Esophagus & Stomach Flashcards
What type of metaplasia in esophagus is associated with increased malignancy risk?
Columnar epithelium (intestinal type metaplasia)
What is the cause of Zenker’s diverticulum
Dysfunction of cricopharyngeal muscle - posterior mucosal herniation through Killian’s triangle
Type I gastric ulcer
Lesser curvature (decreased mucosal protection)
Type II gastric ulcer
Lesser curvature AND duodenum (increased acid secretion/H. pylori)
Type III gastric ulcer
Prepyloric (increased acid secretion/H. pylori)
Type IV gastric ulcer
Cardia/lesser curvature near GE junction (decreased mucosal protection)
Type V gastric ulcer
Anywhere - associated with NSAID use
Management of gastric bezoar
First try chemical dissolution (coca cola)
Stamm gastrostomy placement - where to place?
3cm below costal margin and 3cm left of midline
Thoracic duct course
Originates in cysterna chyli (T10-L3), enters chest to the right of the aorta, turns towards the left at T5 posterior to aortic arch, until neck where it drains into left jugular-subclavian junction
Most common vitamin deficiency in bariatric patients
Vitamin D
Pathologic findings of achalasia
T cell and eosinophil infiltration of myenteric plexus
Manometry findings of achalasia
Aperistalsis in distal esophagus, impaired LES relaxation (>15mmHg), and elevated LES resting pressures
Surgical management of achalasia
Heller myotomy and partial (Dor or Toupet) fundoplication
Dor fundoplication
180 degree anterior wrap
Toupet fundoplication
270 posterior wrap
What effect does adenosine have on gastrin secretion
Inhibits
Surgical options for refractory gastroparesis
Gastric pacemaker or pyloroplasty
Truncal vagotomy
Anterior and posterior vagus nerves are transected at distal esophagus, 4cm proximal to GE junction
Selective vagotomy
Anterior and posterior vagus nerves divided just below posterior celiac branches
Highly selective vagotomy
Nerves are dissected near terminal ends, with preservation of nerve of Latarjet (innvervates the pylorus)
Surveillance for Barrett’s
Lifelong PPI
If no dysplasia, endoscopy q3-5yrs with 4-quadrant biopsies every 2cm
Treatment of T1a esophageal cancer
Can consider endoscopic mucosal resection
Treatment of T1-T2 esophageal cancer (N0)
Upfront esophagectomy
Treatment of T3/T4 or nodal disease esophageal cancer
Neoadjuvant chemoradiation -> surgery
When to give adjuvant chemoradiation for esophageal cancer
After resection if node positive, pT3 or pT4
Size of staples for gastric sleeve
3.5mm large
Complications of jejunoileal bypass
Used to be used for obesity; high rate of nutritional deficiency and end-stage liver failure
Normal phi angle for gastric band
4-58 phi
Gastric poylps
Common in patients with history of H. pylori infection. Low malignant potential
Nutcracker esophagus
Swallowing contractions are too powerful; often caused by GERD
Gastric MALT lymphoma management
If low-grade: antibiotics
If high-grade: chemo
Where are most of the gastrin-secreting G cells located
Antrum
Management of esophageal SCC
If <5cm from cricopharyngeus -> definitive chemorads
If >5cm distance -> neoadjuvant chemorads then surgery for T2 and above
