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Flashcards in Esophagus Deck (97)
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1

the start of the esophagus at the level of what cartilage

cricoid

2

the esophagus ends at the level of?

T11

3

What are the 3 narrowings of the esophagus

1. Cricopharyngeus (C6)
2. Left mainstem bronchus (T4)
3. LES (T11)

4

The artery of the cervical portion of the esophagus is the

inferior thyroid artery

5

the artery of the thoracic portion of the esophagus is the

bronchial arteries

6

the artery of the abdominal portion of the esophagus

Left gastric
inferior phrenic

7

The venous drainage of the cervical portion of the esophagus

inferior thyroid

8

The venous drainage of the thoracic portion of the esophagus

bronchial veins

9

The venous drainage of the abdominal portion of the esophagus

coronary vein

10

[diagnostics]

the first diagnostic test in patients with suspected esophageal disease

barium swallow

11

[diagnostics]

test indicated when a motor abnormality of the esophagus on the basis of complaints

manometry

12

[diagnostics]

most direct method of measuring increased esophageal exposure to gastric juice

24 hours ambulatory pH monitoring

13

[diagnostics]

gold standard for the diagnosis of GERD

24 hour ambulatory pH monitoring

14

the resting pressure of the LES is around

6 to 26mmHg

15

A defective LE sphincter has a mean pressure of

<6 mmHg

16

a defective LE sphincter has an overall length of

<2cm

17

a defective LES has an intraabdominal length of

<1cm

18

[diagnosis]

squamous epithelium turned to columnar in the LES

barrett esophagus

19

what is the hallmark of intestinal metaplasia in barrett esophagus

presence of intestinal goblet cells

20

[GERD surgeries]

360 degree fundoplication around the LES

Nissen

21

[GERD surgeries]

180 degree posterior fundoplication

Toupet

22

[GERD surgeries]

180 degree anterior fundoplication

Dor

23

[GERD surgeries]

use a stapler to divide the cardia and upper stomach

collis gastroplasty

24

[GERD surgeries]

240 to 279 degree fundoplication

Belsey Mark IV

25

[GERD surgeries]

Arcuate ligament repair + gastropexy to diaphragm

Hill Posterior Gastropexy

26

[diagnosis]

structural deterioration of the phrenoesophageal membrane

diaphragmatic hernia

27

[diagnosis: hiatal hernia]

heartburn, regurgitation

sliding hernia

28

[diagnosis: hiatal hernia]

dysphagia, postprandial fullness, massive bleeding, gastric volvulus, infarction

paraesophageal hernia

29

[diagnosis: hiatal hernia]

chest pain, retching with inability to vomit, inability to pass a NGT

borchdart triad

30

[Type of hiatal hernia]

upward dislocation of GEJ and cardia into the thorax through the esophageal hiatus of diaphragm

Type 2: sliding hernia

31

[Type of hiatal hernia]

upward dislocation of the gastric fundus along side a Normally positioned cardia

Type 2: paraesophageal

32

[Type of hiatal hernia]

herniation of part of the stomach without displacement of the GEJ

Type 2: paraesophageal

33

[Type of hiatal hernia]

combined herniation of the cardia and fundus

Type 3: combined hernia

34

[treatment of diaphragmatic hernia]

treated medically

sliding hernia

35

[treatment of diaphragmatic hernia]

treated largely surgical

paraesophageal hernia

36

___ triad

inability to pass NGT, retching without actual food regurgitation, epigastric pain

Borchardt triad

(Gastric volvulus)

37

[diagnosis]

mucosa line pouches that protrude from the esophageal lumen, contains all layers of esophageal wall

true esophageal diverticula

38

[diagnosis]

mucosa line pouches that protrude from the esophageal lumen, contains only submucosa and mucosa

false esophageal diverticula

more common

39

most common esophageal diverticula

zenker diverticula

40

area of potential weakness situated behind the esophagus at the level of the cricopharyngeus

killian triangle

41

[surgical management of zenker diverticula]

2cm or less

Pharyngomyotomy

42

[surgical management of zenker diverticula]

>2cm

diverticulectomy or Diverticulopexy

43

[surgical management of zenker diverticula]

wide based

diverticuloplexy

44

[diagnose[

diverticula located 5cms above and below the level of carina

mid thoracic diverticula

45

[kind of mid-thoracic diverticula]

usually due to granulomatous diseases

traction diverticula

46

[kind of mid-thoracic diverticula]

more common, diffuse motility disorders of the esophagus

pulsion diverticula

47

[diagnose]

pulsion diverticula that occurs distal to 10cm of esophagus

epiphrenic diverticula

48

[diagnose]

loss of peristaltic waveform in the esophageal body and failure of the LES to relax leading to functional outflow obstruction

Achalasia

49

[diagnose]

neurogenic degeneration in the esophagus; hypertension of LES, failure of the LES to relax,

elevation of intraluminal esophageal pressure

achalasia

50

[diagnose]

hypertensive LES
Apresistalsis of esophageal body
failure of LES to relax

achalasia

51

What is the surgical management of achalasia?

Heller myotomy and partial fundoplication

52

wha is the most effective non-surgical treatment; risk of perforation

pneumatic dilatation

53

[diagnosis]

if in the esophagogram a corkscrew deformity is seen,..

diffuse and segmental esophageal spasms

54

[diagnosis]

in manometry, simultaneous waveforms and multipeaked contractions; 20% or more out of 10 wet swallows

diffuse segmental esophageal spasm

55

what is the most common primary esophageal motility disorder

nutcracker esophagus

56

[diagnosis]

the mean peristaltic amplitude in distal esophagus is >180 mmHg; there is an increased duration of contraction; normal peristaltic sequence

nutcracker esophagus

57

[diagnosis]

elevated LES pressure (>26 mmHg); normal LES relaxation; normal peristalsis in the esophageal body

hypertensive LES

58

What is a true surgical emergency in the esophagus?

esophageal perforation

59

____ syndrome

spontaneous rupture of the esophagus; usual history of resisting vomiting

Boerhaave syndrome

60

In diagnosing esophageal perforation, what is the position in doing water soluble contrast esophagogram?

lateral decubitus position

61

[phase of injury: caustic injury]

pain in the mouth, substernal region, hypersalivation, odynophagia, dysphagia, pain, fever, bleeding, vomiting

1st phase

62

[phase of injury: caustic injury]

period when the esophagus is the weakest

2nd phase

63

the most common site of esophageal perforation in caustic injury

mid esophagus

64

[Zargar Classification]

ulcerations, mucosal and submucosal

Zargar 2

A: superficial
B: deep

65

[Zargar Classification]

necrosis, transmural

Zargas 3

A: focal
B: extensive

66

[diagnose]

plaque-like, erosive, papillary

can either be intraepithelial, intramucosal, submucosal

squamous cell CA

67

[diagnosis]

IDA, dysphagia, esophageal webs

plummer-vinson sydnrome

68

Barret esophagus is a precursor of this CA

adenoCA

69

Achalasia is a precursor of this CA

squamous cell CA

70

[diagnose]

dysphagia, stridor, coughing, choking, aspiration pneumonia, bleeding, hoarseness, jaundice, bone pain, anorexia

esophageal CA

71

[functional grade of dysphagia]

Patient able to take liquids only

grade IV

72

[functional grade of dysphagia]

patient able to take semisolids but unable to take any food

Grade III

73

[functional grade of dysphagia]

requires liquids with meals

Grade II

74

[functional grade of dysphagia]

unable to take liquids, but able to swallow saliva

Grade V

75

[diagnostics for esophagus]

evaluation of dysphagia to visualize mucosa, luminal distensibility, motility, and anatomic abnormalities

barium swallow

76

[diagnostics for esophagus]

this provides more accurate result for T and N staging

endoscopic UTZ

77

[surgical management]

Stage I to III (locoregional disease)

Esophagectomy

78

What are the contracindications for curative surgery

1. Age >75
2. FEV1 < 1.25
3. EF <40%
4. >20% weight loss
5. locally advanced tumor

79

[Esophagectomy approach]

esophageal CA limited to the intramucosal layer

vagal sparing esophagectomy

80

[Esophagectomy approach]

upper midline laparotomy
left cervical incision

transhiatal

Orringer and Sloan

81

[Esophagectomy approach]

upper midline incision
right thoracotomy is done

transthoracic

Ivor-Lewis

82

[Esophagectomy approach]

separate laparotomy
right thoracotomy
cervical incision

Three-field
McKeown

83

[Esophagectomy approach]

oblique incision from midpoint between xiphoid and umbilicus to tip of scapula;

abdomen is opened, costal arch divided,

enter through the seventh intercostal space

left thoracoabdominal

Akiyama

84

___ maneuver is the mobilization of the fixed portions of the duodenum

Kocher

85

in Oringger procedure, these arteries are preserved

Right Gastric and right gastroepiploic

86

[Bypass approaches]

allow better maintenance of an esophageal substitute; shortest

transthoracic

87

[Bypass approaches]

best direct conduit to the neck

reduced possibility of recurrent malignant dysphagia

substernal

88

[Esophago-Gastric Junction CA]

Siewert and Stein I corresponds to

Esophageal

TTE + 2 field LAD

89

[Esophago-Gastric Junction CA]

Siewert and Stein II corresponds to

Cardiac

Total gastrectomy + D2 LAD

90

[Esophago-Gastric Junction CA]

Siewert and Stein III corresponds to

Subcardiac

TTE or THE

91

[type of esophageal atresia]

EA without TEF

Type A

92

[type of esophageal atresia]

EA with proximal TEF

Type B

93

[type of esophageal atresia]

EA with distal TEF

Type C

most common

94

[type of esophageal atresia]

EA with double fistula

Type D

95

[type of esophageal atresia]

Tracheoesophageal fistula without atresia

Type E

96

[type of esophageal atresia]

Esophageal stenosis

Type F

97

___ is a thin submucosal ring in the lower esophagus

Schatzki Ring