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Fiser > Esophagus > Flashcards

Esophagus Flashcards

1
Q

Does the esophagus have a serosa?

A

No

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2
Q

What type of muscle is upper 1/3 of the esophagus

A

striated muscle

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3
Q

type of muscle - middle and distal third esophagus

A

smooth muscle

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4
Q

major blood supply of thoracic esophagus

A

vessels directly off the aorta

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5
Q

blood supply of cervical esophagus

A

inferior thyroid artery

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6
Q

blood supply - abdominal esophagus

A

left gastric a. and inferior phrenic a.

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7
Q

venous drainage of esophagus

A

hemi-azygous and azygous veins in chest

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8
Q

lymphatic drainage of esophagus

A

upper 2/3 drains cephalad, lower 1/3 caudad

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9
Q

significance of criminal nerve of grassi

A

can cause persistently high acid levels postop if left undivided after vagotomy

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10
Q

major muscle upper esophageal sphincter

A

the cricopharyngeus muscle

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11
Q

purpose of the cricopharyngeus muscle

A

circular muscle, prevents air swallowing

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12
Q

normal UES pressure at rest

A

60mmHg

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13
Q

normal UES pressure with food bolus

A

15 mm Hg

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14
Q

most common site of esophageal perforation after EGD

A

cricopharyngeus muscle

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15
Q

most common site for esophageal foreign body

A

cricopharyngeus muscle

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16
Q

aspiration with brain-stem stroke is 2/2

A

failure of cricopharyngeus to relax

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17
Q

distance that lower esoph. sphincter from incisors

A

40cm

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18
Q

normal LES pressure at rest

A

15mm Hg

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19
Q

normal LES pressure with food bolus

A

0 mm Hg

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20
Q

three anatomic areas of esophageal narrowing

A
  1. cricopharyngeus muscle
  2. compression by left mainstem bronchus and aortic arch
  3. diaphragn
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21
Q

Three swallowing stages (CNS initiates)

A
  1. primary peristalsis
  2. secondary peristalsis
  3. tertiary peristalsis
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22
Q

surgical approach cervical esoph.

A

left

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23
Q

surgical approach upper 2/3 thoracic esoph

A

right - avoids the aorta

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24
Q

surgical approach - lower 1/3 thoracic esoph.

A

left

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25
Q

four causes of hiccups

A

gastric distention, temperature changes, etoh, tobacco

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26
Q

What is the best initial test of heartburn?

A

Endoscopy

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27
Q

What is the best initial test for dysphagia?

A

Barium swallow/ esophagram

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28
Q

Esophageal perforation - best test?

A

Gastrografin swallow

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29
Q

What is the treatment for plummer-vinson syndrome?

A

Dilation, Fe, need to screen for oral CA

30
Q

Is Zenker diverticulum false or true?

A

false

31
Q

What is the cause of Zenker diverticulum?

A

Failure of the cricopharyngeus to relax

32
Q

Presentation of zenker diverticulum

A

upper esophageal dysphagia, choking, halitosis, regurgitation of non-digested food

33
Q

Best test - Zenker diverticulum

A

Barium swallow

34
Q

Treatment - zenker diverticulum

A

Cricopharyngeal myotomy (removal of diverticula is not necessary)

35
Q

Traction diverticulum - true or false?

A

True

36
Q

Causes of traction diverticulum? (3)

A

inflammation, granulomatous disease, tumor

37
Q

Where is traction diverticulum usually found?

A

Mid-esophagus

38
Q

Presentation - traction diverticulum?

A

regurgitation of undigested food, dysphagia

39
Q

Treatment - traction diverticulum

A

excision and primary closure if symptomatic, may need palliative therapy (ie XRT) if due to invasive cancer. If asymptomatic, leave alone

40
Q

Disorder associated with epiphrenic diverticulum

A

achalasia

41
Q

location - epiphrenic diverticulum

A

distal 10 cm of the esophagus

42
Q

treatment - epiphrenic diverticulum

A

diverticulectomy and esophageal myotomy on the side opposite the diverticulectomy if symptomatic

43
Q

Causes of symptoms of achalasia

A

lack of peristalsis and failure of LES to relax after food bolus

44
Q

Cause - achalasia

A

autoimmune destruction of neuronal ganglion cells in muscle wall

45
Q

Manometry findings in Achalasia

A

Increased LES pressure, incomplete LES relaxation, no peristalsis

46
Q

Why do an EGD in patient with suspected Achalasia?

A

to rule out esophageal cancer

47
Q

First line treatment

A

Balloon dilation of LES

48
Q

Achalasia treatment of medical treatment and dilation fail

A

heller myotomy

49
Q

Medications to try in achalasia

A

nitrates, CCB’s

50
Q

Infection that can cause similar symptoms to achalasia

A

T. cruzi

51
Q

Manometry - diffuse esophageal spasm

A

frequent strong non-peristaltic unorganized contractions, LES relaxes normally

52
Q

Medical treatment - diffuse esophageal spasm

A

CCB, trazodone

53
Q

Surgical treatment - diffuse esophageal spasm

A

Heller myotomy (both upper and lower esophagus)

54
Q

Presentation - nutcracker esophagus

A

chest pain +/- dysphagia

55
Q

manometry - nutcracker esophagus

A

high amplitude peristaltic contractions (>180 mm Hg), LES relaxes normally

56
Q

medical treatments - nutcracker esophagus

A

CCB, trazodone

57
Q

surgical treatment - nutcracker esophagus

A

heller myotomy

58
Q

what is the most common organ involved in scleroderma?

A

esophagus

59
Q

pathophysiology - scleroderma

A

fibrous replacement of esophageal smooth muscle

60
Q

How does scleroderma cause symptoms?

A

causes dysphagia and loss of LES tone with massive reflux and strictures

61
Q

manometry findings in scleroderma

A

low LES pressure and aperistalsis

62
Q

treatment - scleroderma

A

PPI and Reglan, esophagectomy if severe

63
Q

most common defect in GERD

A

lose LES competence

64
Q

GERD + dysphagia, worry about

A

cancer

65
Q

GERD + bloating, worry about

A

aerophagia and delayed gastric emptying. diagnose with gastric emptying study

66
Q

GERD + epigastric pain, worry about

A

peptic ulcer, tumor

67
Q

When to do further diagnostic studies in GERD

A

failure of PPI despite escalating doses (3-4 weeks)

68
Q

best test - GERD

A

pH probe

69
Q

manometry findings in GERD

A

resting LES <6

70
Q

When to do surgery in GERD

A

failure of medical treatment, avoidance lifetime meds, young patients, refractory complications (bleeding, esophagitis, stricture)

71
Q

Most common cause of dysphagia following Nissen

A

wrap is too tight. generally resolves on its own/can dilate after 1 week

72
Q

Type I hiatal hernia

A

sliding hernia from dilation of hiatus, often associated with GERD; GE junction rises above the diaphragm

Fiser (4 decks)

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