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Esophagus Flashcards

(72 cards)

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1
Q

Does the esophagus have a serosa?

A

No

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2
Q

What type of muscle is upper 1/3 of the esophagus

A

striated muscle

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3
Q

type of muscle - middle and distal third esophagus

A

smooth muscle

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4
Q

major blood supply of thoracic esophagus

A

vessels directly off the aorta

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5
Q

blood supply of cervical esophagus

A

inferior thyroid artery

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6
Q

blood supply - abdominal esophagus

A

left gastric a. and inferior phrenic a.

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7
Q

venous drainage of esophagus

A

hemi-azygous and azygous veins in chest

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8
Q

lymphatic drainage of esophagus

A

upper 2/3 drains cephalad, lower 1/3 caudad

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9
Q

significance of criminal nerve of grassi

A

can cause persistently high acid levels postop if left undivided after vagotomy

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10
Q

major muscle upper esophageal sphincter

A

the cricopharyngeus muscle

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11
Q

purpose of the cricopharyngeus muscle

A

circular muscle, prevents air swallowing

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12
Q

normal UES pressure at rest

A

60mmHg

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13
Q

normal UES pressure with food bolus

A

15 mm Hg

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14
Q

most common site of esophageal perforation after EGD

A

cricopharyngeus muscle

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15
Q

most common site for esophageal foreign body

A

cricopharyngeus muscle

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16
Q

aspiration with brain-stem stroke is 2/2

A

failure of cricopharyngeus to relax

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17
Q

distance that lower esoph. sphincter from incisors

A

40cm

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18
Q

normal LES pressure at rest

A

15mm Hg

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19
Q

normal LES pressure with food bolus

A

0 mm Hg

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20
Q

three anatomic areas of esophageal narrowing

A
  1. cricopharyngeus muscle
  2. compression by left mainstem bronchus and aortic arch
  3. diaphragn
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21
Q

Three swallowing stages (CNS initiates)

A
  1. primary peristalsis
  2. secondary peristalsis
  3. tertiary peristalsis
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22
Q

surgical approach cervical esoph.

A

left

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23
Q

surgical approach upper 2/3 thoracic esoph

A

right - avoids the aorta

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24
Q

surgical approach - lower 1/3 thoracic esoph.

A

left

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25
four causes of hiccups
gastric distention, temperature changes, etoh, tobacco
26
What is the best initial test of heartburn?
Endoscopy
27
What is the best initial test for dysphagia?
Barium swallow/ esophagram
28
Esophageal perforation - best test?
Gastrografin swallow
29
What is the treatment for plummer-vinson syndrome?
Dilation, Fe, need to screen for oral CA
30
Is Zenker diverticulum false or true?
false
31
What is the cause of Zenker diverticulum?
Failure of the cricopharyngeus to relax
32
Presentation of zenker diverticulum
upper esophageal dysphagia, choking, halitosis, regurgitation of non-digested food
33
Best test - Zenker diverticulum
Barium swallow
34
Treatment - zenker diverticulum
Cricopharyngeal myotomy (removal of diverticula is not necessary)
35
Traction diverticulum - true or false?
True
36
Causes of traction diverticulum? (3)
inflammation, granulomatous disease, tumor
37
Where is traction diverticulum usually found?
Mid-esophagus
38
Presentation - traction diverticulum?
regurgitation of undigested food, dysphagia
39
Treatment - traction diverticulum
excision and primary closure if symptomatic, may need palliative therapy (ie XRT) if due to invasive cancer. If asymptomatic, leave alone
40
Disorder associated with epiphrenic diverticulum
achalasia
41
location - epiphrenic diverticulum
distal 10 cm of the esophagus
42
treatment - epiphrenic diverticulum
diverticulectomy and esophageal myotomy on the side opposite the diverticulectomy if symptomatic
43
Causes of symptoms of achalasia
lack of peristalsis and failure of LES to relax after food bolus
44
Cause - achalasia
autoimmune destruction of neuronal ganglion cells in muscle wall
45
Manometry findings in Achalasia
Increased LES pressure, incomplete LES relaxation, no peristalsis
46
Why do an EGD in patient with suspected Achalasia?
to rule out esophageal cancer
47
First line treatment
Balloon dilation of LES
48
Achalasia treatment of medical treatment and dilation fail
heller myotomy
49
Medications to try in achalasia
nitrates, CCB's
50
Infection that can cause similar symptoms to achalasia
T. cruzi
51
Manometry - diffuse esophageal spasm
frequent strong non-peristaltic unorganized contractions, LES relaxes normally
52
Medical treatment - diffuse esophageal spasm
CCB, trazodone
53
Surgical treatment - diffuse esophageal spasm
Heller myotomy (both upper and lower esophagus)
54
Presentation - nutcracker esophagus
chest pain +/- dysphagia
55
manometry - nutcracker esophagus
high amplitude peristaltic contractions (>180 mm Hg), LES relaxes normally
56
medical treatments - nutcracker esophagus
CCB, trazodone
57
surgical treatment - nutcracker esophagus
heller myotomy
58
what is the most common organ involved in scleroderma?
esophagus
59
pathophysiology - scleroderma
fibrous replacement of esophageal smooth muscle
60
How does scleroderma cause symptoms?
causes dysphagia and loss of LES tone with massive reflux and strictures
61
manometry findings in scleroderma
low LES pressure and aperistalsis
62
treatment - scleroderma
PPI and Reglan, esophagectomy if severe
63
most common defect in GERD
lose LES competence
64
GERD + dysphagia, worry about
cancer
65
GERD + bloating, worry about
aerophagia and delayed gastric emptying. diagnose with gastric emptying study
66
GERD + epigastric pain, worry about
peptic ulcer, tumor
67
When to do further diagnostic studies in GERD
failure of PPI despite escalating doses (3-4 weeks)
68
best test - GERD
pH probe
69
manometry findings in GERD
resting LES <6
70
When to do surgery in GERD
failure of medical treatment, avoidance lifetime meds, young patients, refractory complications (bleeding, esophagitis, stricture)
71
Most common cause of dysphagia following Nissen
wrap is too tight. generally resolves on its own/can dilate after 1 week
72
Type I hiatal hernia
sliding hernia from dilation of hiatus, often associated with GERD; GE junction rises above the diaphragm

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