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SURGERY > Esophagus > Flashcards

Esophagus Flashcards

1
Q

Spinal level of the Esophagus

A

C6 (Cricoid) - T11 (Cardia of stomach)

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2
Q

3 Regions of the Esophagus

A

Cervical (C6 to T1-2)
Thoracic
Abdominal

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3
Q

Arterial and Venous Supply of Cervical Esophagus

A

Inferior Thyroid artery

Inferior Thyroid vein

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4
Q

Arterial and Venous Supply of Thoracic Esophagus

A

Bronchial arteries

Bronchial veins + Azygous vein + Hemiazygous vein

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5
Q

Arterial and Venous Supply of Abdominal Esophagus

A

Left gastric artery + Inferior phrenic artery

Coronary vein

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6
Q

3 Normal areas of Narrowing of the Esophagus

A

Cricopharyngeus (C6)

Left mainstem bronchus (T4)

Lower Esophageal Sphincter (T11)

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7
Q

1st Diagnostic test in patients with suspected esophageal disease (detects structural abnormalities)

A

Barium swallow

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8
Q

Additional diagnostic for patients complaining of Dysphagia after normal radiography

A

Endoscopic evaluation

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9
Q

Test to detect functional abnormalities (motor, dysphagia, odynophagia, noncardiac chest pain) after normal results on Barium swallow and Endoscopy

A

Manometry

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10
Q

Gold standard Diagnostic test for GERD (detects increased exposure to gastric acid)

A

24 hour ambulatory pH monitoring

Sensitivity and Specificity of 96%

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11
Q

[GERD]

Normal resting pressure of LES

A

6-26 mmHg

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12
Q

[GERD]

Normal length of LES

A

3-5cm

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13
Q

[GERD]

Normal intra-abdominal length of LES

A

2-4cm

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14
Q

Defective Lower Esophageal Sphincter measurements

A

Total length <2cm

Intra-abdominal length < 1cm

Resting pressure < 6mmHg

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15
Q

Hallmark finding of Intestinal Metaplasia

A

Intestinal goblet cells

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16
Q

Indications for Anti-reflux surgery for GERD

A
  • Symptomatic patients w or w/o esophagitis
  • Structurally defective LES
  • Young patients with documented reflux
  • Severe esophagitis
  • Presence of stricture
  • Uncomplicated Barrett esophagus
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17
Q

Most common antireflux surgical procedure

A

Nissen fundoplication

(360º fundoplication around the lower esophagus)

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18
Q

Complications/ Adverse effects of Nissen Fundoplication

A

Dysphagia, Flatulence, Inability to belch, Stricture

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19
Q

Alternative to Nissen Fundoplication that seeks to avoid adverse effects

A

Toupet Fundoplication

(180º posterior fundoplication)

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20
Q

180º Anterior fundoplication

A

Dor Fundoplication

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21
Q

Anti-Reflux surgery wherein the Arcuate ligament is repaired to close the esophageal hiatus + gastropexy to the diaphragm

A

Hill Posterior Gastropexy

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22
Q

Type 1 Diaphragmatic (Hiatal) Hernia

A

Sliding Hernia

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23
Q

Type 2 Diaphragmatic (Hiatal) Hernia

A

Rolling/Paraesophageal hernia

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24
Q

Type 3 Diaphragmatic (Hiatal) Hernia

A

Combined Hernia

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25
Q

Type 4 Diaphragmatic (Hiatal) Hernia

A

Involves another organ apart from the stomach herniated into the thorax

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26
Q

Borchard Triad of Hiatal Hernia (Incarcerated intrathoracic stomach)

A

1) Chest pain
2) Retching with inability to vomit
3) Inability to pass a nasogastric tube

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27
Q

Diagnostic test of choice for Paraesophageal hernia (Type II)

A

Upper GI Barium swallow

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28
Q

Finding of a separate orifice adjacent to the GEJ on Flex Endoscopy

A

Type II PEH

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29
Q

Finding of a Gastric pouch extending above the crural impression on Flex Endoscopy

A

Type I Sliding hernia

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30
Q

Treatment for Type I Sliding hernia (Medical or surgical)

A

Medical

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31
Q

Treatment for Type II Paraesophageal hernia (Medical or surgical)

A

Surgery

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32
Q

CXR findings for Hiatal Hernia

A

Air fluid level behind the cardia of the heart on Lateral view

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33
Q

3 Classifications of Esophageal Diverticula

A

1) Pharyngoesophageal (Zenker)

2) Mid Thoracic (Para bronchial

3) Epiphrenic

34
Q

Area of potential weakness situated behind the Esophagus at the level of the Cricopharyngeus muscle

A

Killian’s triangle

35
Q

Zenker Diverticula occurs due to high pressure generated in the ___________

A

Hypophrynx

36
Q

Surgical treatment for Zenker Diverticulum that is ≤ 2cm

A

Pharyngomyotomy

37
Q

Surgical treatment for Zenker Diverticulum that is > 2cm

A

Diverticulectomy/ Diverticulopexy

38
Q

Surgical treatment for Zenker Diverticulum that is wide-based

A

Diverticulopexy

39
Q

Mid Thoracic diverticula are found __cm above and below the level of the carina

A

5 cm

40
Q

Mid Thoracic Diverticula are classified as either _______ or _______ Diverticula

A

Traction; Pulsion

41
Q

More common classification of Mid Thoracic Diverticula that is results from diffuse motility disorders of the esophagus

A

Pulsion Diverticula

42
Q

Classification of Mid thoracic diverticula that results from granulomatous diseases (TB, Histoplasmosis)

A

Traction Diverticula

43
Q

Treatment of Mid thoracic diverticula

Traction:________; Pulsion: ________

A

Medical management; Surgical management

44
Q

Esophageal Diverticula found at the distal 10cm of Esophagus

A

Epiphrenic diverticula

45
Q

Epiphrenic diverticula is a form of ________ diverticula

A

Pulsion

46
Q

Surgical management of Epiphrenic diverticula (reserved for symptomatic cases)

A

Esophagomy + Diverticulectomy/Diverticulopexy + Partial fundoplication

47
Q

Triad of Achalasia

A

1) Hypertensive LES (>26mmhg)
2) Aperistalsis of Esophageal body
3) Failure of LES to relax

48
Q

Surgical management of Achalasia

A

Heller Myotomy + Partial Fundoplication

49
Q

Non-surgical management of Achalasia

A

Medical: Ca channel blockers, Nitrates, Botulinum toxin

Procedural:
1) Pneumatic dilatation (most effective non-surgical; risk of preforation)
2) POEM (Per Orem Endoscopic Myotomy)

50
Q

Esophagogram showing corkscrew deformity

A

Diffuse and Segmental Esophageal Spasm

51
Q

Most common primary esophageal motility disorder

A

Nutcracker Esophagus

52
Q

Syndrome involving rupture of the esophagus due to forceful emesis

A

Boerhaave syndrome

53
Q

Phases of Caustic Injury

A

1) Acute Necrotic Phase
2) Ulceration and Granulation
3) Cicatrization and Scarring

54
Q

Endoscopic classification system for Caustic Injuries to the Esophagus

A

Zargar Classification

55
Q

Zargar’s Classification Grading

A

1) Mucosa (edema and erythema)
2) Submucosa (A - superficial, B - deep/circumferential)
3) Transmural + Necrosis (A - focal, B - diffuse)
4) Perforation

56
Q

Most common type of Esophageal carcinoma worldwide

A

Squamous cell carcinoma

57
Q

Esophageal carcinoma found in more developed countries

A

Adenocarcinoma

58
Q

Usual Location of Adenocarcinoma

A

Distal Esophagus

59
Q

Usual location of Squamous cell carcinoma

A

Middle third of Thoracic Esophagus

60
Q

Precursor lesion of Squamous cell carcinoma

A

Intraepithelial/ Intramucosal/ Submucosal plaques

61
Q

Precursor lesion of Adenocarcinoma

A

Barrett Metaplasia

62
Q

Triad of Plummer Vinson Syndrome (Increases risk for Squamous cell carcinoma of Esophagus)

A

1) Dysphagia
2) Iron-deficiency anemia
3) Esophageal webs

63
Q

Initial Diagnostic Evaluation of Esophageal Carcinoma

A

1) Endoscopy with Biopsy
2) Barium swallow

64
Q

Metastatic Workup of Esophageal Carcinoma

A

1) CT of Chest and Abdomen (lung/liver mets)
2) Endoscopic ultrasound (better T&N Staging)
3) Thoracoscopy and Laparoscopy

65
Q

Management for Stage I-III of Esophageal Carcinoma

A

Surgical Esophagectomy

Neoadjuvant chemoradiation (some cases)

66
Q

Management for Stage IV of Esophageal Carcinoma

A

Unresectable
- ECOG ≤ 2: Chemo and palliative care
- ECOG > 2: Palliative care

67
Q

Contraindications for Curative surgery of Esophageal Carcinoma

A

1) Age > 75 y/o
2) FEV1 < 1.25, EF < 40%
3) > 20% Weight loss
4) Locally advanced tumor (Horner syndrome, RLN paralysis, Paralysis of diaphragm, Length > 9cms, > 4LN)
5) Distant metastases

68
Q

Surgical approach for cancers limited to the intramucosal layer

A

Vagal-sparing esophagectomy

69
Q

Surgical approach involving formation of a gastric conduit via upper midline laparotomy and left cervical incision (neck)

A

Transhiatal (Orringer and Sloan)

70
Q

Surgical approach involving anastomosis between distal end of esophagus and cardia of stomach

A

Transthoracic (Ivor-Lewis)

71
Q

Surgical approach involving opening of the abdomen and diaphragm to enter chest wall

A

Left thoracoabdominal (Akiyama)

72
Q

Surgical approach for cancers that are in the low thoracic - abdominal esophagus

A

Left thoracoabdominal (Akiyama)

73
Q

Classification of Tracheoesophageal fistula:

TEF without fistula

A

Class A

74
Q

Classification of Tracheoesophageal fistula:

Atresia with distal Fistula

A

Class C

75
Q

Classification of Tracheoesophageal fistula:

Esophageal stenosis

A

Class F

76
Q

Classification of Tracheoesophageal fistula:

TEF without atresia

A

Class E

77
Q

Classification of Tracheoesophageal fistula:

Atresia with Double fistula (Proximal and Distal)

A

Class D

78
Q

Classification of Tracheoesophageal fistula:

Atresia with Proximal Fistula

A

Class B

79
Q

Submucosal ring in the lower esophagus

A

Schatzki ring

80
Q

Mucosal tears located at the Gastroesophageal junction. Presents with hematemesis

A

Mallory weiss tear

81
Q

Classification of Tracheoesophageal fistula:

> Aspiration
NGT tube cannot be inserted
CXR showing lung infiltrates and Hyperinflated stomach

A

Class C

Esophageal Atresia with Distal fistula connecting the trachea and stomach

SURGERY (13 decks)

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