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Written Boards > Esophagus > Flashcards

Esophagus Flashcards

1
Q

MCC of dysphagia and first line treatment?

A

Benign strictures, serial dilations

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2
Q

hiatal hernia ulcer? Mechanism

A

Cameron ulcer, constant movement

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3
Q

Child drinks drain cleaner and p/w drooling/vomiting but otherwise stable…. what next?

A

PO challenge

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4
Q

Benefit of hiatal mesh? what type is preferred? What if hiatus will no close with simple repair?

A

short term recurrence
absorbable
bridging mesh with NA

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5
Q

First line for hiatal hernia evaluation/imaging?

A

Upper GI

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6
Q

GS for esophageal loco-regional staging?

A

PET-CT chest

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7
Q

Diet for Nissen post op

A

1-2 weeks liquid diet to avoid worsening edema

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8
Q

Which operation for Right mid esophagus perforation with large defect, sick patient

A

R PLat thoracotomy, spit fistula, esophagectomy

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9
Q

Size for endoscopic zenkers tx?

A

> 3cm

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10
Q

Structural cause of zenkers?

A

cricopharyngeus

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11
Q

Key step in zenker’s surgery

A

myotomy

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11
Q

Barrier to endoscopic zenkers tx?

A

rigid neck, small sack

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11
Q

treatment of peptic esoph stricture?

A

dilation

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12
Q

Triad for gastric volvulus

A

Borchardt triad (severe epigastric pain, inability to vomit, and inability to pass a nasogastric tube)

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12
Q

Tx for met esophageal ca, chemo reg? Notable receptor target?

A

palliative – needs med onc, FOLFOX/ cisplatin/5fu or nivolumab
PDL-1

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13
Q

high grad dysplasia for esoph with short segment … tx?

A

EMR

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14
Q

low grade dysplasia on EGD, what next

A

6 month surveillance

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15
Q

demeester score indicating surgery appropriateness

A

14.7

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16
Q

Percent of population with GERD

A

20%

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17
Q

4 big causes of GERD

A

Diet/obesity, Scleroderma, lung path, hiatal hernia

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18
Q

4 dg studies for GERD s/s

A

manometry, Egd, motility, impedence, pHstudies

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19
Q

3 measures of a weak LES

A

P<6mmHg, 2cm length, abd length 1 cm

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20
Q

MC esoph dysmotility disorder

A

Achalasia

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21
Q

2 usual achalasia findings on manometry

A

no LES relaxation and absent esoph peristalsis

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22
Q

GS for achalasia surg tx

A

myotomy

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22
Q

med tx for DES

A

nitrates, sildenafil, tricylcics

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22
Q

Gold standard for esophageal leaks

A

gastrograffin and barium if negative initially

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22
Q

Nutcracker med tx?

A

nitrates, sildenafil, tricylcics

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22
Q

4 landmarks for EGD path start to finish

A

Vocal cords/aryepiglottic folds, UES(crichopharyngeal m), Aortic Arch(skeletal to smooth muscle), Squamocolumnar junction(LES)

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22
Q

4 steps of GERD workup

A

1 - Acid Test(demeester)
2 - Manometry
3- Esophagram
4 - EGD(can be same day as surgery

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23
Q

GS for esoph dysmotility?

A

manometry

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24
Q

5 risk factors for GERD

A

Obesity, pregnancy, conn tiss disorders, hiatal hernia, DGE

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25
Q

GS start for GERD testing

A

acid test + impedence

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26
Q

6 PPI side effects

A

HypoMg, osteoporosis, hypergastrinemia, AIN, B12 deficiency, Lupus

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27
Q

4 surgical goals of anti-reflux procedure

A

1 - Reduce hernia
2- Tension free intra-abd
3 - Approx crura
4 - Fundo

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28
Q

Medical steps before fundo after confirmed GERD

A

diet, double ppi

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29
Q

6 GERD surgical indication

A

Failed BID
GERD complications
Preference
Cx of PPI
Lung Tx patients
Atypical pH proven(14.7)

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30
Q

Structural elements predisposing GERD? Inciting disease?

A

Hiatal hernia; scleroderma

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31
Q

4 studies for GERD preop

A

manometry, EGD, impedence, motility

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32
Q

3 objective measures of a defective LES predisposing to GERD

A

P<6; length<2cm; abdominal length>2cm

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33
Q

What is the most common esoph dysmotility disorder? 2 big dg tests and their findings

A

Achalasia
Manometry: poor LES relaxation with absent peristalsis
Esophogram: Bird’s Beak

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34
Q

Pseudoachalasia?

A

Tumor

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35
Q

MOA achalasia

A

dec inhib ganglion cells of LES

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36
Q

How is HTN LES diif than achalasia

A

Inc LES P but it does relax normally

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37
Q

DES treatment? med vs surgery

A

Nitrates, Tricyclics, Sildenafil

Long myotomy

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38
Q

Nutcracker tx?

A

Same as DES

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39
Q

Gold standard for esophageal leaks

A

Esophogram

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40
Q

3 components of the LES complex

A

esoph muscle
phrenoesophligament
Diaphragm

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41
Q

4 landmarks on the path of your EGD esoph approach

A

vocal cords and aryepiglottic folds
UES(cricopahryng m)
Aortic Arch(skeletal to smooth)
Squamocolumnar junction(LES)

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42
Q

GS test for esoph motility

A

manometry

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43
Q

5 indications for manometry

A

Dysphagia after EGD
Non cardiac chest pain
preop
postop
Dg motil dis

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44
Q

Demeester cutoff for GERD

A

14.72 (95%)

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45
Q

4 tests for GERD wu

A

acid(demeester)
Manometry
Esophogram
EGD

46
Q

Impedence test is looking for….

A

bile reflux

47
Q

5 alarm signs of GERD

A

WL
hematemesis
Dysphagia
Melena
Early satiety

48
Q

starting point for classic GERD signs

49
Q

6 side effects of PPI

A

Hypomg
Osteo
AIN
Lupus
B12 defic
Hypergastinemia

50
Q

After suspicion of GERD, what do you start on

if that fails

if confirmed GERD

A

PPI

Workup

Double PPI

51
Q

6 indication for GERD surgery

A

Failed medical
pt pref
Gerd med compl issues
PPI cx
Lung tx pt

52
Q

If there is dysplasia but ready for anti-reflux surgery

A

ablation first

53
Q

4 tenets to a successful anti-reflux procedure

A

Reduce hernia
Tension free intra abdominal esoph
Approx crura
Fundo

54
Q

When to avoid full fundo

A

dysmotility

55
Q

Post op care for fundo pts

A

Limit narcs
Anti emetics
Barium esoph in am
Advance diet after, soft for 6 weeks
Stop PPI
crush meds

56
Q

2 common post fundo complaints post op

A

dysphagia

Gas bloat syndrome

57
Q

path finding for barrets

A

columnar lined esoph, intestinal dysplasia, goblet cells

58
Q

Major cause of barrets

59
Q

What can we do for prevention of worsening barrets + GERD

A

anti reflux med v surgery

60
Q

Tx for LGD Barrett’s, surveillance time

If it works

If it persists

A

PPI, diet 6 months

PPI

ARS

61
Q

Non dysplastic barrets surveillance timing

A

yearly then 3 to 5

62
Q

What is the relationship of HGD, T1a and T1b from a management standpoint

A

HGD/T1a adeno —- ablation/ER/PPI plus minus ARS

T1b submuc — esophagectomy

63
Q

what type of esoph cancer can get ESD

A

Squamous only

64
Q

1 yr risks for barrets

ND
LGD
HGD

What trial set these stats

A

0.2
0.7
7

AIM Dysplasia

65
Q

EGD screening guidelines

A

> 5y GERD symptoms

2 or more of these:
-white male
-50
-central obestiy
-smoker
-1st degree relative

66
Q

4 reasons for pt to get esophagectomy for HGD/
t1a

A

high risk for mets, young, fam hx, long lesions

67
Q

Ablation success percents for HGD/t1a esoph ca

A

RFA
AIM dysphagia trial
81v19
90%remission at 3
low stricture rate

68
Q

% nodal mets estimated for a T1b

esophagectomy 30d mortality in these patients

69
Q

3 PEsoph types

A

1 - sliding
2 - true
3 - mixed

70
Q

2 indications for PE hernia repair

3 investigation tools

A

ALL symptomatics

consider young incidentals

CT/esoph
manometry
EGD

71
Q

5 principles of PE repair

A
  1. Reduce
  2. Excise Sac
  3. REduce GEJ
    4.2-3cm tension free intra abdominal esoph
    5.Repair defect
72
Q

port placement for lap PE hernia repair

73
Q

POD1 for PEH repair

Next diet progression day and what duration

A

UGIS, clears 72h

Soft 1 week

74
Q

What mesh to use if can’t close PEH?

75
Q

MC type of esoph diverticulum

What type is it

A

Zenker’s

False

76
Q

Pathophys for zenker’s

A

poor UES relaxation

77
Q

4 big s/s for zenkers

A

halitosis, regurg, cough, dysphagia

78
Q

4 steps to zenkers open diverticulectomy

What size sacs are these best for

A

1L cervical incsion
2 - Platysma, SCM and carotid sheath lateral
3 - diverticulectomy, stapler vs pexy
4 - myotomy no matter what!!!

less than 3 cm

79
Q

endo parameters for zenkers

A

more than 3 cm

ANVIL must fit

80
Q

2 muscles that make up killians triangle

A

pharyngeal cx m and cricopharyngeus m

81
Q

MC dymotility disorder esoph

82
Q

Theoretical MOA for achalasia

A

infection–> loss of post ganglion inhib cells

83
Q

6 ddx for achalasia

A

gerd, malignancy, webs, esophagitis, strictures, systemic tissue disroders

84
Q

who gets medical management for achalasia and what is its

A

poor surgical candidates

Nitrates — isosorbide
CCBs —-nifedipine
Sildenafil(PE5 inhibit)

Botox

85
Q

3 endoscopic treatments for achalasia

A

botox

dilation

poem

86
Q

Pneumatic dilation of achalasia gerd, relief and relapse rates

A

30%

60-90

33%

87
Q

4 heller complications

A

Leak
GERD
Dysphagia
PTX

88
Q

6th leading cause of cancer deaths

89
Q

MC global esoph cancer

risk factors

A

SCC

Smoking, ETOH, achalasia, caustics

90
Q

Where is esoph adenoCA mc?

risk factors

A

N america and W europe

FAT, WHITE,MALES
advanced age

TYLOSIS —thickened palms

91
Q

2 Late signs of esoph ca and their pathophys

Why are they so late????

A

Dysphagia —2/3 luminal blockage mass effect

Hoarseness/hiccups —- R laryngeal n and phrenic n

92
Q

What is the Seattle Protocol

A

4 quad bx every 1 cm for esoph

93
Q

how is esoph cancer caught early

A

GERD/barretts surveillance

94
Q

4 parts of a full work up for esoph cancer

A

BX during egd
PET CT
EUS
Barium

95
Q

Where do the paths split on t staging and tx in esoph cancer

A

T1a to T1b

mucosal to submucosal

EMR to surgery

96
Q

Diff between T4a and b for esoph

A

a is take outable organs

pleura, pericardium, diaphragm

97
Q

treatment of HGD for esoph

98
Q

What is the next move for T2-T4a esoph cancer

what trial supports this

results?

A

Chemo plus surgery

CROSS

49 vs 24 m
inc R 0 resection

99
Q

regimen for CROSS trial

A

carpiplatin and paclitaxel + rads 5 weeks

100
Q

3 esophagectomies and their incision sites

A

McKeown all

Ivor - chest and abd

Trans Hiatal - neck and abdomen

101
Q

what anatomical branching point does rouviers sulcus indicate

The entrance of what structure into the liver forms this sulcus?

A

bifurcation of the of main hepatic bile duct

right hepatic duct

102
Q

muscle layers of esoph

A

outer - long
inner - circular

103
Q

Upper GI tumors are 2nd only to ___

A

lung cancer

104
Q

Combination of these two invest tools give the best sensitivity for esoph cance staging

A

EUS PET CT

105
Q

What is the timing for esoph cancer surgery after preadjuvant chemo? why? data?

A

6 weeks
less inflam, inctumor regression
no good data

106
Q

3 oncogenes for esoph ca

A

NOTCH1
HER2
VEGF

107
Q

2 main indications for esoph stents

what type

A

Malignancy and fistulas

SEMS

108
Q

esophageal perforation success rate with stents

109
Q

What contrast do we use first for esoph perforation eval

A

GG over barium, less mediastinitis risk

110
Q

Mortality rate of esoph perf

111
Q

what are the causes by percent breakdown
60%
30%
5%

A

Endoscop

Borrhav

Malign/trauma/FB

112
Q

What is a normal LES pressure. What is high

113
Q

Unknown ingestions should be assessed urgently with ….

114
Q

What is the strongest prognostic factor for esophageal CA

A

Number of regional nodes involved

115
Q

5y met esoph adenoca survival rate

116
Q

magnetic sphincter augmentation:
comparison to nissen
how often does erosion occur and what is management
Important post operative tenet

A

nearly equivalent
RARE, removal
eat solid food to prevent capsule formation

117
Q

first line for scleroderma ind atonic esophagus

A

ppi

then toupet NOT nissen

118
Q

What stations are important in esoph ca LN harvest

A

celiac, IPL, lower esoph, crural

119
Q

most important artery for esophagectomy conduit

A

right gastro epiploic

120
Q

What medication can be given for symptomatic improvement in patients undergoing serial dilations for benign stricure

A

Mitomycin C

121
Q

what is the choice for bridging mesh repair for large hiatal defects

122
Q

What percent of distal pancs become T1DM

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