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COMAT - Surgery > Esophagus > Flashcards

Esophagus Flashcards

1
Q

Zenker’s Diverticulum - true or false diverticulum? Why?

A

False
- mucosa and submucosa herniate through the muscularis externa!

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2
Q

What muscles pull the Zenker’s Diverticulum down and are beneath where it rests?

A

Cricopharyngeal muscles

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3
Q

What are 4 symptoms of Zenker’s Diverticulum?

A
  • Choking
  • Trouble swallowing
  • Regurgitation of UNdigested food
  • Halitosis
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4
Q

What are 4 symptoms of Zenker’s Diverticulum?

A
  • Choking
  • Trouble swallowing
  • Regurgitation of UNdigested food
  • Halitosis
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5
Q

What is the diagnostic measure for Zenker’s Diverticulum?

A

Barium Swallow

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6
Q

Treatment for Zenker’s Diverticulum?

A

Surgery to remove the diverticulum

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7
Q

What causes Achalasia?

A

Loss of the myenteric plexus

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8
Q

What occurs with Achalasia?

A

Loss of myenteric plexus
–> LES unable to relax
–> Absent peristalsis

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9
Q

If the LES is tight and unable to relax with absent peristalsis, what is the likely diagnosis?

A

Achalasia

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10
Q

What is a main symptom of Achalasia and where anatomically?

A

Retrosternal Dysphagia at the LES

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11
Q

Achalasia presents with retrosternal dysphagia that is progressive how?

A

Liquids FIRST!! –> Then solids

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12
Q

What is the diagnostic measure for Achalasia and what will be seen?

A

Barium swallow
= Bird’s beak (narrow LES, dilated esophagus)

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13
Q

What is the treatment for Achalasia?

A

Heller Myotomy

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14
Q

What is a possible complication when treating Achalasia with a Heller Myotomy?

A

Loosening the LES too much = GERD

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15
Q

A superficial laceration in the esophagus is commonly called?

A

Mallory Weis tear

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16
Q

What usually causes a superficial laceration?

A

Forceful vomiting

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17
Q

What is the sign of a superficial laceration?

A

Self-limiting hematemesis

18
Q

If a person is still vomiting blood following a mallory weis tear, what do you do? If it has resolved?

A

Still vomiting blood –> EGD
If not –> supportive measures

19
Q

A transmural laceration/perforation of the esophagus is commonly called?

A

Boerhaave’s Esophagus

20
Q

What 2 things commonly cause a transmural laceration?

A
  • Iatrogenic injury
  • Prolonged wretching
21
Q

What are 4 possible signs of a transmural laceration?

A
  • Chest pain
  • Pneumomediastinum
  • SubQ air
  • Crunchy heart sounds (Hamman’s Sign)
22
Q

What are 4 possible signs of a Boerhaave’s transmural tear?

A
  • Chest pain
  • Pneumomediastinum
  • SubQ air
  • Hamman’s Sign (crunchy heart sounds)
23
Q

What are 2 ways to diagnose a transmural laceration?

A
  1. Gastrograffin water soluble swallow study
  2. CT with ORAL contrast
24
Q

What are 2 ways to diagnose a transmural laceration?

A
  1. Gastrograffin water soluble swallow study
  2. CT with ORAL contrast
25
Q

If a transmural laceration is contained, what is the treatment? If not?

A

Contained = Endoluminal stent
If not = Surgery

26
Q

What is GERD?

A

Reflux of acid into the esophagus due to a hiatal hernia or a weakened LES

27
Q

List some symptoms of GERD?

A
  • Burning chest pain
  • Metallic taste in the mouth
  • Regurgitation of partially digested food
  • Symptoms worse with spicy foods/lying down
  • Cough/nocturnal asthma
28
Q

Initial treatment for GERD?

A

Lifestyle/meal changes + PPI

29
Q

What is a possible surgical fix for GERD?

A

Fundoplication = wrapping stomach around LES to tighten it

30
Q

What study is needed before a Fundopolication can be done?

A

24 hour esophageal pH monitoring

31
Q

If GERD goes untreated what can develop?

A

Barrett’s Esophagus

32
Q

What is Barrett’s Esophagus?

A

Stratified squamous –> Simple Columnar

33
Q

If Barrett’s esophagus occurs, what can then develop?

A

Esophageal Adenocarcinoma

34
Q

Where does Esophageal Adenocarcinoma occur?

A

LOWER 1/3

35
Q

If a cancer is in the lower 1/3 of the esophagus, what type is it?

A

Adenocarcinoma

36
Q

What are a few risk factors for Esophageal Squamous Cell Carcinoma?

A
  • HPV
  • Smoking
  • Poverty
  • Hot liquids
37
Q

Where does Esophageal Squamous Cell Carcinoma occur?

A

UPPER 1/3

38
Q

If a cancer is in the upper 1/3 of the esophagus, what type is it?

A

Squamous Cell Carcinoma

39
Q

What is the shared presentation with Esophageal cancers?

A

Progressive dysphagia (solids –> liquids)

40
Q

How are Esophageal cancers diagnosed?

A

Barium swallow
–> EGD with biopsy

COMAT - Surgery (13 decks)

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