Esophagus

Question 1

First diagnostic test in patients with suspected esophageal disease

Answer 1

barium swallow

Question 2

Essential tool in preoperative evaluation of patients before antireflux surgery

Answer 2

manometry

Question 3

Gold standard for diagnosis of GERD

Answer 3

24 hour ambulatory pH monitoring

96% specificity

Question 4

Most specific symptom of foregut disease

Answer 4

dysphagia

Question 5

Characteristics of defective sphincter

Answer 5

1. LES with mean resting pressure of < 6 mmHg
2. overall sphincter length of < 2 cm
3. intraabdominal sphincter length of <1 cm

Question 6

Grading of esophagitis

Answer 6

I - small circular nonconfluent erosion
II - linear erosion with granulation tissue, bleeds easily when touched
III - coalesce to form circumferential loss, cobble stone mucosa
IV - presence of stricture

Question 7

Hallmark of barett esophagus

Answer 7

presence of intestinal goblet cells in the esophageal epitheliem (intestinal metaplasia)

Question 8

Medical Management of GERD

Answer 8

12 weeks of emperic antacid

Question 9

Surgical Management of GERD

Answer 9

1. nissen fundoplication - 360 degree wrap
2. belsey operation - 280 degree wrap
3. hill operation - 180 degree wrap
4. collis gastroplasty - esophageal lengthening
5. angelchik prosthesis - placement of silastic device around the distal esophagus

Question 10

Procedure for esophageal lengthening

Answer 10

collis gastroplasty

Question 11

Procedure for placement of silastic device around the distal esophagus, keeping this segment in the abdomen

Answer 11

angelchik prosthesis

Question 12

Type of hernia where there is upward dislocation of the CARDIA

Answer 12

Type 1

Sliding Hernia

Question 13

Type of hernia where there is upward dislocation of the FUNDUS

Answer 13

Type 2

Rolling Hernia

Question 14

A hernia that stretches the phrenoesophageal ligament

Answer 14

Type 1

Sliding Hernia

Question 15

A hernia with a defect in the phrenoesophageal membrane

Answer 15

Type 2

Rolling Hernia

Question 16

A hernia wherein the esophagogastric junction is in the mediastinum

Answer 16

Type 3

Mixed

Question 17

A complication of hernia that is an emergency

Answer 17

Gastric volvulus

Question 18

Triad of gastric volvulus

Answer 18

Borchardt’s triad

1. pain
2. nausea with inability to vomit
3. inability to pass NGT

Question 19

What is the diagnostic test for paraesophageal hernia

Answer 19

Barium esophagogram

Question 20

It is a thin submucosal circumferential ring in the Lower esophagus at the squamocolumnar junction, often associated with hiatal hernia

Answer 20

Schatzki’s Ring

Question 21

Predominant feature of scleroderma of esophagus

Answer 21

atrophy of the smooth muscle

Question 22

This is the most common esophageal diverticulum

Answer 22

zenkers diverticulum

Question 23

This disease is due to weakness of the cricopharyngeal muscle at the KILLIAN’S AREA

Answer 23

zenkers diverticulum

Question 24

Treatment of zenkers diverticulum

Answer 24

1. pharyngomyotomy: < 2 cm

2. diverticulectomy/diverticulopexy: >2 cm

Question 25

A disease characterized by complete absence of peristalsis in the esophageal body and failure of relaxation of LES

Answer 25

Achalaasia

Question 26

Triad of achalaasia

Answer 26

1. weight loss 2. regurgitation 3. dysphagia

Question 27

treatment of achalasia

Answer 27

Heller's Myotomy

Question 28

Characteristic feature of achalasia in barium esophagogram?

Answer 28

Dilated esophagus with a tapering | Bird's Beak appearance

Question 29

This disease is seen in the esophagogram as corkscrew esophagus or pseudodiverticulosis

Answer 29

DES - diffuse and segmental esophageal spasm

Question 30

This is also known as supersqueezer esophagus

Answer 30

nutcracker esophagus

Question 31

This is a puslion diverticula

Answer 31

Epiphrenic diverticula False Diverticula Cause: Motor Disorder

Question 32

This is a traction diverticula

Answer 32

Midesophageal Diverticula True Diverticula Cause: Inflammatory disorder

Question 33

A disease with spontaneous perforation of the esophagus

Answer 33

Boerhaave;s syndrome | post emetic esophageal rupture

Question 34

Treamtent of esophageal perforation

Answer 34

primary closure of the perforation within 24 hours results in 80 - 90% survival

Question 35

Most common location of esophageal perforation

Answer 35

left lateral wall of esophagus, just above the GEJ

Question 36

This disease is characterized as longitudinal tear in the mucosa of the GE junction

Answer 36

Mallory weiss syndrome

Question 37

Phases of caustic injury

Answer 37

1. acute necrotic phase 2. ulceration and granulation phase 3. cicatrization and scarring

Question 38

The phase of caustic injury where in the esophagus is weakest

Answer 38

ulceration and granulation phase

Question 39

This phase of caustic injury is characterize by dysphagia

Answer 39

Cicatrizaation and scarring

Question 40

Diagnostic test for caustic injury

Answer 40

Esophagogram within 12 hours

Question 41

Most common presenting symptom of esophageal carcinoma

Answer 41

dysphagia

Question 42

Characteristic of cervical esophagus carcinoma

Answer 42

1. squamous 2. unresectable 3. invades larynx, trachea, great vessels

Question 43

treatment of cervical esophagus carcinoma

Answer 43

Stereotactic radiation with concomitant chemotherapy

Question 44

Characteristic of thoracic esophagus carcinoma

Answer 44

1. squamous | 2. lymph node metastasis

Question 45

treatment of thoracic esophagus carcinoma

Answer 45

VATS + thoracotomy

Question 46

Characteristic of distal esophagus carcinoma

Answer 46

1. adenocarcinoma

Question 47

treatment of distal esophagus carcinoma

Answer 47

curative resection requires cervical division of esophagus + >50% gastrectomy

Question 48

It is a procedure for middle/thoracic esophageal lesion wherein all the LN are removed en bloc with the lesser curvature of the stomach

Answer 48

Ivor Lewis Procedure

Question 49

This surgical procedure is excellent in exposure of the distal esophagus

Answer 49

Left thoracoabdominal approach