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First Aid ABSITE > Chapter 4: Esophagus > Flashcards

Chapter 4: Esophagus Flashcards

(73 cards)

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1
Q

Esophageal development occurs primarily during what week of gestation?

A

4th week of gestation

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2
Q

Failure of separation of the dorsal foregut from the laryngeotracheal tree during development

A

Tracheoesophageal fistula

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3
Q

Failure of recanalization of tubular lumen

A

Esophageal atresis, web, stenosis

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4
Q

Extends 18-25cm from the pharynx to the stomach

A

Esophagus

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5
Q

5-6cm and extends from the cricopharyngeus muscle (C6) to thoracic inlet (T1)

A

Cervical Esophagus

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6
Q

15cm and extends from the thoracic inlet (T1) to esophageal hiatus of the diaphragm (T10)

A

Thoracic Esophagus

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7
Q

5-6cm and may be absent in patients with a hiatal hernia or esophageal shortening

A

Abdominal esophagus

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8
Q

Created by the cricopharyngeus and innervated by recurrent laryngeal nerve

A

Upper esophageal sphincter

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9
Q

Narrowest region of the esophagus

A

At level of cricopharyngeus

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10
Q

Anatomic sites of esophageal narrowing

A

Aortic arch
Bronchus (left main stem)
Cricopharyngeus
Diaphragm

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11
Q

Mucosa of the esophagus

A

Nonkeratinizing, stratified squamous epithelium

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12
Q

Esophageal wall is made up of:

A

Mucosa
Submucosa
Muscularis

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13
Q

Provides parasympathetic innervation to the esophagus

A

Vagus nerve

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14
Q

Innervates the cricopharyngeus and cervical esophagus

A

Recurrent laryngeal nerve

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15
Q

Site of cricopharyngeal weakness

A

Killian’s triangle

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16
Q

Most common location to find pseudodiverticula or iatrogenic perforation

A

Killian’s triangle

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17
Q

UES pressure at rest

A

50-70 mmHg

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18
Q

UES pressure with bolus

A

12-14 mmHg

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19
Q

Also referred as the high-pressure zone which prevents reflux of gastric contents into the esophagus

A

LES

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20
Q

Resting LES pressure

A

10-20 mmHg

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21
Q

Characterized by aperistalsis and failure of LES relaxation during swallowing

A

Achalasia

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22
Q

Arterial supply of cervical esophagus

A

Inferior thyroid artery

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23
Q

Arterial supply of thoracic esophagus

A

Aorta and bronchial arteries

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24
Q

Arterial supply of abdominal esophagus

A

Left gastric artery

Inferior phrenic artery

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25
Most common esophageal motility disorder
Achalasia
26
Manometry result in achalasia
Lack of peristalsis | Failure of LES relaxation
27
Bird's beak tapering of distal esophagus with dilation of proximal segment in barium swallow
Achalasia
28
Definitive therapy for achalasia
Heller myotomy
29
Rare disorder characterized by degeneration of smooth muscle, resulting in LES failure and disordered peristalsis of distal esophagus
Scleroderma
30
Primary motility disorder characterized by disordered, high-amplitude motility
Diffuse esophageal spasm
31
Predominant symptom of Diffuse esophageal spasm
Substernal chest pain
32
Barium swallow reveals corkscrew esophagus and segmentation
Diffuse esophageal spasm
33
Manometry reveals frequent, high-amplitude, simultaneous contractions of esophageal body. LES is typically normal
Diffuse esophageal spasm
34
Most common primary esophageal disorder
Nutcracker esophagus
35
Manometry reveals characteristic continuous, high-amplitude (>2 SD above normal) peristalsis
Nutcracker esophagus
36
Pulsion diverticulum usually found at Killian's triangle as a result of discoordination of UES relaxation and swallowing
Pharyngoesophageal or Zenker's diverticula
37
Ulcer in a sliding hiatal hernia commonly found on the lesser curvature
Cameron's ulcer
38
Sliding hiatal hernia
Type I
39
Rolling paraesophageal hernia
Type II
40
Type of hernia where GEJ remains intra-abdominal
Type II/Rollling paraesophageal hernia
41
Borchardt's triad of an incarcerated paraesophageal hernia
Severe chest pain Painful retching without emesis Inability to pass a NGT
42
Longitudinal tears in the esophageal mucosa near the GEJ following repeated retching which commonly occur in alcoholics
Mallory-Weiss tears
43
Definitive diagnosis of mallory-weiss tears
Endoscopy
44
Most common cause of esophageal perforation
Iatrogenic
45
Spontaneous rupture of the esophagus resulting from increased intraabdominal pressure against a closed glottis
Boerhaave's syndrome
46
Most common location of Boerhaave's syndrome
Distal thoracic esophagus
47
Type of necrosis caused by alkali agents
Liquefactive necrosis
48
Type of necrosis caused by acids
Coagulation necrosis
49
Premalignant condition characterized by intestinal metaplasia of the normal esophageal squamous mucosa
Barrett's esophagus
50
Primary risk factor of Barrett's esophagus
GERD
51
Most common esophageal malignancy
Adenocarcinoma
52
What layer is essential to esophageal anastomoses?
Submucosa
53
Which layer is absent in the esophagus?
Serosa
54
A 50-year old man develops an esophageal perforation. Where is the most common site of esophageal perforation during endoscopy?
Killian's triangle
55
Where is the most common site of esophageal perforation after repeated vomiting?
Distal thoracic esophagus
56
What are the risk factors for SCC of the esophagus?
Tobacco use, alcohol, caustic injury, Plummer-Vinson syndrome
57
What are the risk factors of Adenocarcinoma of the esophagus?
Chronic GERD, Barrett's esophagus, obesity
58
A 45-year old man presents with progressive dysphagia to solids. What is the first diagnostics study?
Barium swallow
59
What is the indication for esophagectomy in a patient with Barrett's esophagus?
Severe (high-grade) dysplasia on biopsy
60
What are manometric hallmarks of achalasia?
Aperistalsis and failure of LES relaxation
61
What are manometric hallmarks of DES?
Disordered, high amplitude contractions
62
What are long-term complications of caustic injury to esophagus?
Stricture | SCC
63
What determines resectability of esophageal malignancy?
Freedom from distant mestastases or distant nodal involvement Ability to resect any adjacent, involved structures
64
A 77-year old female presents with severe chest pain, intractable retching, and inability to pass a NGT. What is the diagnosis?
Incarcerated or stangulated paraesophageal hernia
65
A 77-year old female presents with severe chest pain, intractable retching, and inability to pass a NGT. What is the treatment?
Emergent surgical repair
66
An 80-year old man with dysphagia presents with aspiration pneumonia. For his esophageal study, what is the contrast agent of choice?
Nonionis (water soluble) agent to minimize the risk of pneumonitis
67
A 30-year old male has chest pain and dyspnea after upper endoscopy. What CXR findings suggest esophageal perforation?
Pneumomediastinum Subcutaneous emphysema Hydropneumothorax Pleural effusion
68
What are the benefits of laparoscopic Heller myotomy with partial fundoplication compared to left thorascopic myotomy for the treatment of achalasia?
Decreased length of stay | Decreased of postoperative reflux
69
A 30-year old male is incidentally found to have a Zenker's diverticulum. What is the appropriate treatment?
None if asymptomatic | If symptomatic, surgical excision via neck or transoral stapling
70
What is the normal LES resting pressure?
10-20 mmHg
71
What is the normal UES resting pressure
50-70 mmHg
72
A 58-year old man with long history of GERD undergoes endoscopy with biopsy. Pathology reveals mild dysplasia. What is the recommended follow up?
Endoscopic surveillance with biopsies at least every 2 years
73
A 35-year old female presents with progressive hearburn and regurgitation of undigested food. She has a barium swallow that reveals a bird's beak tapering of the distal esophagus. What will her manometry studies show?
Lack of peristalsis and failure of LES relaxation

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