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ABSITE Flashcards > Esophagus > Flashcards

Esophagus Flashcards

1
Q

Strongest layer

A

Mucosa (in small bowel, submucosa is strongest)

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2
Q

Normal LES tone

A

15-25 mm Hg

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3
Q

Swallowing order of events

A

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

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4
Q

Zencker’s diverticulum definition

A

Dysfunction of upper esophageal sphincter muscles

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5
Q

Zenker’s tx

A

division of upper esophageal sphincter muscles
 >3 cm diverticulum: endoscopic division of UES sphincter
 <3 cm diverticulum: open division

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6
Q

Mid-esophageal diverticulum

A

o Traction diverticulum (all three layers of esophageal wall being pulled)

Tx: VATS diverticulotomy and dissection

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7
Q

Barrett’s surveillance

A
  • Surveillance: EGD with bx annually, 4 quadrant biopsy every 1-2 cm of affected segments
    o Low grade dysplasia: repeat EGD in 6 months
    o High grade dysplasia: repeat and confirm  endoscopic mucosal resection
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8
Q

Achalasia manometry findings

A

High LES/normal basal pressure with incomplete LES relaxation

Absent/incomplete peristalsis

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9
Q

Paraesophageal hernia tx

A

Operate -> risk of incarceration, strangulation

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10
Q

Diffuse esophageal spasm manometry findings

A

o Normal LES pressure and relaxation

o High amplitude, uncoordinated esophageal contractions

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11
Q

Achalasia tx

A

Tx: Hellery myotomy with fundoplication

 Myotomy: 6 cm onto the esophagus, 2 cm onto stomach

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12
Q

DES tx

A

CCB, nitrates -> long segment myotomy

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13
Q

Nutcracker esophagus manometry findings

A

o Normal LES pressure and relaxation

o High amplitude, coordinated contractions

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14
Q

Nutcracker esophagus tx

A

CCB, nitrates -> long segment myotomy

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15
Q

Cause of achalasia

A

o Degenerative loss of inhibitory neurons of LES
o Chagas disease, autoimmune, idiopathic
o Pseudoachalasia: secondary to tumor/malignancy

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16
Q

Barrett’s esophagus definition

A

metaplasia from squamous to columnar cells. 1-2% get adenocarcinoma (30-100 x risk) P53 associated (tumor suppresor gene)

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17
Q

main supply to stomach when used to replace esophagus?

A

R gastroepiploic artery

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18
Q

Leiomyoma tx

A

if symptomatic or > 5cm excise by enucleation via thoracotomy (R if middle, L if lower esophagus). Do not biopsy on EGD.

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19
Q

Narrowest point of diaphragm

A

Cricopharyngeus

20
Q

Contained esophageal perforations treatment

A

observation and abx ok

21
Q

Barrett’s histologic change

A

squamous to columnar cells with Goblet cells

22
Q

LES resting pressure

A

10-20 mm Hg

23
Q

UES resting pressure

A

50-70 mm Hg

24
Q

Surgical esophagomyotomy steps

A

Incise 6.5 cm of longitudinal then circular muscle fibers of distal esophagus and 2.5 cm of proximal gastric muscle fibers

25
Q

Mallory Weiss syndrome

A

linear tear of gastroesophageal mucosa

26
Q

Blood supply to the gastric conduit after esophagectomy

A

R gastroepiploic artery

27
Q

Principles of partial fundoplication (Dor - anterior, Toupet - posterior)

A

Restore an intra-abdominal segment of distal esophagus
Accentuate the angle of His
Create a long anterior mucosal valve at GEJ

28
Q

Esophageal cancer T stages

A 
o	T1:
	1A: invades lamina propria or muscularis mucosa
	1B: invades submucosa
o	T2: invades muscularis propria
o	T3: invades adventitia
o	T4: invades surrounding structures
	T4a: resectable (invades pleura/pericardium, etc)
	T4b: unresectable
29
Q

Tx of esophageal CA >5 cm from cricopharyngeus + resectable

A

esophagectomy

30
Q

Tx of esophageal CA <5 cm from cricopharyngeus

A

definitive chemoradiation

31
Q

T1a tumors tx

A

endoscopic mucosal resection +/- ablation

32
Q

T1b (no nodes) tx

A

upfront esophagectomy

33
Q

T2 or greater OR any positive LN tx

A

neoadjuvant + esophagectomy

34
Q

Unresectable disease or distant mets tx

A

chemoradiation only

35
Q

Layers of the esophagus

A

Mucosa
Submucosa
Muscularis propria
NO SEROSA

36
Q

Blood supply of the esophagus

A

Cervical portion: inferior thyroid artery
Thoracic portion: straight from aorta
Abdominal portion: L gastric and inferior phrenic arteries

37
Q

UES is made of? Innervated by?

A

Cricopharyngeus muscle

Superior laryngeal nerve

38
Q

Tx of Barretts with high grade dysplasia?

A

Endoscopic treatment: radiofrequency ablation vs endoscopic mucosal resection

Radiofrequency ablation preferred for long segment Barretts

EMR best for lesions < 2 cm - resect down to submucosa

39
Q

Esophageal varices treatment

A

Prophylactic antibiotics for 7 days
Started on octreotide and/or vaso - reduces portal blood flow and thus reduces portal pressure
Endoscopic therapy: sclerotherapy or variceal banding

40
Q

Techniques of transthoracic heller myotomy

A

Patient positioned in right lateral decubitus position
Enter the pleural space in the 7th intercostal space
Incise the inferior pulmonary ligament
Retract the lung medially and cephalad
Incise the mediastinal pleura
Encircle the esophagus with a penrose drain
Identify both vagus nerves
Perform esophagomyotomy

41
Q

Manometry findings of scleroderma

A

Low amplitude

Simultaneous contractions with normal or low LES pressures

42
Q

Most common complication following fundoplication

A

Dysphagia
MC cause is post-op edema - self limiting and resolves within 6-8 weeks
If dysphagia persists beyond this time frame, further investigation is indicated

43
Q

Hormones that increase LES pressure

A

Gastrin

Motilin

44
Q

Hormones that decrease LES pressure

A 
CCK
Estrogen/progesterone
Glucagon
Somatostatin
Secretin
45
Q

Manometry findings of achalasia

A

Hypertonic LES, failure of LES to relax with a food bolus

Aperistalsis

ABSITE Flashcards (19 decks)

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