Esophagus

Question 1

what are the layers of the esophagus?

Answer 1

mucosa
submucosa
muscularis propria
NO SEROSA

Question 2

What is the blood supply to the esophagus?

- cervical, thoracic, abdominal

Answer 2

cervical: inferior thyroid artery
thoracic: branches off aorta
Abdominal: inferior phrenic artery, left gastric

Question 3

What muscle comprises the UES and what innervates it?

Answer 3

cricopharyngeus innervated by superior laryngeal nerve

Question 4

Part of the neck where Zenker’s diverticulum is most lkely to occur?

Answer 4

Killian’s triangle

-triangular are ain the wall of the pharynx located superior to cricopharyngeus and inferior to constrictors

Question 5

Best study to Tx esophageal perforation?

Answer 5

contrast esophagography

 - use water soluble contrast followed by dilute barium (if no perf is seen)
 - if aspiration risk, use only dilute barium

Question 6

MC site of esophageal perforation?

Answer 6

distal esophagus, left posterolateral aspect, 2-3cm above GEJ

Question 7

MC site of iatrogenic esophageal pref?

Answer 7

at the cricopharyngeus muscle

Question 8

Initial Tx for esophageal perforation?

Answer 8

1. resuscitation and abx (GNR, anaerobes, fungi)

2. then it depends on if the leak is contained or not

Question 9

Tx for isolated cervical esophageal injury?

Answer 9

open neck and place drains

Question 10

Steps for Tx for thoracic esophageal perforation?

Answer 10

1. left thoracotomy
2. debride devitalized tissue
3. myotomy to visualize full extent of mucosal damage
4. repair in 2 layers - inner absorbable, outer permanent
5. buttress with vascularized tissue
6. NG and drain chest, enteral access?

Question 11

What additional Tx do you need to perform if esophageal perf is from achalasia?

Answer 11

contralateral myotomy

Question 12

Tx for unstable patient with esophageal perforation?

Answer 12

exclusion and diversion, control fistula, J tube

Question 13

Manometry findings in achalasia?

Answer 13

incomplete LES relaxation with aperistalsis or hypotonic esophageal contractions

Question 14

Achalasia UGI findings?

Answer 14

Bird’s beak sign with esophageal dilation

Question 15

Pathophys of achalasia?

Answer 15

loss of NO producing inhibitory neurons in the LES

Causes: idiopathic or 2/2 Chagas

Question 16

what is pseudoachalasia?

Answer 16

achalasia caused by malignancy

Question 17

Tx for achalasia?

Answer 17

minimally invasive heller myotomy with partial fundoplication

Question 18

How far on esophagus/stomach do you perform your Heller for achalasia ?

Answer 18

6cm on esophagus, 2cm on stomach

Question 19

manometry for isolated hypertensive LES?

Answer 19

high basal LES pressure with complete relaxation and normal peristalsis

Question 20

Tx for isolated hypertensive LES

Answer 20

Ca channel blocker, nitrates, heller myotomy

Question 21

Manometry for diffuse esophageal spasm?

Answer 21

normal LES pressure and relaxation, HIGH AMPLITUDE UNCOORDINATED ESOPHAGEAL CONTRACTIONS

Question 22

Tx for Diffuse esophageal spasm?

Answer 22

Ca channel blockers, nitrates, surgery not too effective. need long segment myotomy in extreme cases

Question 23

Manometry findings in nutcracker esophagus?

Answer 23

Normal LES pressure and relaxation, high amplitude and coordinated esophageal contractions

Question 24

Tx for nutcracker esophagus?

Answer 24

Ca channel blockers, nitrates, long segment myotomy

Question 25

Pathophysiology of Zenker’s diverticulum?

Answer 25

dysfunction of UES causing increased esophageal pressure