Esophagus

Question 1

GE junction identification points

Answer 1

two endoscopic and two external.
1. The squamocolumnar epithelial junction (Z-line)
2. The transition from the smooth esophageal lining to the rugal folds of the stomach
3. the collar of Helvetius (or loop of Willis), where the circular muscular fibers of the esophagus join the oblique fibers of the stomach
4. the gastro- esophageal fat pad are consistent identifiers of the GEJ

Question 2

LES pressure

Answer 2

26 mmHg

Question 3

diverticulum of esophagus

Answer 3

false diverticulum (вследствие повышенного интралюминального давления):
1. Zenker (pharingeoesophageal) M.C.
2. Epiphrenic

true diverticulum (в следствии воспалительного процесса вне пищевода):
1. midesophageal

Question 4

Killian triangle

Answer 4

The transition between the oblique
fibers of the thyropharyngeus muscle and the horizontal fibers of the cricopharyngeus muscle (site of Zenker diverticulum)
Left side of esophagus

Question 5

treatment of Zenker Diverticulum

Answer 5

open left cervical approach:
- <2 cm - miotomy
>2 dicverticulopexia to the posterior pharynx
>5 - miotomy and excision of sac
endoscopic :
2-5 cm Dohlman procedure

Question 6

A DeMeester score

Answer 6

greater than 14.72 confirms pathologic GERD.

Question 7

Pittsburgh score of severity esophageal perforation

Answer 7

Pittsburgh score of severity esophageal perforation:
1point =
1. AGE >75 

2. Tachycardia >100

3. Leukocytosis >10000

4. pleural effusion 

2 points =
1. fever >38.5

2. noncontained leak (on CT or barium esophagogram)

3. RR >30, or mechanical ventilation

4. Time to diagnosis >24h

3 points =
1. presence of cancer

2. hypotension

(<3 - Mortality 2%
3-5 - Mortality 6%
>5 - Mortality 27%)

Question 8

management principles of esophageal perforation

Answer 8

– treat contamination: ABX + antifungal
– wide local drain
– source control with primary closure, T-tube, endoscopic stenting or esophagectomy
– enteral feeding access

Question 9

surgical approach to esophagus:

Answer 9

neck - left-sided incision
midesophageal - right toracotomy
distal esophageal - left toracotomy/toracoabdominal incision

Question 10

Typical sites for esophageal cancer

Answer 10

SCC may arise in any part of the esophagus, but the majority of cases arise in the proximal and middle esophagus. In contrast, the majority of adenocarcinomas arise in the distal esophagus or GEJ.