Flashcards in Cardiothoracic 2 Deck (11):
55-year-old woman presents with regurgitation chewed, digested food. Long history of dysphasia. Suspected diagnosis? Confirm with? Specific location? Treatment?
Pharyngeal (Zenker) diverticulum; barium swallow or endoscopy
Between lower pharyngeal constrictor and cricopharyngeal muscle
Transection of cricopharyngeal muscle to prevent uncontrolled contraction
45-year-old develops progressive SOB and weakness following respiratory illness. CXR shows a large heart shadow and congested lungs. ECHO reveals EF of 20% with moderate mitral regurgitation. Cardiac catheterization shows normal coronary arteries with poor ventricular contraction – likely diagnosis? Prognosis? Treatment?
Dilated cardiomyopathy (probably related to viral respiratory illness)
One third recovered, one third stay the same, one food dye
#Steroids, diuretics, immunosuppressives
Second location of pulsion diverticulum?
Distal esophageal gastric junction (epiphrenic diverticulum)
Etiology of alcalasia? Treatment?
Loss of smooth muscle ganglionic cells of Auerbach plexus
Heller myotomy (100% effective) or transesophageal dilation (60% effective)
Location of squamous cell carcinoma of the esophagus?
Upper and middle third of the esophagus
Staging of esophageal tumors based on? Determine staging with what tests
Wall penetration and lymph nodes spread
Endoscopic ultrasound; CT scan
Treatment for cervical/upper third esophageal cancer?
#If persists, resection
Treatment for cancer in the middle of the esophagus?
Neoadjuvant chemotherapy, then surgical resection
Treatment for esophageal cancer in the lower third the esophagus?
Esophagectomy and proximal gastrectomy
Patient presents with severe dysphasia and difficulty swallowing. Weight loss if 50 lbs. Coughs constantly - work up? Likely reason for cough? Treatment?
Barium swallow, esophagoscopy, biopsy
Chronic aspiration from TE from tumor erosion into trachea
Cancer progressed too far for curative procedure – palliative care (feeding gastrostomy, stent, radiation, palliative resection)