Esophagus, Stomach Flashcards
First diagnostic test in patients with suspected esophageal disease
Barium swallow.
Determines ANATOMIC problems. if you want to do functional, you can use marshmallow impregnated with barium swallow
Most direct mehod of measuring increased esophageal exposure to gastric juice (not reflux)
24 hour ambulatory pH monitoring
Gold standard for the diagnosis of Gerd
24 hour ambulatory pH monitoring
Most common esophageal pathology
GERD
Most common esophageal pathology
GERD
MC defect of GERD
Intrabdominal esophageal length is less than 1 cm (normal: 2-4cm)
MC antireflux surgical prodecure and is the surgical standard of care
Nissen fundoplication
- full 360 degrees
Partial: Toupet fundoplication and Dor Fundoplication
Increase length: Collis gastroplasty
MC antireflux surgical prodecure and is the surgical standard of care
Nissen fundoplication
- full 360 degrees
Partial: Toupet fundoplication and Dor Fundoplication
Increase length: Collis gastroplasty
MC type of esophageal hernia
Type 1 (slidding hernia) - upward dislocation fo GE junction and cardia into the thorax throgh the esopageal hiatus of the diaphragm. CM: GERD
vs
Type 2 rolling or paraesophageal hernia: fundus
CM obstructive. tx sx
Type 3: combin
chest pain
Retching with inability to vomit
Inability to pass NGT
What do you call this triad
Borchardt triad
- Indicative of incarcerated intra thoracic stomach
MC esophageal diverticula
Zenker diverticulum
- d/t high pressure generated in the hypopharynx
potential weakness behind the cricopharyngeus muscle. A RF for zenker diverticulum
Killian triangle: potential weakness behind the cricopharyngeus muscle
Hypertensive LES
Aperistalsis of esophageal body
Failure of LES to relax
Achalasia
Treatment of choice for achalasia
Heller myotomy + partial fundoplication
MC primary esophageal motility disorder
Nutcracker esophagus / Hypertensive peristalsis
In caustic injury, this is the phase where px is most symptomatic.
Acute necrotic phase (first phase)
In caustic injury, this is the phase where you should do surgery
First phase acute necrotic phase (1 to 4 days)
In caustic injury, this is the phase where the esophagus is at its weakest
2nd phase Ulceration and granulation phase (3-5 days)
MC site of perforation in caustic injuries
Mid esophagus
MC type if esophageal CA
SCC
Cervical sympathetic nerve involved in Horner syndrome (ptosis myosis and anhydrosis)
C4
Cervical sympathetic nerve involved in Horner syndrome (ptosis myosis and anhydrosis)
C4
CURATIVE surgery for esophageal carcinoma
Transthoracic (Ivor Lewis)
Vs transhiatal (Orringer and Sloan)
MCC of drug induced esophageal web
FeSO4
Dysphagia Atrophic oral mucosa Spoon shaped fingers Brittle nails chronic anemia
Plummer vinson syndrome
Most impt management for tracheoesophageal atresia /fistula
Ventilatory support
Criminal nerve of Grassi supplies what organ?
Posterior fundus of the stomach
Secretes HCl and intrinsic factor (for B12)
Parietal or Oxyntic cells
Most numerous cells in the stomach
Chief / Zymogenic cells
Secretes pepsinogen
Gastric lipase
Leptin
Cells left after vagotomy
Enterochromaffin LIKE cells : secretes Histamine
Gastric cells which secretes serotonin A. Enterochromoffin cells B. Enterochromoffin like cells C. S cells D. Zymogenic cell
A
Gold standard for h pylori diagnosis
Histologic examination of antral mucosal biopsy
Standard for test to CONFIRM eradication of H pyrloru post treatment
Urease breath test1
MC type of gastric ulcer
Type 1 antral lesser curvature
Type V NSAID induced
MC pancreatic tumor in patinets with MEN I
Gastrinoma (Zollinger Ellison syndrome)
MC neoplasm of the stomach
Adenocarcinoma 95%
Type of stomach CA with worse prognosis
Diffuse type
- leather bottle
LN metastasis at the pelvix cul de sac secondary to gastric CA
Blumer shelf
Gold standard for dx of gastric CA
most sensitive and most specific
Upper endoscopy with biopsy
MC location of gastric CA
Antrum / distal 75%
Vs ulcers: lesser curvature
Tx of choice: radical subtotal gastrectomy
Characteristic of Diffused type of gastric cancer
Signet ring cells
Lanitis plastica
Leather bottle appearance
Non distendable stomach
First line treatment for low grade gastric lymphoma
H. pylori eradication
If highgrade: chemoradiation
Rapidly increasing gastric tumor, (+) donut sign on barium study
GIST: thickening of the submucosa
Case: 30 yo man with intermittent bleeding. On endoscopy, there is normal appearing mucosa but with pulsating blood. Dx?
Dieulafoy lesion
Bleeding from a submucosal vessel
Surgical management for Pyloric stenosis
Fredet Ramsted pyloromyotomy
- spreading he muscle mucosa until it bulges to level of serosa
- serosa and muscle layer only
