esophagus Flashcards
for patients with esophageal cancer limited to the intramucosal layer without lymphadenectomy
vagal-sparing esophagectomy
done via midline laparotomy and left cervical incision; uses the right gastroepiploic to establish gastrointestinal continuity
transhiatal (Orringer and Sloan)
midline abdominal incision and right thoracotomy is done
anastomosis is done between the distal esophagus and the fundus
tranthoracic (Ivor-Lewis)
separate laparotomy, right thoracotomy and cervical incisions
three field- McKeown)
oblique incision done between the xiphoid and umbilicus; chest entered through the 7th ICS
Left thoracoabdominal (Akiyama)
palliative resection to those who cant undergo curative surgery
bypass surgery
most common bypass surgery
substernal
smooth polypoid lesion on Ba swallow; most are submucosa
esophageal sarcoma
ulcerating and stenosing on barium swallow
esophageal carcinoma
dysphagia, atrophic mucosa, spoon shaped fingers with brittle nails
chronic anemia
esophageal web
plummer vinson syndrome
mucosal tear at the gastroesophageal junction
mallory weiss tear
treatment for mallory weiss tear
laparotomy plus high gastrostomy plus oversewing of tear
most common TEF
EA with distal TEF
Type C
EA w/o TEF
Type A
EA with proximal TEF
Type B
Atresia with double fistula
Type D
Esophageal stenosis
esophageal stenosis
TEF w/o atresia
Type E
Excessive salivation; inability to fully insert NGT; cyanosis and aspiration
TEF
Loss of high pressure zone at gastroesophageal junction
GERD
Normal pressure 6-26
180 degree anterior fundoplication of distal esophagus
dor fundoplication
most common sx tx for GERD
Nissen fundoplication
posterior fundoplication 180 degrees
toupet fundoplication
thoracic approach fundoplication
Belsey Mark IV
Collis gastroplasty
uses a stapler to divide cardia and upper stomach
arcuate ligament repair; sutures stomach to diaphragm
hill posterior gastropexy
structural deterioration of the phrenoesophageal membrane
diaphragmatic /hiatal hernia
chest pain
retching with inability to vomit
inability to pass NGT
Borchardt triad
contains only mucosa and submucosa
false diverticulum
mucosa lined pouches that protrude from the esophageal lumen
esophageal diverticula
most common esophageal diverticula
dysphagia; regurgitation of undigested food; halitosis
Zenker diverticula
area of potential weakness behind the esophagus at the level of the cricopharyngeus
Killian triangle
dx of zenker diverticulum
barium swallow/ esophagogram
tx 2cm or less diverticulum
pharyngomyotomy
tx more than 2cm
diverticulectomy/ diverticulopexy
diverticula located 5cm above and below the carina
mid thoracic diverticula
mid thor diverticula caused by pulmo infection
traction diverticula
mid thor diverticula caused by motility d/o of the esophagus
pulsion diverticula
tx ofr symptomatic patients with pulsion diverticula
esophagomyotomy plus diverticulectomy/ pexy
primary motility disorder characterized as loss of peristaltic waveform
failure of LES to relax
achalasia
triad of achalasia
hypertensive LES
Aperistaltic Esophageal body
Failure to relax LES
Gold standard dx for achalasia
manometry
esophagogram finding of achalasia
BASE
Birds beak (pencil tip)
air fluid level
sigmoid esophagus
esophageal dilatation
tx of achalasia
heller myotomy plus partial fundoplication
simultaneous waveforms and multipeaked contractions
diffuse and segmental esophageal spasm
corkscrew deformity
diffuse and segmental esophageal spasm
spontaneous rupture of the esophagus
boorhaave syndrome
