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SURGERY > Esophagus > Flashcards

Esophagus Flashcards

1
Q

Layer absent from the esophagus

A

Serosa

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2
Q

3 regions of the esophagus and their lengths and blood supply

A

cervical (5cm) - inf. thyroid artery and vein

thoracic (20cm) - bronchial artery, hemiazygous vein, azygous and bronchial veins

abdominal (2cm) - ascending branch of left gastric artery and inferior phrenic artery, coronary vein and left gastric vein

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3
Q

Gold standard treatment for GERD

A

PPIs

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4
Q

Gold standard test for GERD

A

24 hour pH monitoring

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5
Q

Hallmark of intestinal metaplasia

A

Intestinal goblet cells

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6
Q

Characteristics of mechanically defective LES (3)

A

▪️average LES mean resting pressure <6 mmHg
▪️Overall sphincter length <2 cm
▪️Intraabdominal sphincter length of <1 cm (most consistent characteristic)

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7
Q

Most common antireflux surgical procedure ; 360 fundoplication

A

Nissen fundoplication

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8
Q

270 fundoplication

A

Toupet fundoplication

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9
Q

180 fundoplication

A

Dor fundoplication

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10
Q

Use of stapler to divide the cardia and upper stomach, parallel to the lesser curvature of the stomach

A

Collis gastroplasty

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11
Q

240-270 fundoplication performed though a thoracic approach

A

Belsey Mark IV

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12
Q

Arcuate ligament repair + gastropexy to diaphragm

A

Hill posterior gastropexy

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13
Q

Deterioration of the phrenoesophageal membrane

A

Diaphragmatic hernia

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14
Q

Most common type of diaphragmatic hernia

A

Type I (sliding hernia)

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15
Q

Upward dislocation of the gastric fundus alongside a normally positioned cardia

A

Type II (Rolling / Paraesophageal hernia)

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16
Q

Herniation of part of the stomach without displacement of GE junction

A

Type II (Rolling / Paraesophageal Hernia)

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17
Q

Upward dislocation of the GE junction and cardia into the thorax through the esophageal hiatus of diaphragm

A

Type I (Sliding)

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18
Q

Combined herniation of the cardia and fundus

A

Type III (Combined hernia)

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19
Q

Includes an additional organ that herniates aside from the stomach

A

Type IV

20
Q

Also referred to as paraesophageal hernia as a portion of the stomach is situated adjacent to the esophagus

A

Types II-IV

21
Q

Borchardt triad (3)

A

Retching with Inability to vomit
Chest pain
Inability to pass a nasogastric tube

22
Q

Indicative of incarcerated intrathoracic stomach

A

Borchardt triad

23
Q

Paraesophageal repair process (4)

A

Hernia sac dissection and resection
Esophageal mobilization
Crural repair
Fundoplication

24
Q

Plummer Vinson Syndrome Triad

A

Dysphagia
IDA
Esophageal web

25
Q

Pulsion of diverticula of the distal esophagus arising just above the LES, more frequently on the right posterolateral wall

A

Epiphrenic Diverticulum

26
Q

Primary motility disorder characterized by loss of peristaltic waveform in the esophageal body and failure of the LES to relax

A

Achalasia

27
Q

Achalasia Triad

A

Hypertensive LES
Aperistalsis of the esophagus
Failure of LES to relax

28
Q

Gold standard of achalasia and sign seen in esophagogram

A

Manometry
(+) Bird beak esophagus

29
Q

Treatment of achalasia

A

Heller myotomy + partial fundoplication

Pneumatic dilatation - most effective non-surgical management

Medications: CCB, nitrates, botulinum toxin

30
Q

Most common primary esophageal motility disorder

A

Nutcracker esophagus

31
Q

Functional grade of Dysphagia:
Unable to swallow saliva

A

VI

32
Q

Functional Grade of Dysphagia:
Able to take liquids only

A

IV

33
Q

Functional Grade of Dysphagia:
Requires liquids with meals

A

II

34
Q

Functional Grade of Dysphagia:
Able to take semisolids but unable to take any solid food

A

III

35
Q

Most important etiologic factor in the development of primary adenoCA of the esophagus

A

Barrett’s esophagus

36
Q

Diagnostic evaluation that provides more accurate T and N staging

A

Endoscopic ultrasound

37
Q

Esophageal carcinoma treatment in which this is the standard for non surgical management for locally advanced disease

A

Chemoradiation (local regional disease : stage i - iii)

38
Q

Contraindications for curative surgery or resection

A

Age > 75 years old
FEV1 < 1.25 abd EF < 40%
> 20% wt loss
Locally advance tumor
Distant metastasis

39
Q

Phases of Caustic Injury:
1. Acute necrotic phase
2. Ulceration and granulation
3. Cicatrization and scarring

A
  1. First phase (Day 1-4)
  2. Second phase (Day 3-5)
  3. Third phase (3rd week)
40
Q

Phases of Caustic Injury:
▪️Odynophagia and dyphagia
▪️Hypersalivation
▪️Pain in the mouth and substernal region

A

First phase

41
Q

Phases of Caustic Injury:
Reapparance of the dysphagia due to stricture formation

A

Third phase

42
Q

Phases of Caustic Injury:
▪️Disappearance of the symptoms
▪️Period when esophagus is at its weakest

A
43
Q

Usual location in the esophagus for SCC

A

Middle 3rd of thoracic esophagus

44
Q

Usual location for adenocarcinoma in the esophagus

A

Distal esophagus

45
Q

Smooth polypoid lesion on barium swallow

A

Esophageal sarcoma

46
Q

Thin submucosal ring in the lower esophagus

A

Schatzki ring

47
Q

Mucosal tears located at the gastroesophageal junction

A

Mallory Weiss Tear

SURGERY (11 decks)

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