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Surgery > Esophagus > Flashcards

Esophagus Flashcards

1
Q

Dysphagia

A

Difficulty swallowing

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2
Q

Causes of dysphagia

A
  1. Neuromuscular pathologies - MG, Scleroderma, Achalasia
  2. Obstruction - Tumors, webs
  3. Motility issues
  4. Odynophagia (painful swallowing)
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3
Q

How does Neuromuscular pathologies affects swallowing?

A

Difficulties swallowing SOLIDS + LIQUIDS

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4
Q

Tests to identify underlying causes of dysphagia

A
  1. Barium swallow
  2. EGD
  3. Manometry
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5
Q

General Tx of Dysphagia

A
  1. Diet modification
  2. Pharmacologic tx
  3. Training in swallowing techniques
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6
Q

Achalasia

A

Failure of LES to relax

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7
Q

Mechanism of Achalasia

A
  1. Dysfunction of Nitric Oxide Synthase producing neurons
  2. Denervation of esophageal muscle
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8
Q

What does pts. w/ Achalasia have inc. risk for?

A

Esophageal Squamous Cell Carcinoma

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9
Q

Causes of Secondary Achalasia

A
  1. Cancer
  2. Chagas disease
  3. Diabetic neuropathy
  4. Amyloidosis
  5. Sarcoidosis
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10
Q

CFs of Achalasia

A
  • Dysphagia to solids & liquids
  • Chest pain
  • Weight loss
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11
Q

Dx of Achalasia

A
  1. Esophageal manometry
  2. Barium swallow
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12
Q

Esophageal manometry results in Achalasia

A
  1. Inc. resting tone of LES
  2. Dec relaxation of LES after swallowing
  3. Impaired peristalsis
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13
Q

Barium swallow results in Achalasia

A
  1. “Bird’s beak” appearance @ LES
  2. Proximal esophageal dilation
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14
Q

Tx of Achalasia

A
  1. Esophagomyotomy - Preferred tx in pts. w/ low surgical risk
  2. Ballon/ Pneumatic dilation of LES
  3. Botulinum toxin injection in LES
  4. Nitrates
  5. Calcium channel blockers
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15
Q

Mechanism of pharmacologic tx of Achalasia

A

Dec LES tone

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16
Q

Why is ballon dilation less likely treatment choice of Achalasia?

A

-Esophageal rupture

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17
Q

Boerhaave Syndrome

A

Transmural esophageal perforation caused by sudden inc. in intra-esophageal pressure & dec in intrathoracic pressure.

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18
Q

Causes of Boerhaave Syndrome

A
  • Severe vomiting & straining (MCC)
  • Seizure
  • Childbirth
  • Weightlifting
  • Prolonged coughing or laughing
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19
Q

MC location of esophageal rupture in Boerhaave syndrome

A

Left Posterolateral aspect of distal esophagus

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20
Q

Mackler Triad CFs of Boerhaave Syndrome

A
  1. Forceful vomiting
  2. Retrosternal chest pain
  3. Spontaneous emphysema
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21
Q

Other CFs of Boerhaave Syndrome

A
  • Fever
  • Hypotension
  • Abdominal rigidity
  • Tachypnea <– Pleural effusion
  • Odynophagia + Neck pain (Cervical perforation - RARE)
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22
Q

How does Pleural Effusion occur in Boerhaave syndrome?

A

Perforation –> Leakage of esophageal contents into pleural cavity –> Contamination

Mediastinitis-induced effusion

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23
Q

Dx of Boerhaave syndrome

A

CT chest
Water-soluble contrast Esophagram

24
Q

Findings on CT characteristic of Boerhaave syndrome

A
  1. Esophageal wall edema
  2. Esophageal wall thickening
25
Q

Why is Water-soluble contrast preferred to Barium contrast in Esophagography?

A

Barium induces mediastinal inflammation

26
Q

Findings on Chest x-ray (not diagnostic) in Boerhaave syndrome

A
  1. U/L pleural effusion (usually left)
  2. Widened mediastinum (air & fluid)
  3. Pneumomediastinum

Can be -ve in early cases

27
Q

Characteristics of Pleural Effusion analysis in Boerhaave syndrome

A
  1. Inc salivary amylase
  2. pH <6
  3. Undigested food

Exudative fluid

28
Q

Management of Boerhaave symdrome

A
  1. IVF (pt is NPO)
  2. IV PPI
  3. IV broad-spectrum Ab (Ticarcillin-clavulanate)
  4. Surgery
29
Q

PE findings in Boerhaave syndrome

A
  1. Crepitus on chest wall palpation
  2. Mediastinal crunching w/ each heartbeat on auscultation (Hamman’s sign - best heard in left lateral decubitus position)

Air accumulation –> Subcutaneous & Mediastinal emphysema (Pneumomediastinum)

30
Q

Complications of Alcoholism

A
  1. Mallory-Weiss syndrome
  2. Boerhaave syndrome
  3. Wernicke-Korsakoff syndrome
  4. Esophageal varices
  5. Liver disease
  6. Pancreatitis (acute & chronic)

Withdrawal
1. Delirium tremens
2. Alcoholic hallucinosis

31
Q

Cause of Wernicke-Korsakoff syndrome

A

Thiamine (B1) Deficiency<– Alcoholism

32
Q

Triad of Wernicke Encephalopathy

A
  1. Confusion
  2. Ophthalmoplegia
  3. Ataxia
33
Q

Triad of Korsakoff Syndrome

A
  1. Anterograde amnesia
  2. Retrograde amnesia
  3. Confabulation

Untreated Wernicke’s –> Korsakoff

34
Q

MRI findings specific to Wernicke encephalopathy & Korsakoff syndrome

A

Mamillary body atrophy

35
Q

Tx of Wernicke encephalopathy

A

IV Thiamine –> Glucose

Thiamine is always given first bc glucose can precipitate Wernicke encephalopathy

36
Q

Mallory-Weiss Sydrome

A

Longitudinal mucosal laceration @ GEJ caused by excessive vomiting

37
Q

CFs of Mallory-Weiss Syndrome

A

Painful hematemesis

38
Q

Cause & Complication of Esophageal Varices

A

Caused by Portal HTN and can result in bleeding

39
Q

Delirium tremens

A

-Life threatening
- 2-5 days after withdrawal
- Delirium + Hyperthermia + Tachycardia + Seizures

40
Q

Alcoholic Hallucinosis

A
  • 12-48 hours after abstinence
  • resolves w/i 1-2 days
  • Usually visual & tactile hallucinations
  • Stable vital signs
41
Q

Zenker Diverticulum

A

Outpouching of upper, posterior esophagus in Killian’s triangle d/t increased intrabolus pressure during swallowing

42
Q

CFs of Zenker Diverticulum

A
  1. Vomiting of food eaten days before
  2. Bad breath
  3. Problems swallowing
  4. Inc in neck mass w/ eating or drinking
  5. Feelings of aspiration
  6. Dysphagia
43
Q

Dx of Zenker Diverticulum

A

Barium swallow
- Outpouching of esophagus

44
Q

Tx of Zenker Diverticulum

A
  1. Diverticulectomy
  2. Cricopharyngeal myotomy
45
Q

Complications of Zenker Diverticulum

A
  1. Esophageal rupture (during EGD)
46
Q

Complication of Zenker Diverticulum treatment

A
  1. Vocal cord paralysis
  2. Mediastinitis
47
Q

Hiatal hernia

A

Protrusion of upper stomach through the esophageal hiatus in the diaphragm

48
Q

Types of Hiatal hernia

A
  1. Sliding (type 1)
  2. Paraoesophageal (type 2)
49
Q

Sliding hiatal hernia

A

GEJ + Proximal stomach –> Herniation

50
Q

Paraoesophageal hiatal hernia

A

Proximal stomach herniation

51
Q

CFs of Hiatal hernia

A
  1. Asymptomatic
  2. Acid reflux
  3. Chest pain
  4. Nausea
  5. Early satiety
52
Q

Dx of Hiatal hernia

A
  1. Upper endoscopy (best)
  2. Barium swallow
  3. Chest x-ray
53
Q

Complications of hiatal hernia

A
  1. Acid reflux
  2. Esophagitis
  3. Esophageal strictures
  4. Perforation
  5. Volvulus (MC Type 2)
  6. Strangulation (MC Type 2)
54
Q

Tx of hiatal hernia

A
  1. PPI
  2. Diet modification - smaller portions, Inc fiber

Refractory to meds/ Volvulus
1. Nissen fundoplication - 360-degree wrap of fundus around GEJ to prevent herniation

55
Q

RFs for hiatal hernia

A

Inc age >50 years

Surgery (10 decks)

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