Esopagus

Question 1

Blood supply to cervical esophagus

Answer 1

Inferior thyroid artery

Question 2

Blood supply thoracic esophagus

Answer 2

Bronchial arteries

Question 3

Blood supply abdominal esophagus

Answer 3

Aorta- left gastric and splenic

Question 4

Muscle composition of upper esophageal sphincter

Answer 4

Cricopharyngeus mm

Most common site of perf with egd

Question 5

Layers of esophagus

Answer 5

Squamous epithelium
Circular mm layer
Outer longitudinal layer

NO SEROSA–> spread to other organs

Question 6

Resting pressure of UES

Swallowing pressure of UES

Answer 6

Resting: high- remains closed
Swallow: 0 - allows food bolus to come through

Question 7

Resting pressure of LES

Answer 7

6-24mmHg

GERD with abnormal relaxation

Question 8

Reflux more commonly occurs when….

Answer 8

LES is less than 2cm
Intra abdominal LES less than 1cm

LES pressure less than 6
Angle of entry into stomach
Tightness of diaphragmatic crura

Question 9

Zenkers boundaries

Answer 9

Killians triangle

Thyrophargeal m oblique
Cricopharngeus m transverse

Question 10

Treatment for zenkers diverticulim

Answer 10

False divertic

Left cervical incision
Diverticulectomy or diverticopexy

Crico phayngeal myotomy

Leave drains

Pod #1: esophagogram

Question 11

True diverticulim of esophagus

Usually lateral

Answer 11

Traction diverticulim

Mid-esophagus
Tx: excision and primary closure

Question 12

Diverticulim associated with motility disorders

Answer 12

Epi phrenic divertic

Tx: diverticulectomy myotomy opposite side of diverticulectomy

Question 13

Seen as cork screw esophagus on esophagram

Answer 13

Diffuse esophageal spasm

Retro sterna losing to back

Tx: ccb, antispasmodic, nitrates
Heller myotomy - cut upper and lower spincters

Question 14

Heller myotomy is used to treat what condition?

Answer 14

Achalasia

Question 15

Seen with achalasia

Answer 15

No peristalsis
High LES pressure
No LES relaxation

Question 16

Achalasia is caused by

Answer 16

Loss of ganglion cells in auerbachs plexus in esophagus

Question 17

Seen on Xray with achalasia

Answer 17

Bird beak

Question 18

Treatment for achalasia

Answer 18

Ccb
LES dilation
Nitrates

Heller myotomy

Question 19

Steps in heller myotomy

Answer 19

Left thoracotomy
Mm of LES cut and partial fundiplication with stomach

Only cut outer layer of mm- leave mucosal layer intact

Question 20

Dx of GERD

Answer 20

Egd
pH probe -24hrs
Manometry- resting LES less than 6

Question 21

Treatment for GERD

Answer 21

Ppi x 6 months

Nissen:
Divide short gastrics
Pull esophagus into abdomen
Repair defect in phrenoesophageal membrane
Gastric fundus wrap

Identify left crura

Question 22

Alkali ingestion causes

Acid ingestion causes

Answer 22

Liquefaction necrosis

Coagulation necrosis

Alkali worse

Question 23

Tx caustic ingestion

Answer 23

Npo
Cxr- free air
Endoscopy - do not go past site of injury

Question 24

Burn classifications for caustic injury

Answer 24

Primary: hyperemia
Tx: conservative, abx

Secondary: ulcers, exudate
Tx: only Sx if sepsis, peritonitis

Tertiary: deep charring, lumen narrowed
Usually Sx

Need gastrograffin followed by thin barium study

Question 25

Common site for esophagus perf

Answer 25

Cricopharyngeus m Dx: gastrograffin followed by barium

Question 26

Treatment for esophagus perf

Answer 26

Non-Sx: contained, no systemic effects Ivf, npo, abx Sx: non- contained Less than 24hrs: primary closure , drains, intercostal m flap Sick: diversion with esophagostomy, washout mediastinum, chest tubes, feeding tubes Esophagectomy Prox: right thoracotomy Distal: left

Question 27

Dx of esophagus tumors is with?

Answer 27

Egd | EUS- can determine depth and lymph node involvement

Question 28

Cancer spreads along....

Answer 28

Submucosal lymphatic channels

Question 29

Esophageal CA is unresectable when...

Answer 29

Any mets, nerve involvement, airway invasion, mal pleural effusions

Question 30

Types of esophageal CA

Answer 30

AdenoCA- most common- lower esophagus Squamous - upper Xrt and chemo can be used to downstage

Question 31

Esophagectomy surgery details

Answer 31

Transhiatal: Abd and neck incisions Ivor Lewis: abd incisional right thoracotomy - exposes all of esophagus, intrathoracic anastomoses

Question 32

Most common benign tumor of esophagus

Answer 32

Leiomyoma No bx Resect with enuclation Prox/mid: right thoracotomy Distal: left