Hernia, Esophagus

Question 1

NYHUS Classification of Hernia

Answer 1

Type 1- indirect normal sized internal ring
Type 2- indirect, ring enlarged, does not extend to scrotum
Type 3A- direct
3B-indirect (sliding, scrotal, pantaloon)
3C-femoral
Type 4 (Recurrent)
A-direct
B-indirect
C-femoral
D-combination

Question 2

Gold standard for the diagnosis of GERD

Answer 2

24h ambulatory pH monitoring

Question 3

Esophagogram: bird’s beak esophagus, sigmoid esophagus

Dx?
Gold standard test?
Tx?

Answer 3

Achalasia

Manometry

Heller myotomy + partial fundiplication
Medical: CCB, nitrates, Botox

Question 4

Most common primary esophageal motility d/o

Answer 4

Nutcracker esophagus

Question 5

Esophagus

Contraindications for curative sx/resection

Answer 5

Age >75yo
FEV1<1.25 and EF <40%
>20% wt loss
Lovally advanced tumor

Question 6

Tx for esophageal sarcoma

Answer 6

Esophagectomy

*no need for LN dissection

Question 7

Which patients with Gastric Adenocarcinoma May EMR or ESR be offered?

Answer 7

Tumors < 2 cm, limited to the mucosa and submucosa

Question 8

Paraneoplastic Syndromes seen in Gastric AdenoCa?

Answer 8

Trousseau Syndrome

Acanthosis Nigricans

Question 9

First line treatment for low grade gastric lymphoma

Answer 9

H. Pylori eradication

Question 10

Management for persistent localized Gastric lymphoma after initial course of anti H pylori medications

Answer 10

Second course of H. pylori eradication + low dose EBRT

Question 11

Tumor markers for GIST

Answer 11

c-Kit (CD 117)

CD 34

Question 12

Treatment for GIST

Answer 12

Wedge resection with negative margins

Imatinib for metastatic disease

Question 13

Cell of origin of GIST

Answer 13

Interstitial Cells of Cajal

Question 14

Cell of origin of Gastric Carcinoids

Answer 14

Gastric ECL cells