Fiser Ch 29: Esophagus Flashcards Preview

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Flashcards in Fiser Ch 29: Esophagus Deck (53)
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1

layers of the esophagus

mucosa (squamous epithelium)
submucosa
muscularis propria (longitudinal muscle layer)
*NO SEROSA*

2

blood supply of the esophagus: cervical, thoracic, abdominal

cervical: inferior thyroid aa
thoracic: directly from aorta
abdominal: left gastric and inferior phrenic aa

3

normal UES pressure at rest

60 mmHg

4

normal LES pressure at rest

15mmHg

5

what nerve mediates relaxation of LES?

vagus

6

surgical approach: cervical esophagus

left thoracotomy

7

surgical approach: upper 2/3 thoracic esophagus

right thoracotomy

8

surgical approach: lower 1/3 of esophagus

left thoracotomy

9

treatment of Zenker's diverticulum?

cricopharyngeal myotomy via left cervical incision

10

whats plummer vinson syndrome?

- due to iron deficient anemia
- causes upper esophageal webs
tx: dilation, fe, screen for oral ca

11

location of zenkers diverticulum vs traction diverticulum?

zenkers: cervical esophagus and posterior
traction: mid esophagus and lateral

12

what an epiphrenic diverticulum? tx?

- rare, associated w esophageal motility disorders (achalasia)
- distal esophagus
tx: if symptomatic-
diverticulectomy and esophageal myotomy on opposite side

13

what is achalasia and cause?

- lack of peristalsis and failure of LES to relax
- 2/2 autoimmune distruction of neuronal ganglion cells in muscle wall

14

treatment of achalasia?

balloon dilation of LES + nitrates and CCBs initially, then heller myotomy if fails

15

what is a heller myotomy?

left (achalasia) or right (DES, nutcracker) thoracotomy, myotomy of lower esophagus only (achalasia) or upper and lower (DES, nutcracker) + partial nissen fundoplication

16

what is diffuse esophageal spasm?

frequent strong non-peristaltic unorganized contractions, LES relaxes normally

17

tx of diffuse esophageal spasm?

CCBs, trazodone, heller myotomy if fails (myotomy of both UPPER and LOWER

18

what is nutcracker esophagus?

high amplitude peristaltic contractions (>180mmHg), LES relaxes normally

19

best test to diagnose GERD?

pH probe

20

steps of nissen fundoplication

1. divide short gastrics
2. pull esophagus into the chest
3. approximate crura
4. 270 (partial) or 360 degree gastric fundus

21

what is a belsey fundoplication?

same as nissen but approach is through the chest

22

key maneuver for dissection during nissen?

finding the right crura

23

key maneuver for wrap during nissen

finding the left crura

24

what is a collis gastroplasty?

not enough esophagus to pull down into abdomen for nissen fundo so staple off stomach cardia and create a neoesophagus

25

treatment of dysphagia following nissen?

most likely nissen is too tight which generally resolves on its own, clear liquids for 1 week and if still there then dilation

26

Four different types of hiatal hernias

type I: sliding hernia from dilation of hiatus, GE jxn rises above diaphragm
type II: paraesophageal, hole in the diaphragm alongside esophagus, normal GE jxn
type III: combined type I and II
type IV: entire stomach in the chest plus another organ

27

management of high grade dysplasia of barrett's?

1. Esophagectomy OR
2. EGD surveillance every 3 months, 4 quadrant bx very 1cm for entire length of dysplasia

28

surveillance of pt w uncomplicated barrett's

EGD every year for lifetime

29

esophageal cancer: best test to evaluate for resectability?

CT chest abd abdomen

30

esophageal cancer pathology different types

1. Adenocarcinoma: most common, lower 1/3, likely to met to liver
2. Squamous cell: upp 2/3, likely to met to lung