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29 Cards in this Set
- Front
- Back
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Understand the anatomy
Differentiate between benign and malignant disease processes, staging, and survival rates History and Physical Exam findings Knowledge of diagnostic tests Indications for surgery Recognize surgical procedures Describe post op complications |
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Cricopharyngeal Dysfunction
Failure of UES to Relax Formation of ________ Diverticulum Hiatal Hernia and Reflux may be associated Symptoms include dysphagia, reflux, mass, tracheal compression Diagnosis with Barium Swallow |
Zenker’s
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Treatment of Zenker's
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Treatment is Myotomy
Excision or suspension of the Zenckers Diverticulum |
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Unknown Cause
? Ganglionic Dysfunction Abnormal Peristalsis in the Esoph. Body Results: Hi resting LES Pressure Failure of LES to Relax during swallow |
Achalasia
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What problem?
Hypertrophy and dilation of body Chagas’ disease may be related Risk for Carcinoma is 10 times more common Symptoms include dysphagia, regurgitation, weight loss, and aspiration. |
Achalasia
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Treatment for Achalasia
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Treatment is palliative
Dilatation Esophagomyotomy Heller procedure: open vs thoracoscopic Surgery has better long term results than dilatation May be combined with anti-reflux procedure |
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Nutcracker Esophagus
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Strong non-peristaltic contractions
Normal sphincter relaxation and pressures GE Reflux may be present Symptoms: radiating chest pain |
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Diagnosis of Nutcracker esoph
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Radiographs
Barium Swallow: Corkscrew and spasm Manometry: Hi amplitude repetitive contractions with normal sphincter function |
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Treatment of nutcracker
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Medical Treatment:
Ca+ Channel Blockers Smooth Muscle Relaxants Surgical Treatment: Long Esophagomyotomy Avoid LES disruption Concomitant Anti-Reflux procedure may be added |
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What problem?
Prevalent in 80% of population Multiple factors LES displacement from intrabdominal to intrathoracic by herniation. Motility dysfunction Prolonged exposure to Gastric Secretions and/or Bile Secretions |
GERD
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Diagnosis of GERD
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Barium Swallow
Esophagoscopy 24 hour ph monitoring Manometry: essential for both diagnosis and treatment |
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Medical Treatment of GERD
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Proton Pump Inhibitors (PPI)
Motility agents such as metoclopramide Antacids Weight Loss Elevation of head of bed Alcohol and Tobacco cessation |
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Surgical indications to treat GERD
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Surgical Indications:
Failed medical treatment Barrett’s esophagus with progression |
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Surgical procedures to treat GERD
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Antireflux Procedure:
Restores original position of LES Increases LES pressure Repairs Hiatal Hernia if present Nissen fundoplication Most common, 360 degree wrap laparoscopically Belsey Mark IV 270 degree plication Open left Thoracotomy Hill Gastropexy Fixates distal esophagus to arcuate ligament |
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2/3rd of all benign Esophageal tumors
Growth in muscular wall Mucosa is intact |
Leiomyomas
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Leiomyoma:
Treatment |
Biopsy is contraindicated
Surgery for symptomatic individuals Enucleation from the esophageal wall, not mucosa Limited Resection if unable to enucleate |
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Etiology of esoph malignancy
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Exact cause unknown
Associated factors tobacco, alcolhol, nitrosamines, poor dental hygiene, hot beverages Barrett’s, Achalasia, Esophagitis increase risk |
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Types of esoph malignancy
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Squamous Cell (most common)
Adenocarcinoma (2nd) Mucoepidermoid and adenocystic are rare |
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WHAT are most common metastasis endpoints
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Liver, lung, brain
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Diagnosis of Malignant Esoph
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Hx. Dysphagia and Weight Loss
Barium Swallow CT for gross and distant involvement Esophagoscopy with Bx. Esophageal Ultrasound Bronchoscopy to r/o direct invasion PET scan |
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Only cure for malignant esoph
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surgery
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Esophagectomy Approaches
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Transhiatal
Transthoracic (Ivor Lewis technique) |
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Staging (TNM based)
of weoph malignancy |
Staging (TNM based)
0 : High Grade Dysplasia 1 : confined to submucosa 2 : confined to muscularis propria +/- nodes 3 : invades surrounding tissue +/- nodes 4 : distant metastasis |
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Additional therapy for malig esoph
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Neoadjuvant therapy: Platinum based CTX and RTX (impacts long term survival)
Combination CTX Radiotherapy Palliative stenting or bypass |
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How is the esophagus perforated?
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Iatrogenic instrumentation (most commen)
Trauma penetrating or blunt (20%) Boerhaave’s syndrome: postemetic rupture (15%) |
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Diagnosis of perforated esophagus
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History
Exam: crepitance, Hamman’s sign, Shock Barium swallow if perforation in chest Gastrograffin if perforation in abdomen (GE Junction |
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Acute UGI Bleed
Tear at GE Junction Prolonged vomiting and retching |
Mallory-Weiss syndrome
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What is assoc with Upper Esophageal Webs
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Upper: Plummer-Vinson syndrome
Anemia, dysphagia, etc. Treatment: Dilatation |
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What is assoc with Lower Esophageal Webs
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Shatzki’s rings
Reflux and dysphagia Treatment: Dilatation +/- antireflux procedure |
