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ESOPHAGUS Flashcards

1
Q

Esophagus (C6-T11)

Blood Supply

A

cervical INFERIOR thyroid a
thoracic BRONCHIAL a
abdominal L GASTRIC a
INFERIOR phrenic a

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2
Q

Venous Drainage of Esophagus

A

cervical INFERIOR thyroid v
thoracic BRONCHIAL v
AZYGOUS AND HEMIAZYGOUS VEINS
abdominal CORONARY v

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3
Q

Hormones that INCREASE LES pressure

A

motilin

gastrin

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4
Q

Hormones the DECREASE LES pressure

A 
cholecystokinin
estrogen
glucagon
progesterone
somatostatin
secretin
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5
Q

1st diagnostic test in patients w/ suspected esophageal diseases

A

Barium swallow

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6
Q

Indicated in patients complaining of dysphagia even w/ normal radiographic study

A

Endoscopic Evaluation

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7
Q

Indicated when a motor abnormality of the esophagus is considered on the basis of complaints an barium swallow and endoscopy does not show a structural abnormality

A

Manometry

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8
Q

GOLD STAbDARD for the diagnosis of GERD

A

24 hr ambulatory pH monitoring

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9
Q

MC esophageal pathology d.t. loss of high pressure zone at the esophagogastric junction

A

Gastroesophageal Reflux Disease

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10
Q

Lower Esophageal Sphincter - NOT a true anatomic sphincter

resting pressure - 6-26 mmHg
overall length - 3-5 cm
intraabdominal length exposed to positive pressure - 2-4 cm

A

Defective Sphincter
mean resting pressure < 6mmHg
overall length < 2 cm
intraabdominal length < 1 cm - MOST COMMON

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11
Q

Indications for Anti-Reflux Surgery

A 
symptomatic patients w/ or w/o esophagitis
structurally defective LES
young patients w/ documented reflux
severe esophagitis
presence of stricture
uncomplicated Barrett esophagus
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12
Q

MC antireflux surgical procedure; mostly done laparoscopically

360 fundoplication

A

Nissen Fundoplication

AE: dysphagia, inability to belch, flatulence, structure

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13
Q

Alternative to Nissen fundoplication

180 posterior fundoplication around the distal 4 cm of esophagus

A

Toupet Fundoplication

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14
Q

180 ANTERIOR fundoplication of the distal esophagus

A

Dor Fundoplication

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15
Q

240-270 fundoplication performed through a THORACIC approach

A

Belsey Mark IV

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16
Q

Columnar lined epithelium of esophagus rather than squamous epithelium

A

Barrett Esophagus

30-125% increased risk of developing adenocarcinoma

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17
Q

Histologic Hallmark of Barrett Esophagus

A

Goblet cells

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18
Q

Congenital defect in which an OPENING is present in DIAPHRAGM allowing ABDOMINAL ORGANS to move into the CHEST CAVITY

A

Diaphragmatic (Hiatal) Hernia

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19
Q

MC type of hiatal hernia

upward dislocation of GE JUNCTION and CARDIA into thorax through the ESOPHAGEAL HIATUS of diaphragm

A 
Type 1 (SLIDING HERNIA)
	reflux, dysphagia, aspiration
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20
Q

Upward dislocation of the GASTRIC FUNDUS alongside a normally positioned hcardia

Herniation of part of the stomach WITHOUT displacement of GE junction

A 
Type II (ROLLING/PARAESOPHAGEAL HERNIA)
	obstructive symptoms, dysphagia, gastric ulcer, strangulation
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21
Q

Combined herniation of the CARDIA and FUNDUS

A

Type III (COMBINED HERNIA)

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22
Q

Borchardt triad

indicative of incarcerated intrathoracic stomach

A

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

23
Q

Key Indications for Antireflux Surgery

A

objectively proven GERD
typical symptoms of GERD despite adequate medical management
younger patient unwilling to take lifelong medication

24
Q

MC form of esophageal diverticula

False diverticulum w/ MUCOSA and SUBMUCOSA at UES through the Killian Triangle

A

Zenker diverticulum
d.t. increased pressure in the hypopharynx during swallowing against a closed UES
Killian triangle - are of potential weakness behind the esophagus at the level of cricopharyngeus

<2 cm - pharyngomyotomy
>2cm - diverticulectomy, diverticulopexy
25
Loss of PERISTALTIC waveform in the esophageal body and FAILURE of LES to relax during swallowing Neurogenic degeneration of ganglion cells causes a functional outflow obstruction
Achalasia TRIAD: hypertensive LES + aperistalsis of esophageal body + failure of LES to relax dysphagia for BOTH solids and liquids then regurgitation
26
Barium swallow findings (ACHALASIA)
dilated esophagus bird beak esophagus (tapering of LES and GE) air fluid level sigmoid esophagus
27
Management of Achalasia Medical and Surgical
CCB, nitrates, botulinum toxin Laparoscopic Heller myotomy of LES muscles of cardia (LES) are cut allowing food and liquids to pass to the stomach
28
MC primary esophageal motility disorder w/ very strong peristaltic waves
Nutcracker Esophagus (Hypertensive Peristalsis)
29
Cause injury by LIQUEFACTIVE necrosis (saponification of fats) penetrates deeply
alkali agents (pH > 7)
30
Causes COAGULATION necrosis | more superficial
Acids (pH <7)
31
Common sequelae of caustic infection
fibrosis and stricture fistula esophageal SCC
32
MC type of esophageal carcinoma worldwide | MEN - affected 3-4 times
Squamous Cell Carcinoma | middle 3rd of THORACIC carcinoma - usual location
33
MC type of esophageal carcinoma in developed countries | MEN - affected 6-8 times
Adenocarcinoma DISTAL esophagus Barrett metaplasia: PRECURSOR LESION
34
MC presenting symptom of esophageal carcinoma (occurs when >60% of esophageal lumen is infiltrated w/ tumor)
Dysphagia
35
Signs and symptoms of Advanced Esophageal Carcinoma
``` dysphagia odynphagia weight loss supraclavicular lymphadenopathy dyspnea (if w/ phrenic nerve inv) cough (if w/ tracheoesophageal fistula) hoarseness (if w/ recurrent laryngeal nerve invasion) upper body trauma (if w/ SVC) malignant pleural effusion ```
36
Essential for all patients suspected of having esophageal cancer
Endoscopy (EGD) w/ biopsy | histology, location, degree of obstruction and extent of lesion
37
Visualize the mucosa, distensibility and extent of lesion
Barium swallow
38
Determines the local extent and relationship to adjacent structures and distant metastases (lung, liver)
CT scan of chest and abdomen
39
Provides more accurate T and N staging
Endoscopic Ultrasound (EUS)
40
Management for esophageal tumor that invades into the submucosa, without visible LN involvement
Esophagectomy
41
Management for tumor that demonstrates spread through the wall of the esophagus, especially if LNs are enlarged
Induction Chemoradiation therapy (Neodadjuvant therapy)
42
Management for tumor w/ invasion into the pleura ( T4a) in the absence of malignant effusion
Surgical Resection
43
Technique of resecting an esophageal cancer which remains symptomatic after definitive chemoradiotherapy
Salvage Esophagectomy
44
Patients with dysphagia secondary to esophagea cancer treated with radiation can expect the benefit to last
2-3 months
45
How long after completion of neoadjuvant chemoradiotherapy should esophagectomy be performed
6-8 weeks
46
Optimal treatment of an incidentally discovered 3 cm leiomyoma of the upper esophagus in a 45-year-old otherwise healthy man
Enucleation
47
Mucosal tears located at the GEJ | Characterized by arterial bleeding (may be massive)
Mallory Weiss Tear UGIB after repeated vomiting observation medical management- blood replacement, decompression, antiemetics surgical management - laparotomy + high gastrotomy + oversewing the tear
48
Involves simultaneous non-peristaltic contractions of the esophagus
Diffuse Esophageal Spasm (DES) CLASSIC MANOMETRIC FINDINGS: frequent occurrence of simultaneous waveforms multipeaked esophagea contractions
49
Gold Standard test for Achalasia
Manometry
50
Spontaneous rupture of esophagus w/ usual history of resisting of vomiting
Boerhaave syndrome
51
Indications for surgery in the acute setting of caustic ingestion
free air under the diaphragm cervical crepitus full-thickness necrosis of the esophagus or stomach
52
Indications for esophageal resection in Barrett’s esophagus
presence of invasive cancer carcinoma in situ high-grade dysplasia
53
Disorders of the esophagus associated with the development of esophageal carcinoma?
Lye ingestion Achalasia Barrett’s esophagus Plummer–Vinson syndrome
54
The most important determinants of survival after resection of an esophageal carcinoma?
Depth of invasion Presence or absence of lymph node metastases Presence or absence of distant metastases

SURGERY (27 decks)

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