GI Surgery Flashcards
FIRST diagnostic test in patients with suspected esophageal disease
Barium swallow
Can be used when patient complains of dysphagia and no obstruction is seen on barium swallow
Barium-impregnated marshmallow, bread, hamburger
Diagnostic test for patients complaining of dysphagia with normal radiographic study
Endoscopy
Diagnostic test for patients when a motor abnormality is considered and barium swallow and endoscopy are normal
Manometry
Essential tool in preoperative evaluation of patients before antireflux surgery
Manometry
MOST DIRECT method of measuring increased esophageal exposure to gastric juice (NOT REFLUX)
24-hour ambulatory pH monitoring
GOLD STANDARD for diagnosis of GERD
24-hour ambulatory pH monitoring
MOST SPECIFIC symptom of foregut disease
Dysphagia
Primary cause of GERD
Permanent attenuation of collar sling musculature, with resultant opening of gastric cardia and loss of high-pressure zone measured in manometry
3 characteristics of defective LES
1) Mean resting pressure less than 6 mmHg
2) Overall sphincter length less than 2 cm
3) Intraabdominal sphincter length less than 1 cm
MOST IMPORTANT consideration affecting competence of GEJ
Intraabdominal sphincter length less than 1 cm
Grading of esophagitis: Small, circular, non confluent erosions
Grade I
Grading of esophagitis: Linear erosions lined with granulation tissue that bleeds easily when touched
Grade II
Grading of esophagitis: Linear erosions coalesce into circumferential loss of epithelium
Grade III
Grading of esophagitis: Cobblestone mucosa
Grade III
Grading of esophagitis: Stricture
Grade IV
Incidence of esophagitis in patients with GERD
10-15%
End stage of natural history of GERD
Barrett esophagus
HALLMARK of Barrett esophagus
Intestinal metaplasia
Earliest sign for malignant degeneration of Barrett esophagus
Severe dysplasia or intramucosal adenoCA
Fraction of patients with BE that present with malignancy
1/3
Barrett esophagus surveillance frequency
1) Every 2 years
2) Every 6 months if with low-grade dysplasia
Most important etiologic factor for the development of esophageal adenoCA
Barrett esophagus
Management for uncomplicated GERD
12-week empiric treatment with antacid
Most important factor predicting failure of medical therapy for GERD
Structurally defective LES
GERD surgery: Abdominal or thoracic 360-degree circumferential wrap of gastric fundus
Nissen fundoplication
GERD surgery: Chest approach; 280 degree anterior wrap
Belsey operation
GERD surgery: Abdominal approach; 180 degree wrap
Hill
GERD surgery: Esophageal lengthening
Collis gastroplasty
GERD surgery: Horseshoe-shaped silastic device placed around distal esophagus, keeping it in the abdomen
Angelchik prosthesis
GERD surgery: Pressure of distal esophageal sphincter should be restored to a level ___x the resting gastric pressure
2
Diaphragmatic hernia: Structure that herniates into thorax in sliding hernia
Cardia
Diaphragmatic hernia: Structure that herniates into thorax in paraesophageal hernia
Fundus
Sliding vs rolling diaphragmatic hernia: Phrenoesophageal ligament stretched but intact
Sliding
Weak in a Zenker diverticulum
Cricopharyngeus muscle (Killian area/triangle)
Sliding vs rolling diaphragmatic hernia: Most common
Sliding
Sliding vs rolling diaphragmatic hernia: Can evolve into a type III hernia
Sliding
Men vs women: Rolling esophageal hernia
Women
Type of diaphragmatic hernia: GEJ in the mediastinum
Type 3
Type of diaphragmatic hernia: Whole stomach migrates up into the chest by rotating 180 degrees around its longitudinal axis
Type 4
Acquired diaphragmatic hernia: Most common complications (3)
1) Occult GI bleeding from gastritis
2) Ulceration in herniated portion
3) Gastric volvulus
Triad of gastric volvulus
Borchardt’s triad
1) Pain
2) Nausea with inability to vomit
3) Inability to pass NGT
Diagnostic procedure that detects paraesophageal hernia
Barium esophagogram
Diagnostic procedure that detects pouch lined with gastric rugal folds lying 2 cm or more above margins of diaphragmatic crura
Fiber-optic esophagoscopy
Surgical management for esophageal hernia that can reduce recurrence rates if the hernia is > 8cm
Use of mesh
Diagnostic procedure for Boerhaave syndrome
Water-soluble (gastrografin) contrast esophagogram
Most common esophageal diverticulum
Zenker’s diverticulum
True vs false diverticulum: Zenker diverticulum
False
Achalasia: Classic triad
1) Dysphagia
2) Regurgitation
3) Weight loss
Infection that can cause achalasia
T. cruzi infection
Destroyed by T. cruzi, causing achalasia
Auerbach’s plexus
Chance of developing CA in achalasia
10%