Esophagus

Question 1

Layer absent from the esophagus

Answer 1

Serosa

Question 2

3 regions of the esophagus and their lengths and blood supply

Answer 2

cervical (5cm) - inf. thyroid artery and vein

thoracic (20cm) - bronchial artery, hemiazygous vein, azygous and bronchial veins

abdominal (2cm) - ascending branch of left gastric artery and inferior phrenic artery, coronary vein and left gastric vein

Question 3

Gold standard treatment for GERD

Answer 3

PPIs

Question 4

Gold standard test for GERD

Answer 4

24 hour pH monitoring

Question 5

Hallmark of intestinal metaplasia

Answer 5

Intestinal goblet cells

Question 6

Characteristics of mechanically defective LES (3)

Answer 6

▪️average LES mean resting pressure <6 mmHg
▪️Overall sphincter length <2 cm
▪️Intraabdominal sphincter length of <1 cm (most consistent characteristic)

Question 7

Most common antireflux surgical procedure ; 360 fundoplication

Answer 7

Nissen fundoplication

Question 8

270 fundoplication

Answer 8

Toupet fundoplication

Question 9

180 fundoplication

Answer 9

Dor fundoplication

Question 10

Use of stapler to divide the cardia and upper stomach, parallel to the lesser curvature of the stomach

Answer 10

Collis gastroplasty

Question 11

240-270 fundoplication performed though a thoracic approach

Answer 11

Belsey Mark IV

Question 12

Arcuate ligament repair + gastropexy to diaphragm

Answer 12

Hill posterior gastropexy

Question 13

Deterioration of the phrenoesophageal membrane

Answer 13

Diaphragmatic hernia

Question 14

Most common type of diaphragmatic hernia

Answer 14

Type I (sliding hernia)

Question 15

Upward dislocation of the gastric fundus alongside a normally positioned cardia

Answer 15

Type II (Rolling / Paraesophageal hernia)

Question 16

Herniation of part of the stomach without displacement of GE junction

Answer 16

Type II (Rolling / Paraesophageal Hernia)

Question 17

Upward dislocation of the GE junction and cardia into the thorax through the esophageal hiatus of diaphragm

Answer 17

Type I (Sliding)

Question 18

Combined herniation of the cardia and fundus

Answer 18

Type III (Combined hernia)

Question 19

Includes an additional organ that herniates aside from the stomach

Answer 19

Type IV

Question 20

Also referred to as paraesophageal hernia as a portion of the stomach is situated adjacent to the esophagus

Answer 20

Types II-IV

Question 21

Borchardt triad (3)

Answer 21

Retching with Inability to vomit
Chest pain
Inability to pass a nasogastric tube

Question 22

Indicative of incarcerated intrathoracic stomach

Answer 22

Borchardt triad

Question 23

Paraesophageal repair process (4)

Answer 23

Hernia sac dissection and resection
Esophageal mobilization
Crural repair
Fundoplication

Question 24

Plummer Vinson Syndrome Triad

Answer 24

Dysphagia
IDA
Esophageal web

Question 25

Pulsion of diverticula of the distal esophagus arising just above the LES, more frequently on the right posterolateral wall

Answer 25

Epiphrenic Diverticulum

Question 26

Primary motility disorder characterized by loss of peristaltic waveform in the esophageal body and failure of the LES to relax

Answer 26

Achalasia

Question 27

Achalasia Triad

Answer 27

Hypertensive LES Aperistalsis of the esophagus Failure of LES to relax

Question 28

Gold standard of achalasia and sign seen in esophagogram

Answer 28

Manometry (+) Bird beak esophagus

Question 29

Treatment of achalasia

Answer 29

Heller myotomy + partial fundoplication Pneumatic dilatation - most effective non-surgical management Medications: CCB, nitrates, botulinum toxin

Question 30

Most common primary esophageal motility disorder

Answer 30

Nutcracker esophagus

Question 31

Functional grade of Dysphagia: Unable to swallow saliva

Answer 31

VI

Question 32

Functional Grade of Dysphagia: Able to take liquids only

Answer 32

IV

Question 33

Functional Grade of Dysphagia: Requires liquids with meals

Answer 33

II

Question 34

Functional Grade of Dysphagia: Able to take semisolids but unable to take any solid food

Answer 34

III

Question 35

Most important etiologic factor in the development of primary adenoCA of the esophagus

Answer 35

Barrett's esophagus

Question 36

Diagnostic evaluation that provides more accurate T and N staging

Answer 36

Endoscopic ultrasound

Question 37

Esophageal carcinoma treatment in which this is the standard for non surgical management for locally advanced disease

Answer 37

Chemoradiation (local regional disease : stage i - iii)

Question 38

Contraindications for curative surgery or resection

Answer 38

Age > 75 years old FEV1 < 1.25 abd EF < 40% > 20% wt loss Locally advance tumor Distant metastasis

Question 39

Phases of Caustic Injury: 1. Acute necrotic phase 2. Ulceration and granulation 3. Cicatrization and scarring

Answer 39

1. First phase (Day 1-4) 2. Second phase (Day 3-5) 3. Third phase (3rd week)

Question 40

Phases of Caustic Injury: ▪️Odynophagia and dyphagia ▪️Hypersalivation ▪️Pain in the mouth and substernal region

Answer 40

First phase

Question 41

Phases of Caustic Injury: Reapparance of the dysphagia due to stricture formation

Answer 41

Third phase

Question 42

Phases of Caustic Injury: ▪️Disappearance of the symptoms ▪️Period when esophagus is at its weakest

Question 43

Usual location in the esophagus for SCC

Answer 43

Middle 3rd of thoracic esophagus

Question 44

Usual location for adenocarcinoma in the esophagus

Answer 44

Distal esophagus

Question 45

Smooth polypoid lesion on barium swallow

Answer 45

Esophageal sarcoma

Question 46

Thin submucosal ring in the lower esophagus

Answer 46

Schatzki ring

Question 47

Mucosal tears located at the gastroesophageal junction

Answer 47

Mallory Weiss Tear