Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

General Surgery > Esophagus > Flashcards

Esophagus Flashcards

1
Q

Criteria for undergoing endoscopic mucosal resection for Barrett’s

A
  • Focal high-grade dysplasia (HGD) or stage T1a intramucosal lesion <2cm
  • No evidence of lymph node involvement or systemic disease
  • Flat or polypoid lesions without ulceration
  • Lesions without lymphovascular invasions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the rate of progression of high-grade dysplasia to esophageal adenocarcinoma?

A

6%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the recommended surveillance in patients with low-grade dysplasia? Frequency and technique

A

Frequency: Every 6-12mo
Technique: Four quadrant biopsies every 2cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the recommended surveillance in patients with high-grade dysplasia? Frequency and technique

A

Frequency: Every 3mo (if has never undergone ablative therapy)
Technique: Four quadrant biopsies every 1cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the annual rate of neoplastic transformation in Barrett’s patients?

A

0.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the cutoff between long- and short-segment Barrett’s?

A

3cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What percentage of (American) patients with GERD will develop Barrett’s?

A

6-15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

DeMeester score cutoff for physiologic reflux

A

14.72

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Bravo probe location placement

A

5cm above LES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Indications for surgical management of GERD: (6)

3 medication-related, 2 endoscopic-related, 1 symptom-related

A
  • Failed optimal medical management
  • Noncompliance with medical therapy
  • Unwillingness to take lifelong medications
  • Severe esophagitis on endoscopy
  • Complications of GERD (benign stricture, Barrett’s, bleeding, ulceration)
  • Extraesophageal atypical reflux symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Absolute contraindications for surgical management of GERD (5)

A
  • Presence of esophageal cancer
  • Barrett’s with high-grade dysplasia
  • Inability to tolerate anesthesia
  • High surgical risk as a result of comorbidities
  • Portal hypertension and uncorrectable coagulopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Relative contraindications for surgical management of GERD (2)

A
  • BMI >35 (should get bariatric surgery instead)

- Surgeon experience

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Preop evaluation prior to antireflux procedure

A

-Endoscopy (to evaluate for Barrett’s)
-Manometry (to evaluate for disorders of peristalsis)
-Ambulatory pH monitoring (DeMeester >14.72)
PRN:
-UGI series (to evaluate for hiatal hernia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which patients do not require ambulatory pH testing?

A
  • Typical reflux symptoms
  • Histologic evidence of esophagitis
  • Good response to PPIs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Nissen fundoplication

A

360 degree wrap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Toupet fundoplication

A

Posterior 270 degree wrap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Dor fundoplication

A

Anterior 90 or 180 degree wrap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Nissen operative procedure (7)

A
  • Division of gastrohepatic ligament (look for replaced L hepatic artery)
  • Identify R crus and open phrenoesophageal ligament
  • Mobilize R crus off esophagus, dissect anteriorly and circumferentially to the L crus (identify anterior vagus nerve)
  • Divide short gastrics for better visualization of the L crus
  • Create posterior window (identify posterior vagus nerve)
  • Close crura with nonabsorbable pledgeted sutures
  • Perform fundoplication over a 56Fr bougie with 2.5cm length of intra-abdominal esophagus.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Surgical management of gas bloat syndrome

A

Convert full fundoplication to a partial wrap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Medical management of gas bloat syndrome

A

Dietary modification (avoidance of carbonated beverages, avoiding aerophagia) and prokinetic agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Atypical symptoms of GERD (9, 6 pulmonary, 3 non-pulmonary)

A

Pulmonary:

  • Asthma
  • Chronic cough
  • Idiopathic pulmonary fibrosis
  • Recurrent pneumonia
  • Aspiration
  • Recurrent bronchitis

Non-pulmonary

  • Chest pain
  • Hoarseness
  • Dental erosions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Criteria for mechanically defective LES

A 
Pressure (<6mmHg)
Total length (<2cm)
Abdominal length (<1cm)
23
Q

Do typical or atypical symptoms respond better to anti-reflux procedures?

24
Q

Endoscopic finding of “trachealization” of the esophagus

A

Eosinophilic esophagitis

25
Endoscopic finding of salmon-colored mucosa
Barrett's
26
Most common esophageal motility disorder
Achalasia
27
Schatzki's ring type A
Narrowing of lower esophagus that can be asymptomatic or cause dysphagia, may be treated endoscopically if symptomatic. Usually due to mucosal overgrowth. Type A: Above the GEJ
28
Schatzki's ring type B
Narrowing of lower esophagus that can be asymptomatic or cause dysphagia, may be treated endoscopically if symptomatic. Usually due to mucosal overgrowth. Type B: at the squamocolumnar junction
29
Type II achalasia
Achalasia with esophageal compression: - mean integrated relaxation pressure > upper limit of normal - no normal peristalsis - panesophageal pressurization with >20% of swallows
30
Type I achalasia
Classic achalasia: - mean integrated relaxation pressure > upper limit of normal - 100% failed peristalsis
31
Type III achalasia
- Mean integrated relaxation pressure > upper limit of normal - no normal peristalsis but with preserved fragments of distal peristalsis or premature spastic contractions with >20% of swallows
32
Typical reflux symptoms (3)
Heartburn Dysphagia Regurgitation
33
Workup for achalasia (3)
- Esophagram (classic bird's beak finding) - Endoscopy (to rule out pseudoachalasia, especially malignancy) - Manometry (gold standard, classically shows failure of LES relaxation and aperistalsis)
34
T/F: Nissen fundoplication is associated with regression of low-grade dysplasia in non-dysplastic Barrett's esophagus?
True, although no data to support that anti-reflux procedures prevent esophageal cancer
35
In what percentage of patients undergoing esophagectomy for high-grade dysplasia are there foci of unsuspected esophageal cancer?
25-75%, probably on the lower end
36
Type I hiatal hernia
Sliding hiatal hernia
37
Type II hiatal hernia
True paraesophageal hernia, rarest of PEHs
38
Type III hiatal hernia
Combination of true paraesophageal hernia and sliding hernia. Accounts for majority of paraesophageal hernias.
39
Type IV hiatal hernia
Another abdominal organ joins stomach in the hernia sac (spleen, colon, etc). Usually has an abnormal location of the GEJ.
40
Giant paraesophageal hernia
30% or more of the stomach is herniated into the thorax
41
Cameron ulcers
Gastric ulcers within a paraesophageal hernia from friction between opposing, engorged gastric walls
42
Borchardt's triad
Epigastric/chest pain Retching without vomiting Inability to pass an NGT (Gastric volvulus)
43
T/F: An asymptomatic large paraesophageal hernia in a patient >65yo should be repaired
False, the risk of elective repair exceeds any benefit
44
Laimer's membrane
Phrenoesophageal membrane
45
Zenker's diverticulum definition
Posterior outpouching of pharyngeal mucosa just proximal to the cricopharyngeal muscle through Killian's triangle
46
Zenker's diverticulum herniates proximal or distal to cricopharyngeus?
Proximal
47
Symptoms of Zenker's diverticulum (5)
``` Dysphagia Regurgitation Cough Choking episodes Globus sensation ```
48
Extent of Heller myotomy for achalasia
5cm on anterior esophagus, 2 cm on stomach
49
Los Angeles grade A esophagitis
One or several erosions limited to the mucosal folds and no larger than 5mm in extent
50
Los Angeles grade B esophagitis
One or several erosions limited to the mucosal folds and larger than 5mm in extent
51
Los Angeles grade C esophagitis
Erosion(s) extending over mucosal folds but overall less than 3/4s of the circumference
52
Los Angeles grade D esophagitis
Confluent erosions extending over more than 3/4s of the circumference (“circular defects”)
53
What is the surgical approach for a Zenker's diverticulum?
Left cervical incision. (This makes sense since the esophagus bulges to the left on thyroid ultrasounds.)

General Surgery (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions