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ABSITE > Esophagus > Flashcards

Esophagus Flashcards

1
Q

Blood supply to the esophagus

A

Cervical: inferior thyroid artery

Thoracic: Branches of bronchial arteries and directly off aorta

Abdominal: Branches of L gastric, L inferior phrenic artery, Belsey’s artery (connective b/w L gastric & inf phrenic art), splenic artery

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2
Q

Hill esophagogastropexy

A

Patients who require antireflux surgery who have had prior gastric surgery and with inadequate fundus for plication

plication of lesser gastric curvature around right side of esophagus with esophagogastropexy to median arcuate ligament

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3
Q

Surveillance for Barrett’s esophagus

A

No dysplasia: EGD 3-5 years

Low-grade dysplasia: endoscopic eradication w/ RFA or surveillance (EGD 6 mo)

High-grade dysplasia: Endoscopic eradication

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4
Q

Vagal innervation to esophagus/stomach

A

Motor and sensory functions

Nerve injury -> gastroparesis, delayed gastric emptying, reflux, diarrhea (liquid emptying is accelerated)

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5
Q

Achalasia

A

Absent esophageal peristalsis
Abnormal LES relaxation
Raised LES pressure (>45mmHg)
Dysphasia MC sxs
Occurs w/ solids & liquids (functional vs obstruction)
Dysphagia can plateau as pts learn to alleviate sxs w/ certain postural maneuvers that increase esophageal pressure and emptying

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6
Q

Killian Triangle

A

Oblique fibers of thyropharyngeus muscle (sup) and horizontal fibers of cricopharyngeus muscle (inf) in upper esophagus

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7
Q

Esophageal perforation treatment

A

Broad-spectrum Abx
Fungal coverage
CXR - PA/Lat (hydropneumothorax)
Upright abd film if intra-abd portion suspected
Water-soluble esophagram in R lateral decubitus position
(upright makes contrast flow too fast). 10% false neg rate
Barium Esophagram (superior in detecting small perfs; causes mediastinitis)

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8
Q

Esophageal cancer

A

T1: mucosal confined. Tx: rsxn (T1a - EMR + RFA; T1b - +/- chemo d/t 15-25% of LN dz)
T2-3: regional dz

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9
Q

Areas of narrowing in esophagus

A

1st area (Narrowest part): cricopharyngeus muscle (14mm diameter)
2nd area: aortic arch/L mainstem bronchus (15-17mm)
3rd area: diaphragmatic hiatus (19mm)

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10
Q

Diffuse esophageal spasm (DES)

A

Simultaneous contraction >20% wet swallows, intermittent peristalsis
Repetitive or multi-peak contractions (>2 peaks)
Contractions not assoc w/ swallows
Contraction amplitude >30mmHg

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11
Q

Nutcracker esophagus

A

Increased mean distal amplitude (>180mmHg)
Normal peristalsis
Increased distal duration (>6sec)

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12
Q

Hypertensive lower esophageal sphincter

A

Resting LES pressure >45mmHg

Incomplete lower exophageal sphincter relaxation

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13
Q

Esophageal adenocarcinoma

A

Early stage T1a: Endo rsxn

Med fit pts w/ N+ dz, T3 or greater dz, or T2 + high risk features –> neoadj chemorads

High-risk features: >3cm, lymph vascular invasion, poor differentiation

Tumor above carina: bronch

serve esophageal ca: laryngoscopy

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14
Q

W/u esophageal cancer

A

EGD + Bx, EUS, CT C/A, FDG-PET

+pelvic sxs -> CT Pelvis

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15
Q

Access esophagus

A

Cervical esophagus: L, ant to SCM

Mid esophagus: R posterolateral thoracotomy

Distal esophagus: L thoracotomy (through 7/8th intercostal spaces)

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16
Q

Alarm sxs for GERD

A

dysphagia (can be first sxs of Barrett’s), early satiety, hemoptysis, odynophagia, weight loss, continual pain

indicate complication from GERD (Barrett’s, strictures, cancer)

17
Q

Caustic esophageal injuries

A

Acid: some cleaning agents and battery fluids. Superficial coagulation necrosis, more prominent in oropharynx

Alkali: drain cleaners. Liquefactive necrosis, transmural damage. Worse than acid

Zargar classification
Grade 0: Normal mucosa
Grade 1: Superficial edema/erythema
Grade 2: Mucosal/submucosal ulceration (2a: superficial, 2b: deep)
Grade 3: Transmural ulceration w/ necrosis
Grade 4: perforation

18
Q

Margins esophageal cancer resection

A

5cm

19
Q

Siewert Classification GEJ Tumors

A

Type I: +5cm - +1cm from GEJ
Type II: +1cm - -2cm from GEJ
Type III: -2cm - -5cm from GEJ

20
Q

Plummer-Vinson Syndrome

A

IDA + esophageal webs + dysphagia

spoon-shaped fingernails (koilonychia)

aka: sideropenic dysphagia

21
Q

Complications of GERD

A 
Shortening of esophagus (2/2 inflammation & fibrosis)
Stricture
Intestinal metaplasia (columnar)
Erosive esophagitis
Adenocarcinoma
Extra-esophageal:
Asthma
Laryngitis
Cough
Pneumonitis
Dental erosions

ABSITE (41 decks)

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