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SURGERY > ESOPHAGUS > Flashcards

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
Q

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

A

Achalasia
TRIAD: hypertensive LES + aperistalsis of esophageal body + failure of LES to relax

dysphagia for BOTH solids and liquids then regurgitation
26
Q

Barium swallow findings (ACHALASIA)

A

dilated esophagus
bird beak esophagus (tapering of LES and GE)
air fluid level
sigmoid esophagus

27
Q

Management of Achalasia

Medical and Surgical

A

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
Q

MC primary esophageal motility disorder w/ very strong peristaltic waves

A

Nutcracker Esophagus (Hypertensive Peristalsis)

29
Q

Cause injury by LIQUEFACTIVE necrosis (saponification of fats)
penetrates deeply

A

alkali agents (pH > 7)

30
Q

Causes COAGULATION necrosis

more superficial

A

Acids (pH <7)

31
Q

Common sequelae of caustic infection

A

fibrosis and stricture
fistula
esophageal SCC

32
Q

MC type of esophageal carcinoma worldwide

MEN - affected 3-4 times

A

Squamous Cell Carcinoma

middle 3rd of THORACIC carcinoma - usual location

33
Q

MC type of esophageal carcinoma in developed countries

MEN - affected 6-8 times

A

Adenocarcinoma
DISTAL esophagus
Barrett metaplasia: PRECURSOR LESION

34
Q

MC presenting symptom of esophageal carcinoma (occurs when >60% of esophageal lumen is infiltrated w/ tumor)

A

Dysphagia

35
Q

Signs and symptoms of Advanced Esophageal Carcinoma

A 
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
Q

Essential for all patients suspected of having esophageal cancer

A

Endoscopy (EGD) w/ biopsy

histology, location, degree of obstruction and extent of lesion

37
Q

Visualize the mucosa, distensibility and extent of lesion

A

Barium swallow

38
Q

Determines the local extent and relationship to adjacent structures and distant metastases (lung, liver)

A

CT scan of chest and abdomen

39
Q

Provides more accurate T and N staging

A

Endoscopic Ultrasound (EUS)

40
Q

Management for esophageal tumor that invades into the submucosa, without visible LN
involvement

A

Esophagectomy

41
Q

Management for tumor that demonstrates spread through the wall of the esophagus,
especially if LNs are enlarged

A

Induction Chemoradiation therapy (Neodadjuvant therapy)

42
Q

Management for tumor w/ invasion into the pleura ( T4a) in the absence of malignant effusion

A

Surgical Resection

43
Q

Technique of resecting an esophageal cancer which remains symptomatic after definitive chemoradiotherapy

A

Salvage Esophagectomy

44
Q

Patients with dysphagia secondary to esophagea cancer treated with radiation can expect the benefit to last

A

2-3 months

45
Q

How long after completion of neoadjuvant chemoradiotherapy should esophagectomy be performed

A

6-8 weeks

46
Q

Optimal treatment of an incidentally discovered 3 cm leiomyoma of the upper esophagus in a 45-year-old otherwise healthy man

A

Enucleation

47
Q

Mucosal tears located at the GEJ

Characterized by arterial bleeding (may be massive)

A

Mallory Weiss Tear
UGIB after repeated vomiting

observation
medical management- blood replacement, decompression, antiemetics
surgical management - laparotomy + high gastrotomy + oversewing the tear
48
Q

Involves simultaneous non-peristaltic contractions of the esophagus

A

Diffuse Esophageal Spasm (DES)
CLASSIC MANOMETRIC FINDINGS:
frequent occurrence of simultaneous waveforms
multipeaked esophagea contractions

49
Q

Gold Standard test for Achalasia

A

Manometry

50
Q

Spontaneous rupture of esophagus w/ usual history of resisting of vomiting

A

Boerhaave syndrome

51
Q

Indications for surgery in the acute setting of caustic ingestion

A

free air under the diaphragm
cervical crepitus
full-thickness necrosis of the esophagus or stomach

52
Q

Indications for esophageal resection in Barrett’s esophagus

A

presence of invasive cancer
carcinoma in situ
high-grade dysplasia

53
Q

Disorders of the esophagus associated with the development of esophageal carcinoma?

A

Lye ingestion
Achalasia
Barrett’s esophagus
Plummer–Vinson syndrome

54
Q

The most important determinants of survival after resection of an esophageal carcinoma?

A

Depth of invasion
Presence or absence of lymph node metastases
Presence or absence of distant metastases

SURGERY (27 decks)

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