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SB82 Esophagus

SB82 Esophagus - loosely taken from Fiser's ABSITE review

QuestionAnswer
The source of major blood supply to the esophagus _____________ Vessels off the aorta
The esophageal wall lacks this layer ___________ Serosa
This artery supplies the cervical esophagus _____________ ____________ Inferior thyroid
These two arteries supply the abdominal esophagus ______________ Left gastric and inferior phrenic
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
Which portion of the vagus nerve travels on the anterior portion of the stomach (right / left)? _________ Left
Where does the thoracic duct cross from left to right in the chest? At the upper 1/3 of the mediastinum
What is the muscle delineating the upper esophageal sphincter? ____________ Cricopharyngeus
What nerve innervated the UES? _______________ Recurrent laryngeal nerve
What is the most common site of esophageal perforation? __________________ Cricopharyngeus
What mediates the relaxation of the LES? ______________ Inhibitory neurons
What side is the appropriate approach to the cervical esophagus? _________ Left
Which portion of the esophagus should you approach from the right? _____________ Upper 2/3 thoracic esophagus
What is the diagnostic procedure of choice for dysphagia or odynophagia? ______________ Barium swallow
What esophageal disease is caused by iron deficiency? _________________ Plummer-Vinson
False diverticula usually lie in this orientation _________ Posterior
This type of false diverticulum is caused by increased pressure during swallowing _________ Zenker’s
What is the treatment for Zenker’s diverticulum? ________________ Cricopharyngeal myotomy with or without resection of diverticulum
What are the causes of traction diverticulum? _________________ Inflammation, granulomatous disease, tumor
Where in the esophagus is a traction diverticulum usually found? ___________ Mid-thoracic
What is a common cause of epiphrenic diverticulum? ________________ Esophageal dysmotility disorders
What is the treatment of epiphrenic diverticulum? __________ Diverticulectomy and long esophageal myotomy opposite
What are two medical treatments for achalasia? ___________ Calcium channel blocker, nitrates
What infectious organism can cause symptoms similar to achalasia? ______________ Trypanosoma cruzi
What differentiates diffuse esophageal spasm from achalasia? DES has normal LES tone; in achalasia the tone is increased
For which esophageal dysmotility disorder is a Heller myotomy more effective? ___________ Achalasia
In this disease, fibrous replacement of esophageal smooth muscle causes dysphagia and loss of LES tone __________________ Scleroderma
What is the most common cause of dysphagia following a Nissen? ___________ Wrap is too tight
The key maneuver in a Nissen is identification of the ________________ Left crura
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
What is the initial medical therapy for GERD and for how long? ___________________ Omeprazole for 12 weeks
This most common hiatal hernia is due to dilation of the hiatus ____________ Type I (sliding) hernia
Type II hiatal hernias are in this location _________________ Paraesophageal
What is the risk of leaving a Type II hiatal hernia unrepaired? ______________ Incarceration
This condition is characterized by short episodes of dysphagia following rapid swallowing, and often has an associated sliding hernia ______________ Schatzki’s ring
What is the treatment of Schatzki’s ring? ___________ Dilation
Severe Barrett’s esophagus is an indication for what treatment? _____________ Esophagectomy
Esophageal cancer spreads along this route _______________ Submucosal lymphatic channels
If you are trying to determine whether or not an esophageal cancer is unresectable, what do you order? _______________ Chest/abd CT
Where does an esophageal adenocarcinoma usually occur? ____________ Lower 1/3
Is esophageal cancer that has spread to the supraclavicular node resectable or unresectable? ______________ Unresectable
What is the primary blood supply to the stomach after using it to replace the esophagus? _________________ Right gastroepiploic
Chemotherapy for esophageal cancer includes these two medications ____________ and ___________________ 5-FU and cisplatin
The most common benign tumor of the esophagus ____________ Leiomyoma
The location within the esophageal wall of leiomyomas ____________ Submucosa
Why do you refrain from biopsying leiomyomas? Scar that forms may make resection difficult
Criteria for operating on esophageal leiomyomas Size greater than 5 cm, or symptomatic
Treatment of leiomyomas Thoracotomy and enucleation
Diagnostic test for leiomyoma ___________ Esophagram, then endoscopy to rule out cancer
Most common location of esophageal polyps ________________ Cervical esophagus
Caustic esophageal injury: What kind causes liquefaction? __________________ Alkali
What type of caustic esophageal injury is more likely to cause cancer? _________ Alkali
What part of the GI tract is most injured by acid ingestion? ______________ Stomach
What is the treatment for tertiary esophageal caustic injury? _____________ Esophagectomy
What modality do you use to follow caustic esophageal injuries? Gastrografin followed by thin barium swallow on hospital day 2-3
Criteria for non-surgical management of esophageal perforations Contained perforation on contrast study, self-draining, no systemic effects
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
What incision on the esophagus do you perform to assess the extent of esophageal injury? _________ Longitudinal myotomy
What esophageal condition is caused by forceful vomiting, and characterized by severe chest pain, with eventual finding of perforation? _____________________ Boerhaave’s syndrome
Where is the most common location of perforation in Boerhaave’s syndrome? _______________ Left lateral wall of the esophagus at T8 level
Mediastinal crunching on auscultation of patient with Boerhaave’s syndrome also known as _________________ Hartmann’s sign
Created by: StudyBug82
 

 



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