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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
Type 4 Diaphragmatic (Hiatal) Hernia
Involves another organ apart from the stomach herniated into the thorax
26
Borchard Triad of Hiatal Hernia (Incarcerated intrathoracic stomach)
1) Chest pain 2) Retching with inability to vomit 3) Inability to pass a nasogastric tube
27
Diagnostic test of choice for Paraesophageal hernia (Type II)
Upper GI Barium swallow
28
Finding of a separate orifice adjacent to the GEJ on Flex Endoscopy
Type II PEH
29
Finding of a Gastric pouch extending above the crural impression on Flex Endoscopy
Type I Sliding hernia
30
Treatment for Type I Sliding hernia (Medical or surgical)
Medical
31
Treatment for Type II Paraesophageal hernia (Medical or surgical)
Surgery
32
CXR findings for Hiatal Hernia
Air fluid level behind the cardia of the heart on Lateral view
33
3 Classifications of Esophageal Diverticula
1) Pharyngoesophageal (Zenker) 2) Mid Thoracic (Para bronchial 3) Epiphrenic
34
Area of potential weakness situated behind the Esophagus at the level of the Cricopharyngeus muscle
Killian's triangle
35
Zenker Diverticula occurs due to high pressure generated in the ___________
Hypophrynx
36
Surgical treatment for Zenker Diverticulum that is ≤ 2cm
Pharyngomyotomy
37
Surgical treatment for Zenker Diverticulum that is > 2cm
Diverticulectomy/ Diverticulopexy
38
Surgical treatment for Zenker Diverticulum that is wide-based
Diverticulopexy
39
Mid Thoracic diverticula are found __cm above and below the level of the carina
5 cm
40
Mid Thoracic Diverticula are classified as either _______ or _______ Diverticula
Traction; Pulsion
41
More common classification of Mid Thoracic Diverticula that is results from diffuse motility disorders of the esophagus
Pulsion Diverticula
42
Classification of Mid thoracic diverticula that results from granulomatous diseases (TB, Histoplasmosis)
Traction Diverticula
43
Treatment of Mid thoracic diverticula Traction:________; Pulsion: ________
Medical management; Surgical management
44
Esophageal Diverticula found at the distal 10cm of Esophagus
Epiphrenic diverticula
45
Epiphrenic diverticula is a form of ________ diverticula
Pulsion
46
Surgical management of Epiphrenic diverticula (reserved for symptomatic cases)
Esophagomy + Diverticulectomy/Diverticulopexy + Partial fundoplication
47
Triad of Achalasia
1) Hypertensive LES (>26mmhg) 2) Aperistalsis of Esophageal body 3) Failure of LES to relax
48
Surgical management of Achalasia
Heller Myotomy + Partial Fundoplication
49
Non-surgical management of Achalasia
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
Esophagogram showing corkscrew deformity
Diffuse and Segmental Esophageal Spasm
51
Most common primary esophageal motility disorder
Nutcracker Esophagus
52
Syndrome involving rupture of the esophagus due to forceful emesis
Boerhaave syndrome
53
Phases of Caustic Injury
1) Acute Necrotic Phase 2) Ulceration and Granulation 3) Cicatrization and Scarring
54
Endoscopic classification system for Caustic Injuries to the Esophagus
Zargar Classification
55
Zargar's Classification Grading
1) Mucosa (edema and erythema) 2) Submucosa (A - superficial, B - deep/circumferential) 3) Transmural + Necrosis (A - focal, B - diffuse) 4) Perforation
56
Most common type of Esophageal carcinoma worldwide
Squamous cell carcinoma
57
Esophageal carcinoma found in more developed countries
Adenocarcinoma
58
Usual Location of Adenocarcinoma
Distal Esophagus
59
Usual location of Squamous cell carcinoma
Middle third of Thoracic Esophagus
60
Precursor lesion of Squamous cell carcinoma
Intraepithelial/ Intramucosal/ Submucosal plaques
61
Precursor lesion of Adenocarcinoma
Barrett Metaplasia
62
Triad of Plummer Vinson Syndrome (Increases risk for Squamous cell carcinoma of Esophagus)
1) Dysphagia 2) Iron-deficiency anemia 3) Esophageal webs
63
Initial Diagnostic Evaluation of Esophageal Carcinoma
1) Endoscopy with Biopsy 2) Barium swallow
64
Metastatic Workup of Esophageal Carcinoma
1) CT of Chest and Abdomen (lung/liver mets) 2) Endoscopic ultrasound (better T&N Staging) 3) Thoracoscopy and Laparoscopy
65
Management for Stage I-III of Esophageal Carcinoma
Surgical Esophagectomy Neoadjuvant chemoradiation (some cases)
66
Management for Stage IV of Esophageal Carcinoma
Unresectable - ECOG ≤ 2: Chemo and palliative care - ECOG > 2: Palliative care
67
Contraindications for Curative surgery of Esophageal Carcinoma
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
Surgical approach for cancers limited to the intramucosal layer
Vagal-sparing esophagectomy
69
Surgical approach involving formation of a gastric conduit via upper midline laparotomy and left cervical incision (neck)
Transhiatal (Orringer and Sloan)
70
Surgical approach involving anastomosis between distal end of esophagus and cardia of stomach
Transthoracic (Ivor-Lewis)
71
Surgical approach involving opening of the abdomen and diaphragm to enter chest wall
Left thoracoabdominal (Akiyama)
72
Surgical approach for cancers that are in the low thoracic - abdominal esophagus
Left thoracoabdominal (Akiyama)
73
Classification of Tracheoesophageal fistula: TEF without fistula
Class A
74
Classification of Tracheoesophageal fistula: Atresia with distal Fistula
Class C
75
Classification of Tracheoesophageal fistula: Esophageal stenosis
Class F
76
Classification of Tracheoesophageal fistula: TEF without atresia
Class E
77
Classification of Tracheoesophageal fistula: Atresia with Double fistula (Proximal and Distal)
Class D
78
Classification of Tracheoesophageal fistula: Atresia with Proximal Fistula
Class B
79
Submucosal ring in the lower esophagus
Schatzki ring
80
Mucosal tears located at the Gastroesophageal junction. Presents with hematemesis
Mallory weiss tear
81
Classification of Tracheoesophageal fistula: > Aspiration > NGT tube cannot be inserted > CXR showing lung infiltrates and Hyperinflated stomach
Class C Esophageal Atresia with Distal fistula connecting the trachea and stomach

SURGERY (13 decks)

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