Esophagus

Question 1

Narrowest portion of GIT

Answer 1

Pharyngoesophageal junction

Question 2

Diaphragmatic openings

Answer 2

T8- IVC, Phrenic nerve
T10- esophagus, vagus nerve, left gastric artery
T12- aorta, thoracic duct
REMEMBER I8 10 eggs at 12

Question 3

What should be done if a foreign body gets impacted in esophagus ?

Answer 3

Endoscopic removal

Question 4

Most common site for iatrogenic perforation in esophagus?

Answer 4

C6- narrowest- pharyngoesophageal junction

Question 5

What type of blood supply does esophagus receive? Which artery is involved in Mallory Weiss tear?

Answer 5

Segmental supply. Left gastric artery.

Question 6

Upper 3rd of esophagus blood supply

Answer 6

Inferior thyroid artery and vein.

Question 7

Middle 3rd esophagus blood supply

Answer 7

Descending thoracic aorta, bronchial artery. Azygos vein

Question 8

Lower 3rd esophagus blood supply

Answer 8

Left gastric artery and vein ( coronary vein). Vein drains into portal vein to liver. Mets from eso to liver.

Question 9

Type of mets in esophageal carcinoma

Answer 9

Lymphatic- longitudinal, skip mets

Question 10

Based on nature of sphincter, how are upper and lower esophagus sphincters different?

Answer 10

Upper- both anat, physio entity (narrowing, high pressure)
Lower- only physio 8-25 mm hg

Question 11

How does the LES act when food enters the esophagus ?

Answer 11

Les is tonic, relaxes when food enters and contracts again.

Question 12

What happens les relaxes frequently or fails to relax?

Answer 12

Relaxes too frequently- GERD
Fails to relax- achalasia cardia

Question 13

Which layer does the esophagus lack? Which is the strongest layer?

Answer 13

Serosa , submucosa

Question 14

Types of peristalsis in esophagus

Answer 14

Primary- propulsive wave pushes food down
Secondary- if primary can’t push, propulsive secondary peristaltic wave formed
Tertiary- non propulsive, in between meals.

Question 15

Condition where tertiary peristalsis is too frequent

Answer 15

Presbyoesophagus

Question 16

Types of TEF

Answer 16

5- a,b,c,d,e

Question 17

MC and LC tef

Answer 17

Mc- type C, LC- type D

Question 18

Case- newborn presents with dribbling of saliva, respiratory distress, on inserting an orogastric tube, it coils. Diagnosis? IOC? Confirmatory test?

Answer 18

TEF. IOC- for H type- combined tracheo esophagoscopy.
Confirmed by contrast study- iohexol > dinosil> barium

Question 19

DD for congenital anomalies

Answer 19

VACTERL
V- Vertebral defects
A- anorectal malformations
C- cardiac defects
TE- TEF
R- Renal genesis
L- Limb defects

Question 20

Which criteria is used for TEF management?

Answer 20

Watersons criteria-
Birth weight and presence of pneumonia

Question 21

Surgery done done TEF

Answer 21

Posterolateral thoracotomy

Question 22

Surgery done for TEF types b,c,d,e

Answer 22

Cameron haight surgery
Cut fistula- repair trachea- anastomose esophagus

Question 23

How do u manage type A TEF ?

Answer 23

Flourish device, anastomosis

Question 24

What’s the most important factor in maintaining LES tone in preventing reflux? Other factors?

Answer 24

Length of intrabdominal esophagus 3-5 cm
Others- angle of His, pinching effect of right crura, arrangement of gastric folds

Question 25

Length- when gerd develops ?

Answer 25

<2cm and pressure< 6 mm hg. Increased TLOSR

Question 26

GERD IOC and gold standard

Answer 26

IOC- endoscopy, gold standard- 24 hr ph monitoring

Question 27

Which score suggests GERD after ph monitoring?
Any wireless method to do this?

Answer 27

Demeester score of >14.7 .
Bravo 24

Question 28

What are the indications for surgery in GERD?

Answer 28

Fails medical therapy.
Complications like Barrett! Cancer, stricture
Associated with hiatal hernia

Question 29

Surgery done in GERD?

Answer 29

Fundoplication. Shoe sign manoeuver.

Question 30

Types of wraps in fundoplication

Answer 30

Partial - Dor, Toupet, Belsey mark
Complete- Nissen