Flashcards in Fiser Ch 29: Esophagus Deck (53)
layers of the esophagus
mucosa (squamous epithelium)
muscularis propria (longitudinal muscle layer)
blood supply of the esophagus: cervical, thoracic, abdominal
cervical: inferior thyroid aa
thoracic: directly from aorta
abdominal: left gastric and inferior phrenic aa
normal UES pressure at rest
normal LES pressure at rest
what nerve mediates relaxation of LES?
surgical approach: cervical esophagus
surgical approach: upper 2/3 thoracic esophagus
surgical approach: lower 1/3 of esophagus
treatment of Zenker's diverticulum?
cricopharyngeal myotomy via left cervical incision
whats plummer vinson syndrome?
- due to iron deficient anemia
- causes upper esophageal webs
tx: dilation, fe, screen for oral ca
location of zenkers diverticulum vs traction diverticulum?
zenkers: cervical esophagus and posterior
traction: mid esophagus and lateral
what an epiphrenic diverticulum? tx?
- rare, associated w esophageal motility disorders (achalasia)
- distal esophagus
tx: if symptomatic-
diverticulectomy and esophageal myotomy on opposite side
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
treatment of achalasia?
balloon dilation of LES + nitrates and CCBs initially, then heller myotomy if fails
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
what is diffuse esophageal spasm?
frequent strong non-peristaltic unorganized contractions, LES relaxes normally
tx of diffuse esophageal spasm?
CCBs, trazodone, heller myotomy if fails (myotomy of both UPPER and LOWER
what is nutcracker esophagus?
high amplitude peristaltic contractions (>180mmHg), LES relaxes normally
best test to diagnose GERD?
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
what is a belsey fundoplication?
same as nissen but approach is through the chest
key maneuver for dissection during nissen?
finding the right crura
key maneuver for wrap during nissen
finding the left crura
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
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
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
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
surveillance of pt w uncomplicated barrett's
EGD every year for lifetime
esophageal cancer: best test to evaluate for resectability?
CT chest abd abdomen