GERD - heartburn, regard

Alarm = Dysphagia

Question 12

Zenker loaction

Answer 12

Killian triangle
Inferior pharyngeal constrictor and cricopharyngeus in upper esophagus
(False diverticulum)

Question 13

GEJ tumor classification; which class requires esogastrectomy?

Answer 13

Siwert classification

Class II treated with esogastrectomy to achieve R0 resection

Question 14

where is a Heller dissection done?

Answer 14

5-6 cm on the eso and 2 cm on stomach below the GEJ

Question 15

mallory weiss tear bleeding txs?

Answer 15

Endoscopy w banding,etc

If rebleaeed Endoscopy AGAIN

Question 16

Achalasia presentation

Answer 16

Dysphagia to both liquid and solids

Question 17

3 points of narrowing in esophagus

Answer 17

Narrowest=cricopharyngeus 14mm
Aortic arch (15)
Left main(17)

Question 18

Surveillance for BARRETTS

Answer 18

No dysplasia - EGD 3-5 years
Low grade - EDG every 6 MONTHS +/- endoscopic eradication
HIGH grade - endoscopic eradication

Question 19

s/p Nissen PO 1 month with gastropaeresis, what are you considering?

Answer 19

vagus nerve injury

Question 20

what is the minimum amount of intra-abdomen esophagus required for adequate surgical management of reflux?
what if this can’t be achieved?

Answer 20

2-3 CM without tension is required

Can do Collis gastroplasty which creates 4-5 cm of Neo-esophagus

Question 21

ph testing after Heller is DeMeester.

DeMester score > ____ indicates signicant reflux and what is the tx?

Answer 21

14.72

Tx= PPI fo life!

Question 22

EC, what stage does a patient benfit from JUST esophagectomy (not neo chemo rads)?

Answer 22

Early stage T1b or T2 if no nodes, low risk pt, no lymphavasc invasion and lesion well differentiated

Question 23

Mandatory pre-op w/u for patients being considered for operative mgmt of GERD? (4)

Answer 23

1. EGD to r/o CA
2. 24 hour ph monitoring to get DeMeester score
3. Esophogram to motility disorders
4. Manometry to r/o motility disorders