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Flashcards in Esophagus Deck (29):
1

Anatomic location of esophagus

Pharynx to stomach- goes down/left, then right, then left again to connect to stomach.
Posterior border- vertebral column and thoracic duct
Anterior- trachea
Lateral- pleura
Left- Aorta

2

Nerves of esophagus (on outside)

Vagus nerve makes a plexus around it, condenses to form 2 trunks on the lateral esophagus. Trunks rotate- left trunk goes anterior, right trunk goes posterior

3

Layers of the esophagus

Mucosa (squamous epithelium, becomes columnar near GE jn)
Submucosa (contains meissner plexus)
2 muscular layers (longitudinal and circular) with Auerbach's plexus in bt
Esophagus does NOT have a serosa as the outermost layer like other GI stuff.

4

Arterial supply to esophagus

Upper esophagus- superior and inferior thyroid arteries
Lower- intercostal arteries, left gastric, phrenic arteries

5

Venous drainage of esophagus

Upper esophagus- to inferior thyroid vein and vertebral veins
Mid and lower- to azygous, hemiazygous, left gastric veins

6

In what pts do esophageal submucosal veins become enlarged? and what happens?

In pts w portal HTN
It can cause varices and life-threatening bleeding

7

Where do lymphatics from the esophagus drain into?

cervical, mediastinal, celiac, gastric nodes

8

Innervation of the esophagus

Vagus
Cervical sympathetic ganglion
Splanchnic ganglion
Celiac ganglion

9

T/F there is not a true sphincter in the lower esophagus

True! LES- no such thing. Gastric reflux prevented by increased tone.

10

T/F esophageal neoplasms are usually not malignant

False. They are almost always malignant.

11

What are the benign lesions of the esophagus

Benign lesions only account for 1%. They are leiomyomas, hemangiomas, cysts, polyps.
99% are malignant.

12

What kind of esophageal cancer is most common?

In USA- adenocarcinoma
In the world- squamous cell

13

Pathogenesis of esophageal ca (lifestyle)

Mucosal insult- hot liquids, burns from acid/base ingestion, radiation-induced esophagitis, reflux esophagitis
Alch, cig, nitrosamines, malnutrition
Barret's esophagus
Plummer-Vinson

14

HPE of esophageal adenocarcinoma

Progressive dysphagia to solids
esp in older male w hx of GERD.
Usu no other sx, appear well.

15

HPE of esophageal squamous cell carcinoma

Heavy alch/tobacco use
Usu px w more pronounced sx (dysphagia to solids) dt more advanced dz

16

Dx Eval for esophageal lesions

Barium esophagogram- inital study for new dysphagia
Def Dx- tsu confirm by flexible esophagoscopy w biopsy.
EUS to determine stage
Mets- CT/PET

17

T/F the esophageal dz is usu locally invasive or metastatic on px

True bc there is no serosa to keep it contained

18

Rx for esophageal ca

rad, chemo, surg
if contained local dz- esophaectomy

19

Why does achalasia occur?

No peristalsis + LES doesn't relax w swallowing.
Probably a problem w Auerbach's plexus (which is in bt the muscular layers)

20

What is the most common esophageal motility disorder?

achalasia

21

HPE of achalasia

Dysphagia
Regurgitation (non-sour, bc didn't get to stomach) esp w recumbent position
Hx of pneumonia (aspiration)

22

Dx Eval for achalasia

Esophagography- shows distal narrowing. Also, must do this to r/o ca! and look for strictures
Dynamic video img- abn peristalsis
bird's beak and/or prox dilaton

23

Rx for achalasia

Surgery- esophagomyotomy (heller myotomy) via laproscopy. partial fundoplication also performed often in addition to reduce post-op gerd
Can also use botox but doesn't really work for long.
Can also use pneumatic balloon dilatation of LES, but not as good as surg

24

When does esophageal perforation usually occur?

Iatrogenic, after instrumentation
Can also be from foreign bodies, penetrating trauma

25

What is Boerhaave syndrome?

Spontaneous esophageal rupture after vom

26

HPE esophageal perf

recent instrumentation, recent vom (boerhaave).
epigastric abd pain, shoulder pain
subcutanous emphysema
abd tenderness/distention
if delayed dx- sepsis (fever, tachy, hypotension)
Hydropneumothorax

27

Dx eval for esophageal perf

CXR- shows pleural effusion, hydropneumothorax, mediastinal emphysema
Esophageal contrast study- shows location of perf
If needed, flexible endoscopy
Throacentesis- empyema

28

Rx for esophageal perf

immediate exploratory throacotomy and repair of perf
drain w chest tubes post-op
if small lacerations, can give abx and observe

29

T/F if esophageal perforation is not treated immediately, there is very high mortality

True. >50% if not treated in 24hrs