Esophagus

Question 1

Cervical Esophageal blood supply

Answer 1

Inferior thyroid artery (thyrocervical trunk)

Question 2

Thoracic Esophageal blood supply

Answer 2

directly off of aorta

Question 3

Abdominal Esophageal blood supply

Answer 3

Left gastric

Inferior phrenic

Question 4

UES: muscle and innervation

Answer 4

cricopharyngeus
superior laryngeal nerve
15 cm from incisors

Question 5

Killians triangle

Answer 5

wall of pharynx. Superior to circopharyngeus muscle and inferior to inferior constrictor muscle
Zenkers diverticulum likely to occur here

Question 6

Most common sites of esophageal perforation

Answer 6

1) distal esophagus (left posterolateral aspect 2-3 cm above GE junction)
2) Iatrogenic- circopharyngeus

Question 7

Esophageal Perf Abx

Answer 7

Gram - rods, oral flora, anaerobes, fungus

ampicillin, ceftriaxone, metronidazole, fluconazole

Question 8

Esophageal perf, tx if malignancy, caustic peroration, burned out megaesophagus

Answer 8

Esophagectomy

Question 9

Esophageal perf, tx if achalasia

Answer 9

perform contralateral myotomy

Question 10

Esophageal perf, patient unstable

Answer 10

exclusion and diversion

• cervical esophagostomy for proximal diversion
• T tube in defect and draining externally as controlled fistula
• J tube enteral access

Question 11

Manometry findings Achalasia

Answer 11

1) high or normal LES basal pressure
2) incomplete LES relaxation
3) hypotonic or absent peristalsis

Question 12

Isolated hypertensive LES

Answer 12

1) high basal LES pressure
2) complete LES relaxation
3) normal peristalsis

Question 13

Tx Isolated hypertensive LES

Answer 13

CCB, nitrates, Heller

Question 14

Diffuse esophageal spasm

Answer 14

1) normal LES pressure and relaxation

2) high amplitude, uncoordinated esophageal contractions (>30 mmHg > 10% of swallows)

Question 15

Tx Diffuse esophageal spasm

Answer 15

CCB, nitrates

long segment myotomy

Question 16

Nutcracker esophagus

Answer 16

1) normal LES pressure and relaxation

2) high amplitude, coordinated esophageal contractions

Question 17

Tx Nutcracker esophagus

Answer 17

CCB, nitrates, long segment myotomy

Question 18

Zenker diverticulum Tx > 3cm

Answer 18

> 3 cm: endoscopic division of UES creating a common lumen between diverticulum and esophagus

Question 19

Zenker diverticulum Tx < 3 cm

Answer 19

need open myotomy (via left neck incision) with or without diverticulectomy

Question 20

Epiphrenic esophageal diverticulum

Answer 20

Pulsion diverticulum

Tx: diverticulectomy and tx of underlying motility disorder

Question 21

Thoracic esophageal diverticulum

Answer 21

Traction diverticulum
True- all 3 layers
inflammatory condition
Tx: VATS diverticulectomy and myotomy

Question 22

Surveillance of Barrett’s esophagus

Answer 22

EGD annually with 4 quadrant bx

If 2 consecutive years negative for dysplasia –> EGD q3yrs

Question 23

Low grade GEJ dysplasia follow-up

Answer 23

repeat EGD 6 months

Question 24

High grade GEJ dysplasia

Answer 24

repeat bx

EMR

Question 25

Work up of Esophageal cancer

Answer 25

``` H&P Labs endoscopy with bx bronchoscopy if tumor above carina CT EUS w FNA of suspicious nodes PET/CT ```