Key muscle of the upper esophageal sphincter (UES)
Cricopharyngeus muscle
100
LES is hypertensive and fails to relax
What is Achalasia
100
Zenkers occurs in this triangle
Killians, between fibers of thyropharyngeus and cricopharygneus
100
Most common type of cancer in esophagus
Adenocarcinoma, in lower half accounts of 70% esophageal cancer. Squamous is next common with increased risk with smoking, EtOH, caustic injury, food additives, radiation
100
Among caustic injuries, this one tends to be more devastating
Alkali, acids burn and usually only small amounts ingested. Alkalis cause liquefaction necrosis and penetrate deeply
200
Three areas of anatomic narrowing of the esophagus
1) Cricopharyngeus 2) crossing of L mainstem bronchus and aorta 3) diaphragm
200
First line treatments of achalasia
Medical; calcium channel blockers, nitrates
endoscopic interventions second line, surgery third
200
Size of Zenkers that can be treated endoscopically
Over 2 cm
200
Most crucial part of workup for known esophageal cancer
Endoscopic ultrasound (EUS), identifies T and can identify enlarged regional lymph nodes. Tends to over stage T and under stage N. PET is slightly more sensitive than CT which has accuracy of on 57% for T stage
200
Classic timing post injury when able to primarily repair esophagus or not
24 hours, typical defining time between early and late esophageal injury.
300
Blood supply to the segments of esophagus
Cervical = inferior thyroid arteries
Thoracic = direct branches off aorta, bronchial arteries, intercostals
Abdominal = Left gastric and inferior phrenics
300
Concentric repetitive high amplitude contractions of esophagus
Diffuse esophageal spasm (DES), findings on UGI include corkscrew esophagus, manometry shows multiple simultaneous high amplitude contractions
300
Zenkers is this kind of diverticula
Pulsion, false diverticula
300
Most common benign esophageal tumor
Leiomyoma, accounts for < 1% of esophageal tumors, if asymptomatic and < 2cm can watch otherwise enucleation is treatment
300
Postemetic rupture of esophagus
Boerhaaves syndrome, a lesser tear in mucosa after retching is Mallory-Weiss tear
400
Network of lymphatics lies in this layers
Submucosa, just deep to muscularis mucosa
400
Normal relaxation of Lower esophageal sphincter (LES) but elevated pressures
Hypertensive LES, resting pressures of LES > 26 mmHg
400
Epiphrenic diverticula are found in this location
Within 10 cm of GE junction
400
Patient with esophageal cancer with difficulty swallowing and weight loss, strategy to preoperative maximize nutritional status
Laparoscopic J tube is recommended, no G tube, can give TPN. Needs 2 weeks minimum
400
Oral contrast material that is inert in the chest but will cause peritonitis in abdomen
What is Barium
500
Normal resting pressure of Lower esophageal sphincter (LES)
24 mmHg
500
High amplitude peristaltic contracts with complaints of chest pain. UGI often shows no abnormality
Nutcracker esophagus. Amplitudes of peristaltic waves often > 400 mmHg
500
Midesophageal diverticula are caused by this
Traction, inflamed mediastinal lymph nodes and mediastinitis causing traction. Some reports of motility disorders also causing these.
500
Treatment for T1N1 2.2 cm lesion biopsy proven adenocarcinoma of distal esophagus
Neoadjuvant chemo/radiation. T1 N0 is tx with surgery, T1N1 can have surgery first line but not recommended if high risk features; > 2cm, poorly differentiated)
500
Timing of dilation of esophagus after caustic injury
Early, but wait until after re-epithelialization has occurred or will cause more injury