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Surgery > Fiser ABSITE Ch. 29 Esophagus > Flashcards

Fiser ABSITE Ch. 29 Esophagus Flashcards

1
Q

What are the layers of the esophagus?

A

stratified squamous epithelium (mucosa), circular inner muscle layer, outer longitudinal muscle layer; no serosa

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2
Q

What is the blood supply of the cervical esophagus? and abdominal esophagus?

A

Cervical esophagus - supplied by the inferior thyroid artery

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3
Q

Which direction does the lymphatics of the esophagus drain?

A

upper 2/3 drains cephalad, lower 1/3 caudad

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4
Q

What kind of muscle is in the upper esophagus? lower esophagus?

A

striated muscle, smooth muscle

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5
Q

Right vagus nerve - travels on ____ portion of stomach as it exits chest; becomes ____ plexus; also has the criminal nerve of ___ > can cause persistently high acid levels postoperatively if left undivided

A

posterior, celiac, Grassi

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6
Q

Left vagus nerve - travels on ____ portion of stomach; goes to liver and biliary tree

A

anterior

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7
Q

The upper esophageal sphincter is how far from the incisors? and lower?

A

15 cm, 40 cm

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8
Q

What is the most common site of esophageal perforation (usually occurs with EGD)?

A

cricopharyngeus muscle

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9
Q

What muscle comprises the upper esophageal sphincter and prevents air swallowing?

A

cricopharyngeus muscle

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10
Q

What are the 3 anatomic areas of narrowing of the esophagus?

A

cricopharyngeus muscle, compression by the left mainstem bronchus and aortic arch, diaphragm

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11
Q

What is the surgical approach to the cervical esophagus? upper 2/3 thoracic? Lower 1/3 thoracic?

A

Cervical esophagus - left, Upper _ thoracic - right (avoids the aorta), Lower _ thoracic - left (left-sided course in this region)

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12
Q

What is the cause in primary esophageal dysfunction? secondary?

A

unknown in primary; secondary includes systemic disease, gastroesophageal reflux disease (GERD; most common), scleroderma, polymyositis

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13
Q

What is the diagnostic procedure of choice for dysphagia and odynophagia?

A

barium swallow (better at picking up masses)

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14
Q

What is the usual cause of cervical esophageal dysphagia?

A

plummer-vinson syndrome

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15
Q

What is the 3 parts of tx for plummer-vinson syndrome?

A

dilation, Fe, screen for oral CA

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16
Q

What can occur between the cripharyngeus and pharyngeal constrictors?

A

Zenker’s diverticulum

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17
Q

What is the tx for Zenker’s diverticulum?

A

cricopharyngeal myotomy; Zenker’s itself can either be resected or suspended

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18
Q

What do you get on POD #1 after a cricopharyngeal myotomy for Zenker’s?

A

esophagogram

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19
Q

How is a traction diverticulum different from Zenker’s?

A

Zenker’s is a false diverticulum and lies posterior; traction is a true diverticulum is usually lateral in the mid esophagus

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20
Q

What is the tx for a traction diverticulum of the esophagus?

A

excision and primary closure; may need palliative therapy if due to invasive CA

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21
Q

What is caused by failure of peristalsis and lack of LES relaxation after food bolus, and is secondary to neuronal degeneration in muscle wall?

A

Achalasia

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22
Q

What is the medical tx for achalasia (2)? what is next step?

A

CCB, nitrates; LES dilation (effective in 60%)

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23
Q

What is the next step in tx of achalasia if CCB, nitrates and LES dilation fail?

A

Heller myotomy

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24
Q

What infection can produce similar sx to achalasia?

A

T. cruzi

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25
Q

Chest pain; other sx similar to achalasia. May have psych history, normal LES tone, strong unorganized contractions.

A

Diffuse esophageal spasm

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26
Q

What are 4 types of tx for diffuse esophageal spasm?

A

CCB, nitrates, antispasmotics, Heller myotomy

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27
Q

Causes dysphagia, loss of LES tone; most have strictures, fibrous replacement of smooth muscle _ Tx: esophagectomy; Nissen may be effective in some

A

Scleroderma

28
Q

GERD sx with bloating suggests what?

A

aerophagia and delayed gastric emptying

29
Q

What is the best test for GERD?

A

pH probe

30
Q

What is the surgical tx for GERD?

A

Nissen

31
Q

The key maneuver in Nissen is identifcation of what?

A

left crura

32
Q

What is name of the approach through the chest in a Nissen?

A

Belsey

33
Q

During a Nissen, when not enough esophagus exists to pull down into abdomen, can staple along stomach and create a “new” esophagus. What is this called?

A

Collis gastroplasty

34
Q

Name the type of hiatal hernia: Sliding hernia from dilation of hiatus (most common); often associated with GERD

A

Type I

35
Q

Name the type of hiatal hernia: Paraesophageal; hole in the diaphragm alongside esophagus, normal GE junction.

A

Type II

36
Q

What is a Type III hiatal hernia? and type IV?

A

Type III - combined _ Type IV - entire stomach in the chest plus another organ (i.e., colon, spleen)

37
Q

Almost all pts with Schatzki’s ring have an associated ___

A

sliding hiatal hernia

38
Q

What is the tx for Schatzki’s ring?

A

dilatation of the ring usually sufficient; may need antireflux procedure

39
Q

What is the transformation in pts with Barrett’s esophagus?

A

squamous metaplasia to columnar epithilium

40
Q

Pts with Barrett’s esophagus are at 50x increased risk for what?

A

adenocarcinoma

41
Q

Severe Barrett’s dysplasia is an indication for what?

A

esophagectomy

42
Q

Uncomplicated Barrett’s can be treated like GERD with PPI or Nissen and surgery will decrease esphagitis and further metaplasia but it will not prevent what?

A

malignancy or cause regression of the columnar lining

43
Q

Pts with Barrett’s esophagus who get a Nissen still need careful lifetime follow up with what?

A

EGD

44
Q

Esophageal tumors are almost always malignant. How does it spread?

A

submucosal lymphatic channels

45
Q

What is the best test for unresctablity in esophageal CA?

A

Chest/abdominal CT

46
Q

What is the #1 esophageal CA? What type occurs most often in the upper 2/3?

A

Adenocarcinoma; Squamous cell carcinoma

47
Q

Supraclavicular nodes in esophageal CA indicate what?

A

unresectability

48
Q

Distant metastases with esophageal CA is a contraindication to what? what is the survival?

A

esophagectomy,

49
Q

What is the mortality from surgery in esophagectomy for CA? and what percentage is it curative?

A

5%, 20%

50
Q

What is the primary blood supply to stomach after replacing esophagus in esphagectomy?

A

right gastroepiploic artery (have to divide left gastric and short gastrics)

51
Q

What is the name of the type of esophagectomy with an abdominal incision and right thoracotomy -> exposes all of the esophagus; intrathoracic anasomsis

A

Ivor Lewis

52
Q

What type of esophagectomy may be choice in young pts with benign disease when you want to preserve gastric function.

A

Colonic interposition

53
Q

What do you need after esophagectomy on post op day 7?

A

contrast study to rule out leak

54
Q

Name two chemo agents that can be used with esophageal CA for node positive disease or use preop to shrink tumors?

A

5FU and cisplatin

55
Q

In esophageal CA with malignant fistulas, most die within 3 months due to what?

A

aspiration

56
Q

What is the most common benign tumor of the esophagus?

A

Leiomyoma

57
Q

Diagnosis of Leiomyoma is esophogram, endoscopy to rule out CA. Why don’t you bx?

A

can form scar and make subsequent resection difficult

58
Q

Tx for Leiomyoma of the esophagus is excision via thoractomy. What are the 2 indications?

A

> 5 cm or sx

59
Q

Management for caustic esophageal injury: NG tube? Induce vomiting? Irrigation?

A

no, no, no

60
Q

What is first step in dx in caustic esophageal injury? then what?

A

CXR and AXR to look for free air; endoscopy to assess lesion (but not with suspected perforation)

61
Q

What is the most common cause of esophageal perforation?

A

EGD

62
Q

What is the most common site of esophageal perforation?

A

cricopharyngeus muscle

63
Q

How to dx esophageal perforation?

A

gastrograffin swallow followed by barium swallow

64
Q

What is the tx for esophageal perforation that is contained, self-draining and no systemic effects?

A

Conservative: IVF, NPO, spit

65
Q

What type of flap can be used with repair of esophageal perforation to help the area heal?

A

intercostal muscle pedicle flap

66
Q

What is Hartmann’s sign?

A

mediastinal crunching on ascultation

67
Q

How to dx Boerhaave’s syndrome?

A

gastrofrafin swallow

Surgery (33 decks)

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