SB82 Esophagus - loosely taken from Fiser's ABSITE review
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| The source of major blood supply to the esophagus _____________ | Vessels off the aorta
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| The esophageal wall lacks this layer ___________ | Serosa
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| This artery supplies the cervical esophagus _____________ ____________ | Inferior thyroid
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| These two arteries supply the abdominal esophagus ______________ | Left gastric and inferior phrenic
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| This branch of the right vagus nerve can cause persistently high post-op acid levels if left undivided during a vagotomy ________________ | Criminal nerve of Grassi
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| Which portion of the vagus nerve travels on the anterior portion of the stomach (right / left)? _________ | Left
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| Where does the thoracic duct cross from left to right in the chest? | At the upper 1/3 of the mediastinum
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| What is the muscle delineating the upper esophageal sphincter? ____________ | Cricopharyngeus
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| What nerve innervated the UES? _______________ | Recurrent laryngeal nerve
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| What is the most common site of esophageal perforation? __________________ | Cricopharyngeus
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| What mediates the relaxation of the LES? ______________ | Inhibitory neurons
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| What side is the appropriate approach to the cervical esophagus? _________ | Left
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| Which portion of the esophagus should you approach from the right? _____________ | Upper 2/3 thoracic esophagus
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| What is the diagnostic procedure of choice for dysphagia or odynophagia? ______________ | Barium swallow
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| What esophageal disease is caused by iron deficiency? _________________ | Plummer-Vinson
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| False diverticula usually lie in this orientation _________ | Posterior
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| This type of false diverticulum is caused by increased pressure during swallowing _________ | Zenker’s
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| What is the treatment for Zenker’s diverticulum? ________________ | Cricopharyngeal myotomy with or without resection of diverticulum
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| What are the causes of traction diverticulum? _________________ | Inflammation, granulomatous disease, tumor
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| Where in the esophagus is a traction diverticulum usually found? ___________ | Mid-thoracic
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| What is a common cause of epiphrenic diverticulum? ________________ | Esophageal dysmotility disorders
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| What is the treatment of epiphrenic diverticulum? __________ | Diverticulectomy and long esophageal myotomy opposite
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| What are two medical treatments for achalasia? ___________ | Calcium channel blocker, nitrates
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| What infectious organism can cause symptoms similar to achalasia? ______________ | Trypanosoma cruzi
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| What differentiates diffuse esophageal spasm from achalasia? | DES has normal LES tone; in achalasia the tone is increased
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| For which esophageal dysmotility disorder is a Heller myotomy more effective? ___________ | Achalasia
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| In this disease, fibrous replacement of esophageal smooth muscle causes dysphagia and loss of LES tone __________________ | Scleroderma
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| What is the most common cause of dysphagia following a Nissen? ___________ | Wrap is too tight
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| The key maneuver in a Nissen is identification of the ________________ | Left crura
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| This operation involves stapling a portion of the stomach into a “new” esophagus when the esophagus is not long enough to pull into the abdomen ______________ | Collis gastroplasty
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| What is the initial medical therapy for GERD and for how long? ___________________ | Omeprazole for 12 weeks
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| This most common hiatal hernia is due to dilation of the hiatus ____________ | Type I (sliding) hernia
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| Type II hiatal hernias are in this location _________________ | Paraesophageal
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| What is the risk of leaving a Type II hiatal hernia unrepaired? ______________ | Incarceration
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| This condition is characterized by short episodes of dysphagia following rapid swallowing, and often has an associated sliding hernia ______________ | Schatzki’s ring
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| What is the treatment of Schatzki’s ring? ___________ | Dilation
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| Severe Barrett’s esophagus is an indication for what treatment? _____________ | Esophagectomy
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| Esophageal cancer spreads along this route _______________ | Submucosal lymphatic channels
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| If you are trying to determine whether or not an esophageal cancer is unresectable, what do you order? _______________ | Chest/abd CT
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| Where does an esophageal adenocarcinoma usually occur? ____________ | Lower 1/3
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| Is esophageal cancer that has spread to the supraclavicular node resectable or unresectable? ______________ | Unresectable
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| What is the primary blood supply to the stomach after using it to replace the esophagus? _________________ | Right gastroepiploic
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| Chemotherapy for esophageal cancer includes these two medications ____________ and ___________________ | 5-FU and cisplatin
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| The most common benign tumor of the esophagus ____________ | Leiomyoma
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| The location within the esophageal wall of leiomyomas ____________ | Submucosa
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| Why do you refrain from biopsying leiomyomas? | Scar that forms may make resection difficult
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| Criteria for operating on esophageal leiomyomas | Size greater than 5 cm, or symptomatic
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| Treatment of leiomyomas | Thoracotomy and enucleation
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| Diagnostic test for leiomyoma ___________ | Esophagram, then endoscopy to rule out cancer
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| Most common location of esophageal polyps ________________ | Cervical esophagus
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| Caustic esophageal injury: What kind causes liquefaction? __________________ | Alkali
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| What type of caustic esophageal injury is more likely to cause cancer? _________ | Alkali
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| What part of the GI tract is most injured by acid ingestion? ______________ | Stomach
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| What is the treatment for tertiary esophageal caustic injury? _____________ | Esophagectomy
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| What modality do you use to follow caustic esophageal injuries? | Gastrografin followed by thin barium swallow on hospital day 2-3
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| Criteria for non-surgical management of esophageal perforations | Contained perforation on contrast study, self-draining, no systemic effects
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| What are the potential treatments for non-contained esophageal perforations? | Primary repair with drains and intercostal muscle flap if <24 hours since injury; otherwise cervical esophagostomy, washout and chest tubes
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| What incision on the esophagus do you perform to assess the extent of esophageal injury? _________ | Longitudinal myotomy
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| What esophageal condition is caused by forceful vomiting, and characterized by severe chest pain, with eventual finding of perforation? _____________________ | Boerhaave’s syndrome
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| Where is the most common location of perforation in Boerhaave’s syndrome? _______________ | Left lateral wall of the esophagus at T8 level
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| Mediastinal crunching on auscultation of patient with Boerhaave’s syndrome also known as _________________ | Hartmann’s sign
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