Esophagus Flashcards
Esophagus starts at the level of __ and ends at __
Cricoid catilage (c6)
Cardia of stomach (T11)
Layer that is absent in the esophagus is
Serosa
Blood supply of the cervical region of esophagus is
Inferior thyroid artery
What is the blood supply of the thoracic region of the esophagus
Bronchial arteries
Blood supply of the abdominal region of esophagus
Ascending branch of the left gastric artery
Inferior phrenic artery
This is the gold standard for the diagnosis of GERD
24 hour ambulatory pH monitoring
Most consistent characteristic of a mechanical defective LES
Intraabdominal sphincter length of <1cm
Hallmark of intestinal metaplasia
(+) intestinal goblet cells
Gold standard treatment for GERD
Proton Pump Inhibitor
Most common antireflux procedure that involves 360 deg fundoplication around the lower esophagus for a distance of 4-5cm, without division of the short gastric vessel
Nissen fundoplication
270 deg fundoplication around the distal 4cm of esophagus
Toupet fundoplication
180 deg anterior fundoplication of the distal esophagus
Dor fundoplication
This procedure uses stapler to divide the cardia and upper stomach which results to gastric tube continuous with the esophagus thereby extending length of esophagus by several centimeters
Collis gastroplasty
A 240-270 deg fundoplication is done thru thoracic approach
Belsey mark IV
Arcuate ligament repair plus gastropexy to diaphragm
Hill Posterior Gastropexy
Deterioration of the phrenopharyngeal membrane
Diaphragmatic hernia
Signs and symptoms of sliding hernia
GERD (heart burn, regurgitation)
Common symptoms of paraesophageal hernia
Dysphagia
Postprandial fullness
Massive bleeding
Gastric volvolus
Infarction
Borchardt triad
Chest pain
Retching with inability to vomit
Inability to pass a nasogastric tube
This is indicative of incarcerated intra thoracic stomach
Borchardt triad
Findings of the upper GI barium swallow in hiatal hernia
Outpouching of barium at the lower end of esophagus
Wide hiatus
Free reflux of barium
Most common esophageal diverticula that results from high pressure from the hypopharynx
Zenker diverticulum or pahryngoesophageal diverticulum
This is the area of potential weakness situated behind the esophagus at the level of cricopharyngeus muscle
Killian triangle
Symptoms of zenker diverticulum
Dysphagia
Regurgitation of undigested food
Halitosis
Choking
Aspiration
Tx of zenker diverticulum of less than or equal 2cm
Pharyngotomy
Tx for zenker diverticulum that is more than 2cm
Diverticulectomy or diverticulopexy
It is a primary motility disorder characterized by loss of peristaltic waveform in the esophageal body and failure of the LES to relax
Achalasia
Triad of achalasia
Hypertensive LES
Aperistalsis of the esophagus
Failure of the LES to relax
Gold standard for dx of Achalasia
Manometry
Sign of Achalasia in esophagram
(+) Bird’s beak
Most effective non surgical management for achalasia
Pneumatic dilatation
Medications that can be given for Achalasia
CCB, Nitrate or Botilinum toxin
Most common primary esophageal motility disorder
Nutcracker esophagus
Necrosis caused by alkali
Liquefactive necrosis
Acids cause this necrosis
Coagulation necrosis
Most common type of esophageal carcinoma
Squamous cell carcinoma
Squamous cell carcinoma of the esophagus is most commonly seen at what site?
Middle 3rd of the thoracic esophagus
Most common site of adenocarcinom of esophagius
Distal esophagus
Premalignnt lesion of adenocarcinoma
Barret’s esophagus
Triad of plummer vinson syndrome
Iron deficiency anemia
Dysphagia
Esophageal web
