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27 Cards in this Set
- Front
- Back
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Describe Barrett's Esophagus
1. possible causes 2. How the type of epithelium is grade (4 grades) |
Columnar lined esophagus = Barrett’s
– Ulceration, bleeding, stricture, malignant degeneration 1. Chronic GERD and esophagitis 2. • Normal squamous epithelium – Grade 2 Linear erosions with granulation tissue – Grade 3 Islands of epithelium, cobblestone appearance – Grade 4 presence of stricture |
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Describe the three area of narrowing of the esophagus and what can get stuck at each?
a. apple b. normal anatomic narrowing seen on barium swallow c. distal esophagus |
Narrowing
a. Crichopharyngeal muscle C6 level (1.5 cm) b. Left mainstem bronchus and aortic arch (1.6 cm) c. Hiatus of diaphragm (1.6-1.9 cm) |
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How long are the following?
a. cervical esophagus b. thoracic c. abdominal What is special about the abdominal? |
a. Cervical esophagus 5 cm
– Ends at sternal notch b. Thoracic esophagus 20 cm long c. Abdominal esophagus 2 cm long- has positive opposed to negative pressure |
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What type of muscle is found in the esophogus? Where is each found?
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a. Upper 2-6 cm is striated muscle
b. Mid & lower areas all smooth muscle |
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What decreases LES pressure and LES increases pressure in Esophagus
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1. Decreased LES pressure with (burping)
– Peppermint, chocolate, coffee, ethanol, fat 2. Increased LES with (less reflux) – Antacids, cholinergics, metaclopromide (Reglan), gastrin |
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a. What is the standard currently for anti-reflux operation?
b. What procedure do you use secondary to it? |
a. nissen fundoplication
b. belsey fundoplication (Mark IV) |
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a. ZENKER’S DIVERTICULUM is what?
b. where does it occur? c. what are symptoms? |
a. Pharyngoesophogeal diverticulum
b. caraco pharyngeal muscle c. dypshagia and regurgitation also HALOTOSIS |
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Where do barber poles come from?
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In England surgeons were not doctors and were in the same union as barbers but were eventually kicked out
- red in pole is the blood resembled from surgeons |
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– Distal third thoracic esophagus
– Near diaphragm – Pulsion diverticuli |
Epiphrenic diverticuli
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Type of diverticuli noted with TB in the 19th century
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Traction diverticuli (midesophageal diverticuli)
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What is the most popular cancer of esophagus?
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squamous in world but Adenocarcinoma in US from Barrets
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For esophageal cancer surgery what are the requirements for....
a. age b. FEV1 c. Nerve status d. Tumor size |
– Age < 75
– FEV1 >2 liters – No nerve paralysis or Horner’s – Tumor < 8 cm |
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What is the most common type of esophageal tumor?
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Leiomyoma= 50% are benign
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intima, media, adventitia
Which is thickest? |
layers of artery
- in artery media |
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protein C, S, antithrombin 3, NO
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secreted by endothelium
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Vasovasorum
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vessels penetrate to the adventitia to perfuse the media
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a. claudication
b. 1.5 x normal diameter, these are fusiform or sacular c. coronary, carotids, iliacs, adductor canal |
a. pain in the muscle from exercise
b. aneurysms c. atherosclerosis most likely to find |
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a. levels of matrix metaloprotinases are found in these structures
b. above belly button, below sternum c. rupture of this artery (a type of aneurysm) can result in death of female at time of child birth |
a. AAA
b. abdominal aortic aneurysm is felt there c. splenic artery aneurysm |
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a. wakes patients up during sleep, but gets better with feet dangling off bed
b. test differentiates between claudication and ischemic rest pain |
a. ischemic rest pain
b. ankle brachial index or ABI, get a BP on both arms and calves, and if different |
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a. look malnourished Postprandial pain and fear of food
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a. mesenteric ischemia
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What type of surgery is usually used to remove benign lesions?
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proximal and middle right thoracotomy
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With Zenker's diverticulum which presents with dysphagia, regurgitation of undigested material, and halotosis what is treatment?
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Myotomy through neck incision above and below diverticulum
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What are three main esophageal diagnostic modalities?
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DIAGNOSTIC MODALITIES
• 24 hour pH probe • Barium (or gastrograffin) swallow • Esophagoscopy |
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What is indicated for penetrating injury to the chest?
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thoracotomy
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What are the three most common types of esophageal perforations with instrumentation?
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1. Spontaneous perforation Boerhaave’s (15%)
2. Foreign Bodies 14% 3. Trauma 10% |
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What needs to be done to someone with Boerhaave's perforation of the esophagus?
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1. ASAP drain mediastiunum
2. closure within 24 hrs 3. L lateral wall above GE junction, nissen |
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What is one of the possible procedures for cancer of the esophagus?
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gastroesophogeal anastomsis
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