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Esophagus Flashcards

1
Q

the start of the esophagus at the level of what cartilage

A

cricoid

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2
Q

the esophagus ends at the level of?

A

T11

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3
Q

What are the 3 narrowings of the esophagus

A
  1. Cricopharyngeus (C6)
  2. Left mainstem bronchus (T4)
  3. LES (T11)
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4
Q

The artery of the cervical portion of the esophagus is the

A

inferior thyroid artery

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5
Q

the artery of the thoracic portion of the esophagus is the

A

bronchial arteries

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6
Q

the artery of the abdominal portion of the esophagus

A

Left gastric

inferior phrenic

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7
Q

The venous drainage of the cervical portion of the esophagus

A

inferior thyroid

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8
Q

The venous drainage of the thoracic portion of the esophagus

A

bronchial veins

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9
Q

The venous drainage of the abdominal portion of the esophagus

A

coronary vein

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10
Q

[diagnostics]

the first diagnostic test in patients with suspected esophageal disease

A

barium swallow

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11
Q

[diagnostics]

test indicated when a motor abnormality of the esophagus on the basis of complaints

A

manometry

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12
Q

[diagnostics]

most direct method of measuring increased esophageal exposure to gastric juice

A

24 hours ambulatory pH monitoring

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13
Q

[diagnostics]

gold standard for the diagnosis of GERD

A

24 hour ambulatory pH monitoring

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14
Q

the resting pressure of the LES is around

A

6 to 26mmHg

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15
Q

A defective LE sphincter has a mean pressure of

A

<6 mmHg

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16
Q

a defective LE sphincter has an overall length of

A

<2cm

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17
Q

a defective LES has an intraabdominal length of

A

<1cm

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18
Q

[diagnosis]

squamous epithelium turned to columnar in the LES

A

barrett esophagus

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19
Q

what is the hallmark of intestinal metaplasia in barrett esophagus

A

presence of intestinal goblet cells

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20
Q

[GERD surgeries]

360 degree fundoplication around the LES

A

Nissen

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21
Q

[GERD surgeries]

180 degree posterior fundoplication

A

Toupet

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22
Q

[GERD surgeries]

180 degree anterior fundoplication

A

Dor

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23
Q

[GERD surgeries]

use a stapler to divide the cardia and upper stomach

A

collis gastroplasty

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24
Q

[GERD surgeries]

240 to 279 degree fundoplication

A

Belsey Mark IV

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25
Q

[GERD surgeries]

Arcuate ligament repair + gastropexy to diaphragm

A

Hill Posterior Gastropexy

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26
Q

[diagnosis]

structural deterioration of the phrenoesophageal membrane

A

diaphragmatic hernia

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27
Q

[diagnosis: hiatal hernia]

heartburn, regurgitation

A

sliding hernia

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28
Q

[diagnosis: hiatal hernia]

dysphagia, postprandial fullness, massive bleeding, gastric volvulus, infarction

A

paraesophageal hernia

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29
Q

[diagnosis: hiatal hernia]

chest pain, retching with inability to vomit, inability to pass a NGT

A

borchdart triad

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30
Q

[Type of hiatal hernia]

upward dislocation of GEJ and cardia into the thorax through the esophageal hiatus of diaphragm

A

Type 2: sliding hernia

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31
Q

[Type of hiatal hernia]

upward dislocation of the gastric fundus along side a Normally positioned cardia

A

Type 2: paraesophageal

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32
Q

[Type of hiatal hernia]

herniation of part of the stomach without displacement of the GEJ

A

Type 2: paraesophageal

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33
Q

[Type of hiatal hernia]

combined herniation of the cardia and fundus

A

Type 3: combined hernia

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34
Q

[treatment of diaphragmatic hernia]

treated medically

A

sliding hernia

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35
Q

[treatment of diaphragmatic hernia]

treated largely surgical

A

paraesophageal hernia

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36
Q

___ triad

inability to pass NGT, retching without actual food regurgitation, epigastric pain

A

Borchardt triad

Gastric volvulus

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37
Q

[diagnosis]

mucosa line pouches that protrude from the esophageal lumen, contains all layers of esophageal wall

A

true esophageal diverticula

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38
Q

[diagnosis]

mucosa line pouches that protrude from the esophageal lumen, contains only submucosa and mucosa

A

false esophageal diverticula

more common

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39
Q

most common esophageal diverticula

A

zenker diverticula

40
Q

area of potential weakness situated behind the esophagus at the level of the cricopharyngeus

A

killian triangle

41
Q

[surgical management of zenker diverticula]

2cm or less

A

Pharyngomyotomy

42
Q

[surgical management of zenker diverticula]

> 2cm

A

diverticulectomy or Diverticulopexy

43
Q

[surgical management of zenker diverticula]

wide based

A

diverticuloplexy

44
Q

[diagnose[

diverticula located 5cms above and below the level of carina

A

mid thoracic diverticula

45
Q

[kind of mid-thoracic diverticula]

usually due to granulomatous diseases

A

traction diverticula

46
Q

[kind of mid-thoracic diverticula]

more common, diffuse motility disorders of the esophagus

A

pulsion diverticula

47
Q

[diagnose]

pulsion diverticula that occurs distal to 10cm of esophagus

A

epiphrenic diverticula

48
Q

[diagnose]

loss of peristaltic waveform in the esophageal body and failure of the LES to relax leading to functional outflow obstruction

49
Q

[diagnose]

neurogenic degeneration in the esophagus; hypertension of LES, failure of the LES to relax,

elevation of intraluminal esophageal pressure

50
Q

[diagnose]

hypertensive LES
Apresistalsis of esophageal body
failure of LES to relax

51
Q

What is the surgical management of achalasia?

A

Heller myotomy and partial fundoplication

52
Q

wha is the most effective non-surgical treatment; risk of perforation

A

pneumatic dilatation

53
Q

[diagnosis]

if in the esophagogram a corkscrew deformity is seen,..

A

diffuse and segmental esophageal spasms

54
Q

[diagnosis]

in manometry, simultaneous waveforms and multipeaked contractions; 20% or more out of 10 wet swallows

A

diffuse segmental esophageal spasm

55
Q

what is the most common primary esophageal motility disorder

A

nutcracker esophagus

56
Q

[diagnosis]

the mean peristaltic amplitude in distal esophagus is >180 mmHg; there is an increased duration of contraction; normal peristaltic sequence

A

nutcracker esophagus

57
Q

[diagnosis]

elevated LES pressure (>26 mmHg); normal LES relaxation; normal peristalsis in the esophageal body

A

hypertensive LES

58
Q

What is a true surgical emergency in the esophagus?

A

esophageal perforation

59
Q

____ syndrome

spontaneous rupture of the esophagus; usual history of resisting vomiting

A

Boerhaave syndrome

60
Q

In diagnosing esophageal perforation, what is the position in doing water soluble contrast esophagogram?

A

lateral decubitus position

61
Q

[phase of injury: caustic injury]

pain in the mouth, substernal region, hypersalivation, odynophagia, dysphagia, pain, fever, bleeding, vomiting

62
Q

[phase of injury: caustic injury]

period when the esophagus is the weakest

63
Q

the most common site of esophageal perforation in caustic injury

A

mid esophagus

64
Q

[Zargar Classification]

ulcerations, mucosal and submucosal

A

Zargar 2

A: superficial
B: deep

65
Q

[Zargar Classification]

necrosis, transmural

A

Zargas 3

A: focal
B: extensive

66
Q

[diagnose]

plaque-like, erosive, papillary

can either be intraepithelial, intramucosal, submucosal

A

squamous cell CA

67
Q

[diagnosis]

IDA, dysphagia, esophageal webs

A

plummer-vinson sydnrome

68
Q

Barret esophagus is a precursor of this CA

69
Q

Achalasia is a precursor of this CA

A

squamous cell CA

70
Q

[diagnose]

dysphagia, stridor, coughing, choking, aspiration pneumonia, bleeding, hoarseness, jaundice, bone pain, anorexia

A

esophageal CA

71
Q

[functional grade of dysphagia]

Patient able to take liquids only

72
Q

[functional grade of dysphagia]

patient able to take semisolids but unable to take any food

73
Q

[functional grade of dysphagia]

requires liquids with meals

74
Q

[functional grade of dysphagia]

unable to take liquids, but able to swallow saliva

75
Q

[diagnostics for esophagus]

evaluation of dysphagia to visualize mucosa, luminal distensibility, motility, and anatomic abnormalities

A

barium swallow

76
Q

[diagnostics for esophagus]

this provides more accurate result for T and N staging

A

endoscopic UTZ

77
Q

[surgical management]

Stage I to III (locoregional disease)

A

Esophagectomy

78
Q

What are the contracindications for curative surgery

A
  1. Age >75
  2. FEV1 < 1.25
  3. EF <40%
  4. > 20% weight loss
  5. locally advanced tumor
79
Q

[Esophagectomy approach]

esophageal CA limited to the intramucosal layer

A

vagal sparing esophagectomy

80
Q

[Esophagectomy approach]

upper midline laparotomy
left cervical incision

A

transhiatal

Orringer and Sloan

81
Q

[Esophagectomy approach]

upper midline incision
right thoracotomy is done

A

transthoracic

Ivor-Lewis

82
Q

[Esophagectomy approach]

separate laparotomy
right thoracotomy
cervical incision

A

Three-field

McKeown

83
Q

[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

A

left thoracoabdominal

Akiyama

84
Q

___ maneuver is the mobilization of the fixed portions of the duodenum

85
Q

in Oringger procedure, these arteries are preserved

A

Right Gastric and right gastroepiploic

86
Q

[Bypass approaches]

allow better maintenance of an esophageal substitute; shortest

A

transthoracic

87
Q

[Bypass approaches]

best direct conduit to the neck

reduced possibility of recurrent malignant dysphagia

A

substernal

88
Q

[Esophago-Gastric Junction CA]

Siewert and Stein I corresponds to

A

Esophageal

TTE + 2 field LAD

89
Q

[Esophago-Gastric Junction CA]

Siewert and Stein II corresponds to

A

Cardiac

Total gastrectomy + D2 LAD

90
Q

[Esophago-Gastric Junction CA]

Siewert and Stein III corresponds to

A

Subcardiac

TTE or THE

91
Q

[type of esophageal atresia]

EA without TEF

92
Q

[type of esophageal atresia]

EA with proximal TEF

93
Q

[type of esophageal atresia]

EA with distal TEF

A

Type C

most common

94
Q

[type of esophageal atresia]

EA with double fistula

95
Q

[type of esophageal atresia]

Tracheoesophageal fistula without atresia

96
Q

[type of esophageal atresia]

Esophageal stenosis

97
Q

___ is a thin submucosal ring in the lower esophagus

A

Schatzki Ring

Pathology (36 decks)

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