Esophagus

Question 1

Esophagus layers:
No ___.
___ is the strongest layer (vs. in small bowel where ___ is the strongest).

Answer 1

No serosa; mucosa is the strongest layer; small bowel its submucosa

Question 2

____ initiates ___ which elicits primary peristalsis of esophagus.
___ then elicits secondary peristalsis.

Answer 2

Central input initiates swallow which elicits primary.

Distention then elicits secondary.

Question 3

Esophagus sphincters are ___ (relaxed/contracted) at rest.

Normal LES tone= ___. Length is ___

Answer 3

sphincters contracted at rest.

normal LES tone= 15-25mmHg. Length is 4cm.

Question 4

Swallowing order of events:
Soft palate opens/closes nasopharynx?
Larynx up/down? Larynx opens/closes?
UES contracts/relaxes? Pharyngeal contracts/relaxes?

Answer 4

soft palate closes nasopharynx, larynx up, larynx closes, UES relaxes, pharyngeal contraction

Question 5

Zenker’s diverticulum:
Occurs where? ___
due to? ___
Rx?_____ via _____ (approach)

Answer 5

occurs in killian’s triangle; due to increase pressure pulsion tic); need myotomy and diverticulectomy/pexy. approach via left cervical incision

Question 6

Paraesophageal hernia rx?

Answer 6

Always operate since risk of incarceration, strangulation (Every year)

Question 7

Diffuse esophageal spasm medical rx?

Answer 7

Ca channel blockers

Question 8

Esophgeal rupture (Boerhaave's) key to survival is \_\_\_.
\_\_\_% dead if greater than \_\_\_ (time).

Answer 8

early diagnosis; 85% if > 36 hours

Question 9

Achalasia:

Mechanism?

Answer 9

decreased ganglion cells in auerbach’s plexus, absence of peristalsis and esophageal dilation

Question 10

Achalasia tests show:
Barium swallow ___.
Manometry _____ and ____.

Answer 10

bird’s beak on barium swallow;

manometry shows no peristalsis, high LES pressure/failure to relax

Question 11

Achalasis Rx:

__________ or ____________________

Answer 11

laparoscopic or thorascopic heller myotomy

Question 12

Barrett’s esophagus:
Mech? ____
____% get _____ cancer
____ associated (gene)

Answer 12

metaplasia from squamous to columnar cells;
1-2% get adenocarcinoma (30-100 x risk);
p53 associated (tumor suppressor gene)

Question 13

Achalasia and chemical ingestion also increased risk of _____.

Answer 13

esophageal cancer

Question 14

____ now #1 esophageal cancer over ______. (also true for _____ cancer)

Answer 14

adenoCA now #1 esophageal cancer over squamous (also true for lung CA)

Question 15

____ is main supply to stomach when use to replace esophagus

Answer 15

right gastroepiploic artery

Question 16

Leiomyoma of esophagus:
Excise if _____ or ____ by enucleation via thoracotomy.
__ (R/L) if middle, __ (R/L) if lower esophagus.
Do or do not biopsy on EGD? ____

Answer 16

Excise if symptomatic or >5cm;
R if middle, L if lower esophagus;
Do NOT biopsy on EGD