Esophageal Injury
Most common cause of esophageal perforation
Iatrogenic (endoscopy)
Approach for injuries to the cervical esophagus
Left neck
Name risk factors for esophageal cancer (at least 2)
Smoking, Alcohol, GERD, Barrett esophagus, obesity, Nitrosamines (found in pickled and smoked foods), Ingestion of hot or caustic liquids, Vitamin A and mineral deficiencies (zinc, molybdenum)
treatment of esophageal cancer for cancers beyond T2.
chemoradiation and esophagectomy
How many layers of the esophageal wall
4
Name for a tear in the mucosa and name for a full-thickness tear
Mallory-Weiss and Boerhaave
Middle and distal esophagus are approached through the ____ and ____ chest respectively
Right, Left
Most common esophageal cancer in the upper 2/3 and the lower 1/3
SCC and adenocarcinoma respectively
Treatment for high-grade dysplasia
radiofrequency ablation or endoscopic mucosal resection and cryotherapy.
mucosa, submucosa, muscularis propria, and adventitia
Standard for diagnosis of esophageal perforation.
Barium Esophagram
Small injuries with healthy tissue can be repaired in _____ layer with _____
2, tissue flap coverage
leiomyoma
main blood supply to stomach after gastric pull-up
right gastroepiploic artery
four zones of the esophagus
pharyngeal, cervical, thoracic, and abdominal.
Possible X-ray findings in esophageal perforation
pleural effusion, pneumomediastinum, and subcutaneous emphysema.
How often to replace and assess endovac
Seattle biopsy protocol for mapping of Barrett esophagus with high-grade dysplasia
four-quadrant biopsies at 1-cm intervals along the entire length of Barrett esophagus in addition to targeted biopsies of all visible lesions.
Siewert type III classification
center of the tumor is 2 to 5 cm below the GE junction
Lymphatic drainage of the esophagus arises from which layers?
submucosa and muscularis layers
Most common site of injury during endoscopy in general is _____, and during esophageal dilation is_____?
1. In the neck at the cricopharyngeus muscle
2. At the site of dilation
What is bipolar exclusion?
cervical esophagostomy and gastrostomy
T,N,M of tumor that invades into but not beyond the muscularis propria, metastasis in 3-6 regional lymph nodes, and no distant mets
T2 N2 M0
Locations of incisions for transthoracic (Ivor Lewis), Transhiatal, and Three-incision technique (McKeown)
1. abdomen and chest
2. abdomen and neck
3. abdomen, chest, and neck
Blood supply of the esophagus. Cervical___, thoracic___, and abdominal____
inferior thyroid arteries
directly from the aorta
left gastric artery and inferior phrenic arteries