TCV Flashcards
What should you use to rate control a COPD patient with new onset Afib?
Calcium channel blocker like diltiazem or verapamil (NOT BB 2/2 COPD)
What are the types of hiatal hernias?
Type I: GE junction slides above the hiatus. Assoc with GERD
Type II: paraesophageal–a bit of stomach goes through hole in diaphragm. Assoc with early satiety, chest pain, dysphagia
Type III: mix of type I and II
Type IV: entire stomach + another organ in chest
What serves as blood supply to the conduit in a transhiatal esophagectomy?
the right gastroepiploic artery
Where are incisions and anastomoses in different esophagectomy approaches?
THE: abdominal and left cervical incisions, cervical anastomosis
Ivor Lewis: abdominal incision and right thoractomy, thoracic anastomosis
3 hole: all 3 incisions
What is the best diagnostic test for atrial myxoma?
Echo
Blood supply to cervical esophagus? Thoracic? Abdominal?
Cervical: inferior thyroid off the thyrocervical trunk
Thoracic: directly off aorta
Abdominal: left gastric
Path of thoracic duct?
Starts on the right at T12, crosses to the left in the mediastinum (T4-5), and drains into L subclavian vein
Describe path of vagus nerves?
Right vagus travels posteriorly to the stomach and becomes the celiac plexus, also gives off the criminal nerve of grassi (will keep acid levels high after vagotomy if not divided). Left vagus travels anteriorly and goes to liver and biliary tree.
Another name for upper esophageal sphincter? Innervation?
Crichopharyngeus muscle. Prevents air swallowing. Innervated by recurrent laryngeal nerve.
How far from incisors is UES? LES?
UES is 15 cm. LES is 40 cm.
What is normal LES pressure at rest?
15 mmHg
What are the areas of anatomic esophageal narrowing?
1) Cricopharyngeus muscle (15 cm)
2) L mainstem bronchus and aortic arch (24-26 cm)
3) Diaphragm (40 cm)
What mediates relaxation of the LES?
Vagus nerve
Surgical approach to different areas of esophagus?
Cervical = left neck
Upper 2/3 thoracic: right (avoids aorta)
Lower 1/3 thoracic: left
What is Plummer-Vinson syndrome?
Dysphagia, iron deficiency, esophageal web. Increased risk of SCC of the esophagus and pharynx.
What is Zenkers diverticulum?
A false diverticulum proximal to UES, caused by failure of the UES to relax during swallowing. Lies posterior
Tx of Zenkers?
cricopharyngeal myotomy via left cervical incision, or endoscopic division of the septum
What is epiphrenic diverticulum and what is tx?
in the distal 10 cm of esophagus, assoc with motility disorders. Tx is diverticulectomy and esophageal myotomy on the side opposite the diverticulum
Tx for achalasia?
try balloon dilation of LES first + med tx (nitrates, calcium channel blockers), then if that fails do Heller myotomy (left thoracotomy + myotomy of lower 1/3 of esophagus + partial nissen)
Manometry findings for achalasia?
increased LES pressure, failure of LES to relax + LACK of peristalsis
Manometry of diffuse esophageal spasm?
disorganized, nonperistaltic contractions in >10% of swallows, LES relaxes NORMALLY
Tx of DES?
Try medical (Ca channel blockers, nitrates) because surgery is less effective and would need a long myotomy
Manometry of nutcracker esophagus?
high amplitude peristaltic contractions, LES relaxes NORMALLY
Tx of nutcracker esophagus?
Try medical and avoid surgery bc need a long segment myotomy (upper and lower)
Initial tx for GERD?
trial of PPI for 3-4 wks. If no improvement, EGD, pH probe, or manometry (rest LES <6 mmHg)
What is normal UES pressure at rest?
60 mmHg
What is a Schatzki’s ring and what is it assoc with? tx?
An esophageal ring usually assoc with hiatal hernia. Tx is dilation and PPI.
