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Flashcards in Esophagus Deck (49):
1

First diagnostic test in patients with suspected esophageal disease

barium swallow

2

Essential tool in preoperative evaluation of patients before antireflux surgery

manometry

3

Gold standard for diagnosis of GERD

24 hour ambulatory pH monitoring
96% specificity

4

Most specific symptom of foregut disease

dysphagia

5

Characteristics of defective sphincter

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

6

Grading of esophagitis

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

7

Hallmark of barett esophagus

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

8

Medical Management of GERD

12 weeks of emperic antacid

9

Surgical Management of GERD

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

10

Procedure for esophageal lengthening

collis gastroplasty

11

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

angelchik prosthesis

12

Type of hernia where there is upward dislocation of the CARDIA

Type 1
Sliding Hernia

13

Type of hernia where there is upward dislocation of the FUNDUS

Type 2
Rolling Hernia

14

A hernia that stretches the phrenoesophageal ligament

Type 1
Sliding Hernia

15

A hernia with a defect in the phrenoesophageal membrane

Type 2
Rolling Hernia

16

A hernia wherein the esophagogastric junction is in the mediastinum

Type 3
Mixed

17

A complication of hernia that is an emergency

Gastric volvulus

18

Triad of gastric volvulus

Borchardt's triad
1. pain
2. nausea with inability to vomit
3. inability to pass NGT

19

What is the diagnostic test for paraesophageal hernia

Barium esophagogram

20

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

Schatzki's Ring

21

Predominant feature of scleroderma of esophagus

atrophy of the smooth muscle

22

This is the most common esophageal diverticulum

zenkers diverticulum

23

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

zenkers diverticulum

24

Treatment of zenkers diverticulum

1. pharyngomyotomy: < 2 cm
2. diverticulectomy/diverticulopexy: >2 cm

25

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

Achalaasia

26

Triad of achalaasia

1. weight loss
2. regurgitation
3. dysphagia

27

treatment of achalasia

Heller's Myotomy

28

Characteristic feature of achalasia in barium esophagogram?

Dilated esophagus with a tapering
Bird's Beak appearance

29

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

DES - diffuse and segmental esophageal spasm

30

This is also known as supersqueezer esophagus

nutcracker esophagus

31

This is a puslion diverticula

Epiphrenic diverticula
False Diverticula
Cause: Motor Disorder

32

This is a traction diverticula

Midesophageal Diverticula
True Diverticula
Cause: Inflammatory disorder

33

A disease with spontaneous perforation of the esophagus

Boerhaave;s syndrome
(post emetic esophageal rupture)

34

Treamtent of esophageal perforation

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

35

Most common location of esophageal perforation

left lateral wall of esophagus, just above the GEJ

36

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

Mallory weiss syndrome

37

Phases of caustic injury

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

38

The phase of caustic injury where in the esophagus is weakest

ulceration and granulation phase

39

This phase of caustic injury is characterize by dysphagia

Cicatrizaation and scarring

40

Diagnostic test for caustic injury

Esophagogram within 12 hours

41

Most common presenting symptom of esophageal carcinoma

dysphagia

42

Characteristic of cervical esophagus carcinoma

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

43

treatment of cervical esophagus carcinoma

Stereotactic radiation with concomitant chemotherapy

44

Characteristic of thoracic esophagus carcinoma

1. squamous
2. lymph node metastasis

45

treatment of thoracic esophagus carcinoma

VATS + thoracotomy

46

Characteristic of distal esophagus carcinoma

1. adenocarcinoma

47

treatment of distal esophagus carcinoma

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

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

Ivor Lewis Procedure

49

This surgical procedure is excellent in exposure of the distal esophagus

Left thoracoabdominal approach