Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BTK Review 2023 > Esophagus > Flashcards

Esophagus Flashcards

1
Q

What are the layers of the esophagus?

A
  • mucosa
  • submucosa
  • muscularis propia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the blood supply to the esophagus?

A
  • inferior thyroid artery to the cervical esophagus
  • vessels off the aorta to the thoracic esophagus
  • left gastric and inferior phrenic arteries to the abdominal esophagus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What muscle forms the upper esophageal sphincter? What is it innervated by?

A

the cricopharyngeus innervated by the superior laryngeal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Killian’s triangle?

A
  • an area in the wall of the pharynx which is a potential weak spot where a Zenker’s can form
  • superior to the cricopharynxgeus muscle and inferior to the inferior constrictor muscles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where do Zenker’s diverticulum form?

A

in Killian’s triangle, above the cricopharyngeus and below the inferior constrictor muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What features on a CXR would support a diagnosis of esophageal perforation?

A
  • pneumomediastinum
  • pleural effusion
  • subcutaneous emphysema
  • pneumothorax
  • sub diaphragmatic air
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the study of choice to diagnose an esophageal perforation?

A

gastrografin (water soluble) swallow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When should you use gastrografin versus dilute barium?

A
  • gastrografin should generally used first to diagnose a leak because it is less likely to cause problems after extravasation
  • dilute barium can be used because it has higher sensitivity or in patients at high risk of aspiration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the most common site of an esophageal perforation? What about the most common site of iatrogenic perf?

A
  • most common: distal esophagus in the left posterolateral aspect 2-3 cm above the GEJ
  • iatrogenic: at the cricopharyngeus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where is the most common site of iatrogenic esophageal perforation?

A

at the cricopharyngeus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How should a cervical esophageal perforation be managed?

A
  • IVF resuscitation
  • broad spectrum abx (ampicillin, ceftriaxone, flagyl, and fluc)
  • wide local drainage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How should thoracic esophageal perforations be managed in a stable patient?

A
  • IVF resuscitation
  • broad spectrum abx (ampicillin, ceftriaxone, flagyl, fluc)
  • primary repair (left thoracotomy, debride, myotomy to visualize whole mucosal injury, two layer repair with absorbable and permanent suture, buttress, leak test, NGT, mediastinal drain, enteral access, closure)
  • consider esophagectomy depending on etiology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which patients should have an esophagectomy for perforation?

A

those with malignancy, caustic perforation, or burned out megaesophagus from achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How should thoracic esophageal perforation be managed in an unstable patient?

A

exclusion and diversion
- closure of perforation over a T-tube
- mediastinal drainage
- cervical esophagostomy
- J-tube placement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What defines achalasia?

A

incomplete relaxation of the LES with peristalsis or hypotonic esophageal contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the three types of achalasia?

A
  • type I: normal esophageal pressure with apersitalsis and impaired LES relaxation
  • type II: increased intraesophageal pressure, absent peristalsis, impaired LES relaxation
  • type III: distal esophageal spastic contractions, absent peristalsis, impaired LES relaxation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Bird’s beak is used to describe what esophageal pathology?

A

achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the etiology of achalasia?

A

degenerative loss of NO-producing inhibiting neurons within the LES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is pseudoachalasia?

A

achalasia caused by malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the treatment for achalasia?

A
  • lap Heller myotomy with partial fundoplication (6cm onto esophagus, 2cm onto stomach)
  • endoscopic therapies increase the rate of surgical complications in subse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the treatment for achalasia?

A
  • lap Heller myotomy with partial fundoplication (6cm onto esophagus, 2cm onto stomach)
  • endoscopic therapies increase the rate of surgical complications in subsequent interventions and are thus avoided in healthy patients that can undergo surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

If a patient with achalasia is undergoing balloon dilation and a perforation is caused, what is the next step?

A

repair with myotomy at the same time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is isolated hypertensive LES?

A

high basal LES with complete relaxation and normal peristalsis

24
Q

How is isolated hypertensive LES treated?

A
  • calcium channel blockers
  • nitrates
  • heller
25
Q

What is the difference between diffuse esophageal spasm and nutcracker esophagus?

A

diffuse esophageal spasm is characterized by uncoordinated contractions while nutcracker is characterized by coordinated ones

26
Q

How are diffuse esophageal spasm and nutcracker esophagus treated?

A
  • calcium channel blockers
  • nitrates
  • long-segment heller
27
Q

How are Zenker’s diverticuli managed?

A
  • less than 3cm: open mytoomy via left neck with or without diverticulectomy (resection or suspension)
  • more than 3cm: endoscopic division of cricopharyngeus
28
Q

What is an epiphrenic esophageal diverticulum and how is it managed?-

A
  • a type of pulsion diverticulum associated with esophageal dysmotility
  • treated with diverticulectomy and treatment of the dysmotility, usually with heller
29
Q

How is a mid-esophageal diverticulum treated?

A

VATS diverticulectomy and myotomy if symptomatic

30
Q

What is unique about a mid-esophageal diverticulum?

A
  • a traction (true) diverticulum
  • usually associated with a lead point/inflammatory condition
  • treated with diverticulectomy if symtpomatic
31
Q

What is Barrett’s esophagus?

A

a metaplasia of the lower esophagus from squamous to columnar epithelium

32
Q

What is the recommended surveillance for Barrett’s esophagus?

A
  • annual EGD with four quadrant biopsies every 1-2 cm
  • repeat immediately if high-grade dysplasia is found
  • repeat in 6 months if low-grade dysplasia is found
  • can go to every three years after two years without dysplasia
33
Q

How is high-grade dysplasia treated in those undergoing Barrett’s esophagus?

A
  • first step is to repeat EGD with biopsies to confirm
  • second step is endoscopic mucosal resection
34
Q

What are the risk factors for adenocarcinoma and SCC of the esophagus?

A
  • adenocarcinoma: male, western country, obesity, GERD, Barrett’s
  • SCC: male, eastern country, alcohol, smoking
35
Q

How is esophageal cancer worked up and staged?

A
  • H&P with standard labs
  • endoscopy with biopsy
  • add bronchoscopy if above the carina
  • CT chest/abdomen
  • PET
  • EUS of suspicious nodes
36
Q

How is esophageal cancer staged?

A
  • T1a: invades lamina propria or muscularis mucosa-
  • T1b: invades the submucosa
  • T2: invades muscularis mucosa
  • T3: invades adventitia
  • T4: invades surrounding structures
  • N1: involves 1-2 nodes
  • N2: involves 3-6 nodes
  • N3: involves >7 nodes
37
Q

How does the location of an esophageal cancer change management?

A

those less than 5cm from the cricopharyngeus are considered unresectable and thus receive definitive chemoradiation

38
Q

Which esophageal cancers are candidates for endoscopic resection and ablation?

A

high grade dysplasia, Tis, and T1a tumors less than 2 cm that are well-to-moderately differentiated

39
Q

Which esophageal cancer patients get neoadjuvant chemoradiation?

A

those with a T2 lesion or any nodal disease

40
Q

What makes esophageal cancer unresectable?

A

distant mets or invasion of aorta/vertebrae/trachea

41
Q

What structures can esophageal cancers invade while remaining resectable?

A
  • pericardium
  • pleura
  • diaphragm
42
Q

Neoadjuvant chemotherapy for esophageal cancer is based on what agents?

A

fluorouracil or taxanes

43
Q

Which esophageal cancers get upfront esophagectomy?

A

T1b lesions without nodal disease

44
Q

What is an Ivor-lewis esophagectomy?

A
  • laparotomy and right thoracotomy with upper thoracic esophagogastric anastomosis
  • good for distal tumors
45
Q

What is a McKeown esophagectomy?

A
  • similar to Ivor lewis (laparotomy and right thoracotomy) but with cervical anastomosis
46
Q

What is a transhiatal esophagectomy?

A
  • laparotomy with left cervical incision and cervical anastomosis
  • cervical leaks are better tolerated and avoids thoracotomy
  • but limits lymph node harvest and difficult to mobilize large, mid-thoracic tumors
  • equal long-term survival
47
Q

Which is better tolerated, a thoracic or cervical esophageal leak?

A

cervical

48
Q

If a gastric conduit is not available for esophageal reconstruction, what is the next best option?

A

a colon interposition conduit

49
Q

What does the gastric conduit survive on for blood supply in an esophagectomy?

A

the right gastroepiploic

50
Q

Who gets adjuvant therapy for esophageal cancer?

A

everyone except those with SCC and those with T1N0 adenocarcinoma that had an R0 resection

51
Q

What is Fanconi anemia?

A

a combination of SCC of the head/neck/esophagus and pancytopenia

52
Q

What is the most common benign tumor of the esophagus?

A

a leiomyoma

53
Q

How are esophageal leiomyomas managed?

A
  • enucleation for those that are symptomatic or larger than 5cm
  • do not biopsy these as it makes resection more difficult
54
Q

Patient with long-standing GERD now has dysphagia and a narrowed ring of mucosa just above the GEJ on endoscopy.

A
  • has a schatzki ring
  • treat with dilatation and PPI
55
Q

How is the esophagus approached based on the level?

A
  • cervical: left
  • mid-thoracic: right
  • low thoracic: left

BTK Review 2023 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions