Esophagus Flashcards
1
Q
the start of the esophagus at the level of what cartilage
A
cricoid
2
Q
the esophagus ends at the level of?
A
T11
3
Q
What are the 3 narrowings of the esophagus
A
- Cricopharyngeus (C6)
- Left mainstem bronchus (T4)
- LES (T11)
4
Q
The artery of the cervical portion of the esophagus is the
A
inferior thyroid artery
5
Q
the artery of the thoracic portion of the esophagus is the
A
bronchial arteries
6
Q
the artery of the abdominal portion of the esophagus
A
Left gastric
inferior phrenic
7
Q
The venous drainage of the cervical portion of the esophagus
A
inferior thyroid
8
Q
The venous drainage of the thoracic portion of the esophagus
A
bronchial veins
9
Q
The venous drainage of the abdominal portion of the esophagus
A
coronary vein
10
Q
[diagnostics]
the first diagnostic test in patients with suspected esophageal disease
A
barium swallow
11
Q
[diagnostics]
test indicated when a motor abnormality of the esophagus on the basis of complaints
A
manometry
12
Q
[diagnostics]
most direct method of measuring increased esophageal exposure to gastric juice
A
24 hours ambulatory pH monitoring
13
Q
[diagnostics]
gold standard for the diagnosis of GERD
A
24 hour ambulatory pH monitoring
14
Q
the resting pressure of the LES is around
A
6 to 26mmHg
15
Q
A defective LE sphincter has a mean pressure of
A
<6 mmHg
16
Q
a defective LE sphincter has an overall length of
A
<2cm
17
Q
a defective LES has an intraabdominal length of
A
<1cm
18
Q
[diagnosis]
squamous epithelium turned to columnar in the LES
A
barrett esophagus
19
Q
what is the hallmark of intestinal metaplasia in barrett esophagus
A
presence of intestinal goblet cells
20
Q
[GERD surgeries]
360 degree fundoplication around the LES
A
Nissen
21
Q
[GERD surgeries]
180 degree posterior fundoplication
A
Toupet
22
Q
[GERD surgeries]
180 degree anterior fundoplication
A
Dor
23
Q
[GERD surgeries]
use a stapler to divide the cardia and upper stomach
A
collis gastroplasty
24
Q
[GERD surgeries]
240 to 279 degree fundoplication
A
Belsey Mark IV
25
[GERD surgeries]
Arcuate ligament repair + gastropexy to diaphragm
Hill Posterior Gastropexy
26
[diagnosis]
structural deterioration of the phrenoesophageal membrane
diaphragmatic hernia
27
[diagnosis: hiatal hernia]
heartburn, regurgitation
sliding hernia
28
[diagnosis: hiatal hernia]
dysphagia, postprandial fullness, massive bleeding, gastric volvulus, infarction
paraesophageal hernia
29
[diagnosis: hiatal hernia]
chest pain, retching with inability to vomit, inability to pass a NGT
borchdart triad
30
[Type of hiatal hernia]
upward dislocation of GEJ and cardia into the thorax through the esophageal hiatus of diaphragm
Type 2: sliding hernia
31
[Type of hiatal hernia]
upward dislocation of the gastric fundus along side a Normally positioned cardia
Type 2: paraesophageal
32
[Type of hiatal hernia]
herniation of part of the stomach without displacement of the GEJ
Type 2: paraesophageal
33
[Type of hiatal hernia]
combined herniation of the cardia and fundus
Type 3: combined hernia
34
[treatment of diaphragmatic hernia]
treated medically
sliding hernia
35
[treatment of diaphragmatic hernia]
treated largely surgical
paraesophageal hernia
36
___ triad
inability to pass NGT, retching without actual food regurgitation, epigastric pain
Borchardt triad
| Gastric volvulus
37
[diagnosis]
mucosa line pouches that protrude from the esophageal lumen, contains all layers of esophageal wall
true esophageal diverticula
38
[diagnosis]
mucosa line pouches that protrude from the esophageal lumen, contains only submucosa and mucosa
false esophageal diverticula
more common
39
most common esophageal diverticula
zenker diverticula
40
area of potential weakness situated behind the esophagus at the level of the cricopharyngeus
killian triangle
41
[surgical management of zenker diverticula]
2cm or less
Pharyngomyotomy
42
[surgical management of zenker diverticula]
>2cm
diverticulectomy or Diverticulopexy
43
[surgical management of zenker diverticula]
wide based
diverticuloplexy
44
[diagnose[
diverticula located 5cms above and below the level of carina
mid thoracic diverticula
45
[kind of mid-thoracic diverticula]
usually due to granulomatous diseases
traction diverticula
46
[kind of mid-thoracic diverticula]
more common, diffuse motility disorders of the esophagus
pulsion diverticula
47
[diagnose]
pulsion diverticula that occurs distal to 10cm of esophagus
epiphrenic diverticula
48
[diagnose]
loss of peristaltic waveform in the esophageal body and failure of the LES to relax leading to functional outflow obstruction
Achalasia
49
[diagnose]
neurogenic degeneration in the esophagus; hypertension of LES, failure of the LES to relax,
elevation of intraluminal esophageal pressure
achalasia
50
[diagnose]
hypertensive LES
Apresistalsis of esophageal body
failure of LES to relax
achalasia
51
What is the surgical management of achalasia?
Heller myotomy and partial fundoplication
52
wha is the most effective non-surgical treatment; risk of perforation
pneumatic dilatation
53
[diagnosis]
if in the esophagogram a corkscrew deformity is seen,..
diffuse and segmental esophageal spasms
54
[diagnosis]
in manometry, simultaneous waveforms and multipeaked contractions; 20% or more out of 10 wet swallows
diffuse segmental esophageal spasm
55
what is the most common primary esophageal motility disorder
nutcracker esophagus
56
[diagnosis]
the mean peristaltic amplitude in distal esophagus is >180 mmHg; there is an increased duration of contraction; normal peristaltic sequence
nutcracker esophagus
57
[diagnosis]
elevated LES pressure (>26 mmHg); normal LES relaxation; normal peristalsis in the esophageal body
hypertensive LES
58
What is a true surgical emergency in the esophagus?
esophageal perforation
59
____ syndrome
spontaneous rupture of the esophagus; usual history of resisting vomiting
Boerhaave syndrome
60
In diagnosing esophageal perforation, what is the position in doing water soluble contrast esophagogram?
lateral decubitus position
61
[phase of injury: caustic injury]
pain in the mouth, substernal region, hypersalivation, odynophagia, dysphagia, pain, fever, bleeding, vomiting
1st phase
62
[phase of injury: caustic injury]
period when the esophagus is the weakest
2nd phase
63
the most common site of esophageal perforation in caustic injury
mid esophagus
64
[Zargar Classification]
ulcerations, mucosal and submucosal
Zargar 2
A: superficial
B: deep
65
[Zargar Classification]
necrosis, transmural
Zargas 3
A: focal
B: extensive
66
[diagnose]
plaque-like, erosive, papillary
can either be intraepithelial, intramucosal, submucosal
squamous cell CA
67
[diagnosis]
IDA, dysphagia, esophageal webs
plummer-vinson sydnrome
68
Barret esophagus is a precursor of this CA
adenoCA
69
Achalasia is a precursor of this CA
squamous cell CA
70
[diagnose]
dysphagia, stridor, coughing, choking, aspiration pneumonia, bleeding, hoarseness, jaundice, bone pain, anorexia
esophageal CA
71
[functional grade of dysphagia]
Patient able to take liquids only
grade IV
72
[functional grade of dysphagia]
patient able to take semisolids but unable to take any food
Grade III
73
[functional grade of dysphagia]
requires liquids with meals
Grade II
74
[functional grade of dysphagia]
unable to take liquids, but able to swallow saliva
Grade V
75
[diagnostics for esophagus]
evaluation of dysphagia to visualize mucosa, luminal distensibility, motility, and anatomic abnormalities
barium swallow
76
[diagnostics for esophagus]
this provides more accurate result for T and N staging
endoscopic UTZ
77
[surgical management]
Stage I to III (locoregional disease)
Esophagectomy
78
What are the contracindications for curative surgery
1. Age >75
2. FEV1 < 1.25
3. EF <40%
4. >20% weight loss
5. locally advanced tumor
79
[Esophagectomy approach]
esophageal CA limited to the intramucosal layer
vagal sparing esophagectomy
80
[Esophagectomy approach]
upper midline laparotomy
left cervical incision
transhiatal
Orringer and Sloan
81
[Esophagectomy approach]
upper midline incision
right thoracotomy is done
transthoracic
Ivor-Lewis
82
[Esophagectomy approach]
separate laparotomy
right thoracotomy
cervical incision
Three-field
| McKeown
83
[Esophagectomy approach]
oblique incision from midpoint between xiphoid and umbilicus to tip of scapula;
abdomen is opened, costal arch divided,
enter through the seventh intercostal space
left thoracoabdominal
Akiyama
84
___ maneuver is the mobilization of the fixed portions of the duodenum
Kocher
85
in Oringger procedure, these arteries are preserved
Right Gastric and right gastroepiploic
86
[Bypass approaches]
allow better maintenance of an esophageal substitute; shortest
transthoracic
87
[Bypass approaches]
best direct conduit to the neck
reduced possibility of recurrent malignant dysphagia
substernal
88
[Esophago-Gastric Junction CA]
Siewert and Stein I corresponds to
Esophageal
TTE + 2 field LAD
89
[Esophago-Gastric Junction CA]
Siewert and Stein II corresponds to
Cardiac
Total gastrectomy + D2 LAD
90
[Esophago-Gastric Junction CA]
Siewert and Stein III corresponds to
Subcardiac
TTE or THE
91
[type of esophageal atresia]
EA without TEF
Type A
92
[type of esophageal atresia]
EA with proximal TEF
Type B
93
[type of esophageal atresia]
EA with distal TEF
Type C
most common
94
[type of esophageal atresia]
EA with double fistula
Type D
95
[type of esophageal atresia]
Tracheoesophageal fistula without atresia
Type E
96
[type of esophageal atresia]
Esophageal stenosis
Type F
97
___ is a thin submucosal ring in the lower esophagus
Schatzki Ring
