All Esophagus

Question 1

Best test to distinguish oropharyngeal dysphagia from a Zenker diverticulum?

Answer 1

modified barium swallow

Question 2

Surveillance regimen for Barrett’s esophagus with low grade dysplasia:

Answer 2

follow endoscopically every 6 months

Question 3

True or false. Metastatic esophageal cancer has an almost zero 5 year survival rate.

Answer 3

true

Question 4

surgical approach for esophageal perforation in middle third of esophagus

Answer 4

right posterolateral thoracotomy

Question 5

surgical approach for esophageal perforation to distal third of esophagus (intrathoracic)

Answer 5

left posterolateral thoracotomy

Question 6

True or false. Neoadjuvant chemoradiotherapy significantly prolongs disease free interval and survival in patient’s with esophageal SCC and adenocarcinoma.

Answer 6

true

Question 7

Neoadjuvant chemoradiotherapy for esophageal cancer consists of:

Answer 7

5 FU plus cisplatinum concomitantly with 40-60 cGy to the mediastinum

Question 8

Which patients with esophageal cancer should be offered neoadjuvant therapy prior to surgery?

Answer 8

those with T2 or T3 lesions

Question 9

management of esophageal leiomyomas based on size:

Answer 9

endoscopic removal for tumors <5cm size; tumor >5cm in size should be excised with VATS or laparoscopy depending on location

Question 10

Dysmotility disorder of the esophagus and LES defined by absent peristalsis (aperistalsis) and lack of LE sphincter relaxation:

Answer 10

achalasia; has an elevated integrated relaxation pressure of the LES that is >15mmHg on manometry

Question 11

term for the measure of vigor of the esophageal contraction on manometry

Answer 11

distal contractile integral (DCI)

Question 12

DCI >8000 mmHg-s-cm is characteristic of whta?

Answer 12

hypercontractile esophagus

Question 13

Diffuse esophageal spasm has a distal latency time of ____

Answer 13

<4.5 sec

Question 14

Most common site of iatrogenic esohageal perforation:

Answer 14

cricopharyngeus

Question 15

Most common site of spontaneous esophageal perforation:

Answer 15

distal 1/3 of the esophagus

Question 16

blood supply to cervical esophagus:

Answer 16

inferior thyroid artery

Question 17

When should endoscopic surveillance begin after caustic ingestion?

Answer 17

15-20 years after, due to risk of SCC

Question 18

Blood supply to thoracic esophagus:

Answer 18

branches of bronchial arteries and branches off aorta

Question 19

Blood supply to abdominal esophagus:

Answer 19

branches of left gastric and inferior phrenic artery

Question 20

T1 esophageal cancer that does not invade past the ____ can be treated with endoscopic resection

Answer 20

submucosa

Question 21

Neoadjuvant chemoradiotherapy is recommended for what T stage esophageal cancers before surgery?

Answer 21

all T3 and T4 lesions

Question 22

traction diverticula location and layers of wall:

Answer 22

occurs in mid esophagus and contains all layers of the esophageal wall

Question 23

pulson diverticula location and layers of wall:

Answer 23

occurs in very proximal or distal esophagus; only contains mucosa and submucosa

Question 24

treatment & surveillance of Barrett’s without dysplasia:

Answer 24

start PPI; consider antireflux surgery for patients with continued symptoms after PPI

random 4 quadrant biopsies every 2cm;Surveillance every 3-5 years

Question 25

treatment and surveillance of Barrett's with low grade dysplasia:

Answer 25

start PPI; if low grade dysplasia persists on repeat EGD, RFA should be used random 4 quadrant biopsies every 1 cm; EGD every 6-12 months with bx

Question 26

treatment of Barrett's with high grade dysplasia:

Answer 26

start PPI; endoscopic resection of mucosal irregularities followed by RFA

Question 27

True or false. Endoscopic resection is an appropriate surgical management for T1a esophageal adenocarcinoma

Answer 27

True

Question 28

Motility disordered characterized by corkscrew appearance on UGI

Answer 28

diffuse esophageal spasm

Question 29

Components of truncal vagotomy:

Answer 29

main trunks of vagus divided; needs a drainage procedure

Question 30

Components of selective (total gastric) vagotomy:

Answer 30

anterior and posterior nerves of latarjet are ligated after take off of celiac/hepatic branches; pyloric drainage procedure is needed b/c pylorus is denervated

Question 31

Components of highly selective (parietal cell) vagotomy:

Answer 31

nerve fibers that innervate parietal cells within the serosa of the body and fundus of the stomach only are divided; preserves nerve supply to antrum and pylorus (nerves of Latarjet) and no drainage procedure needed

Question 32

timing and mechanism of early dumping syndrome:

Answer 32

within 30 minutes of eating; hyperosmotic load causes a large fluid shift

Question 33

timing and mechanism of late dumping syndrome:

Answer 33

2-3 hours after eating; due to large insulin release from large food bolus hitting duodenum and causing hypoglycemia

Question 34

first line pharmacotherapy for esophageal variceal hemorrhage

Answer 34

octreotide

Question 35

first line endoscopic intervention for esophageal variceal hemorrhage

Answer 35

endoscopic variceal ligation or endoscopic sclerotherapy

Question 36

management of Zenker diverticulum <1cm:

Answer 36

observation

Question 37

management of Zenker diverticulum <2cm:

Answer 37

diverticulopexy alone or myotomy alone

Question 38

management of Zenker diverticulum 2-5 cm:

Answer 38

myotomy plus diverticulopexy or diverticulectomy

Question 39

Where do Zenker diverticula arise?

Answer 39

between the inferior pharyngeal constrictor and cricopharyngeus

Question 40

How many lymph nodes are needed for adequate staging of esophageal cancer during esophagectomy?

Answer 40

15 nodes

Question 41

Where do abdominal esophageal lymph nodes drain?

Answer 41

drain to celiac and cardiac nodes which eventually drain to the cisterna chyli or thoracic duct

Question 42

Most effective nonsurgical treatment of achalasia:

Answer 42

pneumatic dilation

Question 43

Manometry in hypertensive LES syndrome:

Answer 43

>45mm Hg; may have incomplete LES relaxation

Question 44

manometry findings for nutcracker esophagus:

Answer 44

increased mean distal amplitude > 18mm Hg; normal peristalsis; increased distal duration

Question 45

manometry findings for diffuse esophageal spasm:

Answer 45

premature/simultaneous contractions with swallow, intermittent peristalsis, repetitive multipeak contractions, contraction amplitude >30mm Hg; normal LES

Question 46

Treatment of diffuse esophageal spasm:

Answer 46

calcium channel blockers, PPI, and/or TCAs

Question 47

Achalasia is characterized by degeneration of _____

Answer 47

the myenteric plexus

Question 48

Most effective treatment of achalasia:

Answer 48

laparoscopic heller myotomy

Question 49

Steps of Peroral endoscopic myotomy (POEM):

Answer 49

submucosal space entered and allowed to dissect submucosa distally along the muscular layer using spray coagulation to create a submucosal tunnel that extends beyond the GEJ; myotomy of circular esophageal and gastric bundles performed and mucosal incision closed with hemostatic clips

Question 50

True or False. Patients with severe or absent esophageal dysmotility benefit from a complete fundoplication over a partial.

Answer 50

false. they benefit more from partial fundoplication

Question 51

In what patients is a partial fundoplication contraindicated

Answer 51

achalasia or scleroderma

Question 52

Most commonly used organ for esophageal substitution in children?

Answer 52

colon

Question 53

low amplitude or absent peristalsis and normal or decreased LES pressures

Answer 53

scleroderma

Question 54

low amplitude simultaneous contractions with high LES pressures

Answer 54

achalasia

Question 55

high amplitude contractions with normal LES pressures

Answer 55

nutcracker esophagus

Question 56

normal amplitude contractions with high LES pressures

Answer 56

hypertensive esophagus