Esophagus Review

Question 1

What kind of cell is the esophagus typically populated with?

Answer 1

stratified squamous epithelium

Question 2

What is the first kind of change you expect, within the esophagus, after prolonged low pH exposure?

Answer 2

• Metaplasia

i. e. replacement of stratified squamous epithelium by intestinal columnar epithelium

Question 3

What is necessary on pathology, from esophageal biopsies, to diagnose Barrett’s esophagus?

Answer 3

1. metaplasia (intestinal columnar epithelium

2. goblet cells (this is key, for test taking)

Question 4

indications for surgical treatment of GERD?

Answer 4

• extra esophageal symptoms (cough, aspiration, persistent chest pain)
• failure of medical management
• adverse effects to medical management
• structural abnormality as a result to GERD (stricture, Barrett esophagus)

Question 5

patient presents with nausea, bloating, and early satiety 1 year after fundoplication…what should you be worried about?

Answer 5

• vagal injury causing gastroparesis

- may need partial gastrectomy with roux-en-y, get nuclear medicine gastric emptying study and EGD

Question 6

most common place for iatrogenic esophageal injury after diagnostic EGD?

Answer 6

Killian’s triangle, just superior to cricopharyngeas muscle

Question 7

What forms Killian’s triangle?

Answer 7

• inferior pharyngeal constrictor muscles superiorly

- cricopharyngeus muscle inferiorly

Question 8

right vagus nerve becomes the what nerve at the level of the GE junction?

Answer 8

posterior vagus

Question 9

left vagus nerve turns into what nerve at the level of the GE junction?

Answer 9

anterior vagus nerve

Question 10

what does the posterior vagus nerve give rise to more distally?

Answer 10

• Criminal nerve of Grassi

- eventually joins the celiac plexus

Question 11

what does the anterior vagus nerve give rise to more distally?

Answer 11

gives rise to the hepatic branch, and gives off the nerve of Latarjet which innervates the pylorus

Question 12

who is a candidate for non-operative management in esophageal perforation?

Answer 12

• iatrogenic injuries, patients are NPO and there is less gastric spillage
• clinically stable young healthy patients
• present within 24 hours of injury

Question 13

For which conditions is a heller myotomy good for?

Answer 13

• hypertensive lower esophageal sphincter

- achalasia

Question 14

when would you consider neoadjuvant chemorads in esophageal adenocarcinoma?

Answer 14

T1b lesion, invading the submucosa

Question 15

What is a Stewart class I tumor?

Answer 15

• esophageal cancer 1-5 cm above GEJ

Question 16

what is a stewart class II tumor?

Answer 16

esophageal cancer 1cm above to 2 cm below the GEJ

Question 17

What is a Stewart class III tumor?

Answer 17

esophageal cancer 2cm or more below the GEJ

Question 18

during endoscopy for hematemesis, what sign is associated with the highest rate of a rebeeled?

Answer 18

active pulsatile bleeding

Question 19

approach for distal esophageal injury

Answer 19

left posterolateral thoracotomy

Question 20

approach to mid esophageal injury

Answer 20

right postero-lateral thoracotomy

Question 21

narrowest portion of esophagus under normal conditions

Answer 21

cricopharyngeus muscle

Question 22

predominant symptom in achalasia

Answer 22

dysphagia to solids +/- liquids

Question 23

benefit of transthoracic esophagectomy vs transhiatal esophagectomy

Answer 23

• decreased risk of anastomotic leak

Question 24

benefit of transhiatal esophagectomy vs tranthoracic esophagectomy

Answer 24

decreased risk of pulmonary complications

Question 25

how much intra-abdominal length is needed on the esophagus to adequately treat reflux?

Answer 25

• you want 2-3 cm, tension free, within the abdomen

Question 26

what maneuver can you use to add length to the intra-abdominal esophagus

Answer 26

• mediastinal mobilization

- if that fails collis gastroplasty

Question 27

Plummer-Vinson syndrome

Answer 27

esophageal webs
dysphagia
anemia

Question 28

which adenocarcinoma tumors of the esophagus can be resected endoscopically?

Answer 28

• pTis, high grade dysplasia confined to the basement membrane
• T1a, tumor invades the lamina propria or muscularis mucosa (intramucosal)

Question 29

Zenker Diverticulum fase or true?

Answer 29

false pulsion diverticulum

Question 30

Epiphrenic diverticulum false or true?

Answer 30

false pulsion diverticulum

Question 31

when would you scope someone for GERD

Answer 31

• advanced age
• unintentional weight loss
• blood in stools
• dysphagia
• basically you need other concerning symptoms besides just heart burn