Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

General Surgery > Oesophagus > Flashcards

Oesophagus Flashcards

1
Q

Oesophagus pierces the diaphragm at level of ___, together with ___

A

T10, vagus nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common site of oesphageal perforation is at ___

A

cricopharyngeus (UES)

located at lower border of cricoid cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Lower esophageal sphincter is created due to?

A

High pressure in right crus of diaphragm

Diaphragmatic fibers loop around oesophagus at oesophageal hiatus (OGJ), contracts when abdominal pressure increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Muscles in diff parts of oesophagus

A

upper 1/3rd: striated
middle: striated + smooth
lower: smooth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Meissner’s plexus located in ____, Auerbach’s plexus located in ___

A

Submucosa

Muscularis propria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Read up on anatomy of thorax in page 100 of medbear

A

medbear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pain with swallowing is known as

A

odynophagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Two types of dysphagia

A

Oropharyngeal, oesophageal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 4 Ts that cause mechanical dysphagia?

A

Thymus, thyroid, teratoma, terrible lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Dysphagia can be classified into

A

Neuromuscular disease

Mechanical lesions - intraluminal, mural, extramural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Neuromuscular causes of oropharyngeal dysphagia

A

Central: parkinson’s, stroke

Peripheral: myasthenia gravis, myopathies, peripheral neuropathy

Post-infectious: poliomyelitis, syphilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Neuromuscular causes of oesophageal dysphagia

A

Primary motility disorder: achalasia, spastic disorders

Secondary motility disorders: scleroderma, multiple sclerosis, sjogren’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can cause strictures in the oesophagus?

A

Chemical - caustic ingestion
Peptic - GERD
Radiation
Medication
Malignancy
Eosinophilic oesophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of odynophagia

A

Chemicals
Drug-induced
Radiation
Infectious - candida, HSV
Ulcerative oesophagitis secondary to GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Oropharyngeal dysphagia is when ____, presents with ____, tends to be ___ cause

A

there is difficulty initiating swallowing

choking, coughing, nasal regurg, drooling, dysarthria

neuromuscular - parkinson’s, STROKE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Oesophageal dysphagia presenting complaint is ____, can be ___ or ___ cause

A

food getting stuck in throat/chest

neuromuscular, mechanical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Mechanical dysphagia: difficulty swallowing ___ more than ___

A

solid, liquid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Trouble swallowing liquid more than solid, or both trouble, hints to

A

achalasia, diffuse spasm, nutcracker oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Time pattern for development of trouble swallowing solids more than liquids hint to

A

rapidly progressing: red flag for malignancy

slowly progressing: strictures

intermittent: webs, rings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Risk factors for dysphagia

A

Reflux symptoms - heartburn, acid brash (sour taste in mouth), excessive salivation, postural aggravation

Smoking, alcoholism

Previous chemical ingestion

Systemic disease - neuromuscular issues (stroke, DM, myopathies)

Previous surgeries, radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Classic oesophageal appearances on barium swallow

A

Bird’s beak/rat tail - achalasia

Sharp right angled contour - malignant stricture

Smooth contour - benign stricture

Corkscrew - diffuse oesophageal spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

For pt with suspected motility disorders, investigation is via ___

A

oesophageal manometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is achalasia

A

Failure of lower oesophageal sphincter to relax appropriately with swallowing

+ aperistalsis + increase LES tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Types of achalasia

A

Primary: idiopathic (neuronal degeneration)

Secondary: Chagas disease (bite bug infection), diabetic autonomic neuropathy, dorsal motor nuclei lesions

*pseudo-achalasia: caused by malignancy, presents with features of achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What causes achalasia

A

Degeneration of Auerbach’s plexus

Hypertensive LES

Failure of LES to relax w swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Investigations for dysphagia

A

Oestogastroduodenoscopy
Barium swallow
Manometry

27
Q

Clinical presentation of achalasia

A

Progressive difficulty in swallowing both solid & liquid

Immediate regurgitation of undigested food/water/saliva

Retrosternal chest pain due to oesophageal spasm

28
Q

Complications of achalasia

A

Aspiration pneumonia
Stasis of food -> friability, erosions, candida esophagitis

Increased risk of oesophageal SCC

29
Q

Medical therapy for achalasia

A

1) CCB
2) Botulinum toxin injection

aim to decrease LES tone

30
Q

Definition of GERD

A

reflux of stomach contents causing distressing/troublesome symptoms and/or complications

31
Q

Risk factors for GERD

A

oesophageal motility disorders

increased gastric acid

GOO, delayed gastric emptying

LES decreased tone, hiatal hernia

increased IAP - tight clothes, pregnancy, obesity

smooth muscle relaxants

32
Q

What maintains gastro-oesophageal continence?

A

1) LES
2) Angle of His
3) Diaphragmatic crus
4) pressure difference b/w oesophagus & intra-abdominal stomach

33
Q

Syndromes caused by GERD

A

1) oesophageal syndromes
1a) symptomatic syndromes - chest pain
1b) injury syndromes - oesophagitis, stricture, barrett’s, adenoCA

2) extraoesophageal syndromes
2a) established - cough, laryngitis, asthma, dental erosions
2b) proposed - sinusitis, pharyngitis

34
Q

What is heartburn?

A

Post-prandial retrosternal burning sensation. Aggravated by lying down May be relieved by antacid. >2times a week significant

35
Q

Complications of GERD

A

Benign peptic strictures, Barrett’s esophagus

respi cx - recurrent pneumonia
throat cx - halitosis, chronic cough/laryngitis/sinusitis

36
Q

Investigations for oesophagitis

A

1) OGD - evaluate esophagitis, take samples for Barrett’s, rule out malignancy

2) 24 hours oesophageal pH probe - gold standard

3) manometry - check location & function of LES, exclude oesophageal motility disorder

4) barium swallow, follow-through

37
Q

Surgical therapy for GERD is via ___

A

fundoplication - Nissen (360deg wrap) or Partial wrap of fundus of the stomach around the oesophagus

38
Q

What is Barrett’s oesophagus?

A

Metaplasia of columnar epithelium with gastric/intestinal features that replace normal stratified squamous epithelium

39
Q

Risk factors of Barrett’s oesophagus?

A

Longstanding GERD (>5yr)

males, smoking, central obesity

Presence of hiatal hernia - 80% of BE cases

40
Q

in healthy ppl, the ___ junction is the same level as the ___. Known as the __ line

A

squamocolumnar
gastroesophageal

z-line

41
Q

Cx of Barrett’s

A

Oesophageal ulcers (4 Bs): bleed, burrow, burst, block

Oesophageal scarring & strictures

*INCREASED RISK OF ADENOCARCINOMA (40%)

42
Q

In Barrett’s, the SCJ is shifted ___ from the GEJ

A

proximally

43
Q

Omeprazole standard dosing

A

20mg BD = 40mg OD

44
Q

Most common types of esophageal cancer

A

Squamous cell carcinoma
Adenocarcinoma

45
Q

Risk factors for SCC oesophagus

A

Smoking, alcohol

hot beverages, nutrition deficiency

betel nut chewing

Achalasia

46
Q

Risk factors for adenoCA

A

Barrett’s oesophagus
Chronic GERD
Obesity -> hiatus hernia -> reflux

47
Q

SCC typically occurs in ___ of oesophagus, adenoCA occurs in ___

A

middle 1/3rd
distal 1/3rd

48
Q

Clinical presentation of esophageal CA

A
  1. dysphagia - liquid > solid
  2. odynophagia (late)
  3. regurgitation of undigested food
  4. anaemia (+- melena, haematemesis)
49
Q

SCC tends to spread ___, AdenoCA spreads ___

A

intra-thoracic
intra-abdominal

50
Q

Features of complicated oesophagus cancer

A
  • bleeding
  • obstructive: malnutrition, aspiration pneumonia
  • hoarseness (RLN invasion)
  • Horner’s syndrome
  • Respiratory (tracheo-oesophageal fistula)
51
Q

T staging for cancer is by ___ of tumour invasion

A

depth

52
Q

Where are tumours located in gastroesophageal junction tumours?

A
  • Type 1: 5 cm of distal esophagus
  • Type 2: cardia (GEJ)
  • Type 3: sub-cardial (within 5cm below GEJ)
53
Q

Treatment for GEJ tumours

A

Type 1: treat as esophageal cancer (esophagectomy)
Type 3: treat as gastric cancer (total/proximal gastrectomy)

Type 2: resection of parts/whole of esophagus and stomach

54
Q

Impt cx of hiatal hernia

A

Gastric volvulus: ischemia - septic shock, multi-organ failure

Clinical presentation of Borchardt’s triad - epigastric/chest pain, retching without vomiting, inability to pass NG tube

55
Q

Classification of hiatal hernias

A

Type 1: sliding
Type 2: rolling
Type 3: mixed
Type 4: giant

56
Q

Type 1 hiatal hernia

A

Sliding: GEJ displaced only

upper stomach + lower oesophagus slides into chest when pt lies down - oesophagitis w heartburn

57
Q

Type 2 hiatal hernia

A

Rolling: only fundus of stomach herniates

fundus rolls up through hiatus in front of oesophagus

can cause lesions - linear gastric erosions that cause GI bleeding

58
Q

Type 3 hiatal hernia

A

Mixed hernia

Both GEJ & fundus of stomach displaced

59
Q

Type 4 hiatal hernia

A

Giant hernia

Presence of additional organ (eg. colon, spleen, omentum) in the hernia sac

60
Q

Where does oesophageal perforation most commonly occur

A

Left lateral wall of oesophagus, 3-5cm above GEJ

61
Q

Risk factors for oesophageal perforation

A

iatrogenic (OGD, dilatation etc.)

Boerhaave’s syndrome - often due to trauma from severe vomiting

caustic chemical ingestion

foreign body

62
Q

Presentation of oesophageal perforation

A

subcutaneous emphysema (cervical crepitation/swelling)

pain, fever

Hartmann’s sign - mediastinal crunching on auscultation (pneumomediastinum)

63
Q

Mackler’s triad seen in ___, 3 symptoms ____

A

Boerhaave’s syndrome
vomiting, chest pain, subcutaneous emphysema

64
Q

Distal oesophageal perforation leads to ___

Mid-thoracic perforation leads to ___

A

left sided pleural effusion

right sided pleural effusion

General Surgery (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions