Brainscape's Knowledge GenomeTM

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


See full index

Surgery M4 part 2 > Esophagus 1 > Flashcards

Esophagus 1 Flashcards

1
Q

What is the course of the esophagus?

A

starts at C6
passes the hiatal opening at T10
reaches stomach at T11

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

What are the 3 points of constriction in the esophagus?

A
  • at the start behind the cricoid cartilage
  • where its crossed by the aortic arch in front & the left main bronchus in the posterior mediastinum
  • esophageal hiatus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

dysfunction of which sphincter causes GERD?

A

lower esophageal sphincter (physiological)

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

What is the anti-reflux mechanism of the lower esophageal sphincter?

A
  • angle of Hiss
  • higher pressure intra abdominally
  • rosette arrangement of gastric folds present at cardia
  • pinchock effect of the right crus of the diaphragm
  • continuous release of acetylcholine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the cause of the spread of malignancy from lower to upper part of the esophagus?

A

bidirectional flow of lymph

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

What is the lining of the esophagus?

A

stratified squamous epithelium NON KERATINIZED

EXCEPT LOS turns into simple columnar

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

What is the musculature of the esophagus composed of?

A

Upper 1/3 = striated muscles
middle 1/3 = mixed
lower 1/3 = smooth muscles

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

What induces the relaxation of the LOS?

A

peristalsis pushing the food towards it

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

What are the causes of GERD?

A
  • sliding hiatus hernia (MOST COMMON)
  • physiological in < 2 years
  • obesity
  • smoking
  • alcohol
  • scleroderma
  • delayed gastric emptying
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the complications of GERD?

A
  • deep ulceration
  • bleeding
  • stricture
  • esophageal shortening
  • Barret’s esophagus (columnar metaplasia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does GERD present?

A
  • heart burn (retrosternal, simulates angina, increased by fatty meals & lying flat)
  • dysphagia ( due to esophageal stricture or spam)
  • regurgitation (increased by laying flat)
  • recurrent chest infections
  • hematemesis & anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most diagnostic investigation for GERD?

A

24hrs ambulatory PH monitoring

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

What are the investigations used for GERD?

A

BARIUM MEAL -> hiatus hernia diagnosis in Trendelenburg position
UPPER GI ENDOSCOPY -> demonstrates presence of complications & guides biopsy
ESOPHAGEAL MANOMETRY -> assess pressure of LOS
24HR AMBULATORY PH -> pH <4 in distal 5cm for > 30mins

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

What are the grades in Belsy Classification?

A

I -> hyperemic mucosa
II -> superficial ulceration
III -> extensive ulceration
IV -> stricture or Barret’s

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

What is the main line of treatment in GERD?

A

CONSERVATIVE

  • change lifestyle (reduce weight, stop smoking, small meals)
  • medical treatment
    • decrease gastric acidity: H2 blockers, antacids, PPI
    • regulate motility: metoclopramide, cisapride
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the indications for surgical intervention in GERD?

A
  • failure of conservative for 6 months
  • presence of complications
  • Saint’s triad (hiatal hernia, chronic cholecystitis, diverticular disease)
  • non complaint patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What surgical procedure is used in GERD?

A

Nissen’s Fundoplication

- wrapping fundus around the lower esophagus

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

What causes Barret’s esophagus?

A

response to chronic irritation -> columnar metaplasia -> can progress to dysplasia & malignant transformation

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

What is the treatment of Barret’s esophagus?

A
  • higher dose of PPI + close surveillance + endoscopic follow up
  • Nissen’s fundoplication
  • local ablation
  • resection (if high grade dysplasia is present)
20
Q

What are the predisposing factors for a sliding hernia?

A
  • obesity
  • tight corsets
  • repeated pregnancies
21
Q

What is the difference between a sliding hernia & a rolling hernia?

A

SLIDING -> herniation of cardia & adjoining part of stomach through hiatus
ROLLING -> herniation of part of greater curvature through hiatus while GEJ is below diaphragm

22
Q

What investigation should be preformed for sliding & rolling hiatal hernia?

A

BARIUM MEAL in Trendelenburg position

23
Q

What is the presentation of a sliding hernia? How should it be treated?

A

GERD (GEJ is intra-thoracic)

Nissen’s Fundoplication + repair of right diaphragmatic crus

24
Q

What is the presentation of a rolling hiatal hernia? (para-esophageal hernia)

A

pressure manifestations

  • esophagus -> dysphagia
  • heart -> arrhythmia
  • phrenic nerve -> hiccough
25
Q

What are the complications of a rolling hernia?

A

strangulation & gangrene

rupture & mediastinitis

26
Q

How should a rolling HH be treated?

A

surgical reduction & diaphragm repair

27
Q

What is achalesia of the cardia?

A

failure of LOS relaxation with absent peristalsis

28
Q

How does achalesia of the cardia present?

A

in young & middle ages

  • dysphagia -> more to liquids
  • retrosternal pain -> due to esophagitis
  • regurgitation -> bad odor & alkaline
  • halithosis -> putrefaction of retained food causing bad mouth odor
29
Q

What are the complications of achalasia?

A
  • recurrent respiratory infections
  • sigmoid esophagus
  • anemia & malnutrition
  • esophageal diverticulum
  • malignant changes
30
Q

What is the most important investigation that should be used in achalasia?

A

BARIUM SWALLOW

  • delayed emptying
  • parrot break
  • if late -> sigmoid esophagus
31
Q

What investigation is mandatory PRE-OP?

A

ESOPHAGEAL MANOMETRY

  • hypertensive LOS (n=8/25mmHg)
  • failure of relaxation
  • absent peristalsis
32
Q

What will be seen on an X-ray in case of achalasia?

A
  • widened mediastinum

- absent gastric air bubbles

33
Q

What is the esophagoscope used for?

A

FOLLOW UP

to exclude carcinoma

34
Q

How should Achalasia be treated?

A
  • medical (nitrates & Ca channel blockers)

- endoscopic treatment (injection of botox in LOS or balloon dilatation)

35
Q

What are the indications for surgery in achalasia?

A
  • failure of previous measures
  • severe cases from the start
  • incompliant patients
  • complicated cases
  • assosicated pathology (HH)

USE MODIFIED HELLER’S MYOTOMY

36
Q

What is Killian’s triangle?

A

space between transverse cricopharyngeus & oblique thyropharyngeus in lateral pharyngeal wall

37
Q

What is the cause of Zenker’s diverticulum?

A

spasm of cricopharyngeus muscle -> increase intrapharyngeal pressure -> herniation of mucosa

38
Q

What are the complications of Zenker’s diverticulum?

A
  • recurrent respiratory chest infections
  • diverticulitis
  • perforation
  • malignant transformation
39
Q

How does Zenker’s diverticulum present?

A
  • in old males
  • progressive dysphagia
  • regurgitation of undigested food
  • swelling on left side of the neck that increases with eating, is soft, compressible, and has gurgling sensation of compression
40
Q

What is the best investigation for Zenker’s diverticulum?

A

Barium swallow -> flask shaped pouch

  • endoscopy is diagnostic & therapeutic BUT DANGEROUS
41
Q

What is the treatment of Zenker’s diverticulum?

A

ENDOSCOPIC -> repeated dilation of cricopharyngeus musch (if small pouch)
-> cut through cricopharyngeus muscle with stapler

SURGICAL -> small: inversion of pouch with repair of the triangle
-> large: diverticulectomy with cricopharyngeus myotomy

42
Q

What is the nutcracker esophagus?

A
  • hypercontractile esophagus

- prolonged & high amplitude peristaltic waves

43
Q

What is the corkscrew esophagus?

A
  • diffuse esophageal spasm
  • NOT PERISTALTIC
  • simultaneous repetitive contractions
44
Q

What are the clinical features & investigations done for nutcracker & corkscrew esophagus?

A

CLINICALLY

  • pain: retrosternal, acute, severe pain, simulating angina pectoris
  • dysphagia: TO FLUIDS

INVESTIGATIONS

  • Barium swallow
  • esophageal manometry is DIAGNOSTIC
45
Q

How is nutcracker esophagus treated?

A

MEDICALLY (main line)
- nitrates & Ca channel blockers

Endoscopic dilatation

46
Q

How is Corkscrew esophagus treated?

A

Medically (1st line)

Surgically: longitudinal myotomy

Surgery M4 part 2 (36 decks)

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