Esophagus Review Flashcards
What kind of cell is the esophagus typically populated with?
stratified squamous epithelium
What is the first kind of change you expect, within the esophagus, after prolonged low pH exposure?
- Metaplasia
i. e. replacement of stratified squamous epithelium by intestinal columnar epithelium
What is necessary on pathology, from esophageal biopsies, to diagnose Barrett’s esophagus?
- metaplasia (intestinal columnar epithelium
2. goblet cells (this is key, for test taking)
indications for surgical treatment of GERD?
- 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)
patient presents with nausea, bloating, and early satiety 1 year after fundoplication…what should you be worried about?
- vagal injury causing gastroparesis
- may need partial gastrectomy with roux-en-y, get nuclear medicine gastric emptying study and EGD
most common place for iatrogenic esophageal injury after diagnostic EGD?
Killian’s triangle, just superior to cricopharyngeas muscle
What forms Killian’s triangle?
- inferior pharyngeal constrictor muscles superiorly
- cricopharyngeus muscle inferiorly
right vagus nerve becomes the what nerve at the level of the GE junction?
posterior vagus
left vagus nerve turns into what nerve at the level of the GE junction?
anterior vagus nerve
what does the posterior vagus nerve give rise to more distally?
- Criminal nerve of Grassi
- eventually joins the celiac plexus
what does the anterior vagus nerve give rise to more distally?
gives rise to the hepatic branch, and gives off the nerve of Latarjet which innervates the pylorus
who is a candidate for non-operative management in esophageal perforation?
- iatrogenic injuries, patients are NPO and there is less gastric spillage
- clinically stable young healthy patients
- present within 24 hours of injury
For which conditions is a heller myotomy good for?
- hypertensive lower esophageal sphincter
- achalasia
when would you consider neoadjuvant chemorads in esophageal adenocarcinoma?
T1b lesion, invading the submucosa
What is a Stewart class I tumor?
- esophageal cancer 1-5 cm above GEJ
what is a stewart class II tumor?
esophageal cancer 1cm above to 2 cm below the GEJ
What is a Stewart class III tumor?
esophageal cancer 2cm or more below the GEJ
during endoscopy for hematemesis, what sign is associated with the highest rate of a rebeeled?
active pulsatile bleeding
approach for distal esophageal injury
left posterolateral thoracotomy
approach to mid esophageal injury
right postero-lateral thoracotomy
narrowest portion of esophagus under normal conditions
cricopharyngeus muscle
predominant symptom in achalasia
dysphagia to solids +/- liquids
benefit of transthoracic esophagectomy vs transhiatal esophagectomy
- decreased risk of anastomotic leak
benefit of transhiatal esophagectomy vs tranthoracic esophagectomy
decreased risk of pulmonary complications
how much intra-abdominal length is needed on the esophagus to adequately treat reflux?
- you want 2-3 cm, tension free, within the abdomen
what maneuver can you use to add length to the intra-abdominal esophagus
- mediastinal mobilization
- if that fails collis gastroplasty
Plummer-Vinson syndrome
esophageal webs
dysphagia
anemia
which adenocarcinoma tumors of the esophagus can be resected endoscopically?
- pTis, high grade dysplasia confined to the basement membrane
- T1a, tumor invades the lamina propria or muscularis mucosa (intramucosal)
Zenker Diverticulum fase or true?
false pulsion diverticulum
Epiphrenic diverticulum false or true?
false pulsion diverticulum
when would you scope someone for GERD
- advanced age
- unintentional weight loss
- blood in stools
- dysphagia
- basically you need other concerning symptoms besides just heart burn
