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16 Cards in this Set
- Front
- Back
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LES tone |
- Increase by alpha, gastrin and motilin - Decrease by beta, cholecystokinin, estrogen, glucagon, progesterone, somatostatin, and secretin |
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Most deleterious esophageal mucosal injury is caused by? |
Gastric acid & pepsin |
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Barrett's Esophagus |
- Metaplsia: Squamous to Columnar - Pre-cursor to Adenocarcinoma - 4 categories: none, indeterminate, low-grade dysplasia, and high-grade dysplasia (50% will need esophagectomy or Lap. mucosal resection. fundoplication CI because doesn't cause regression) - Only need to perform surveillance EGD. No surgery - Role of H. Pylori not established - Can do Nissen then PPI and surveillance for low-grade dysplasia (6-10% malignancy risk per year) - Dysplasia and adenocarcinoma are most common in the gastric mucosa type with intestinal metaplasia |
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Recurrent hiatal hernia diagnostic imaging |
UGI |
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Laparoscopic Fundoplication |
- Crural dissection, preservation of both vagi (hepatic branch of anterior vagus) - dissect both crura and close posteriorly behind esophagus - Mobilize fundus, divide short gastrics - Finally, a short, loose fundoplication is created by enveloping the lower esophagus with the anterior and posterior walls of the fundus - MC error: pulling anterior portion of fundus behind esophagus |
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24 hour pH monitoring |
- Most sensitive test for GERD (GS). pH < 4 (a) cumulative time the esophageal pH is below a certain threshold, (b) frequency of reflux episodes below a chosen threshold, and (c) duration of the episodes - Also need EGD - |
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MCC esophageal perforation |
- iatrogenic (EGD) - Primary repair making sure to incise the muscularis over the perforation to cover defect - 2 layer closure & buttressed with a flap of pleura or intercostals muscle - chest tube placed & removed until a contrast study done at day 6 or 7 postoperatively demonstrates no leakage. |
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cervical esophagus |
- 5cm; C6-T1, curve left down, incision left anterior SCM; |
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MC site of spontaneous perforation |
- The lower part of the esophagus is covered only by flimsy mediastinal pleura on the left, and this portion is most commonly the site of spontaneous perforation in Boerhaave syndrome |
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phrenoesophageal ligament |
- Fibroelastic membrane, arises from sub diaphragmatic fascia. Lower limit of of this membrane anteriorly is marked by a fat pad corresponding to GE junction |
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Aspiration after transmittal esophagectomy |
Serious episodes of aspiration following recurrent nerve injury are caused not only by cricopharyngeal dysfunction, but also inability to close the glottis during swallowing and loss of the protection afforded by effective coughing. |
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Achalasia |
- failure of the lower esophageal sphincter to relax - Dysphagis. Solids then liquids - Weight loss later in the course - Barium swallow study |
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Esophagus muscle |
- Striated upper halg - Smooth lower half |
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Lower LES |
- Secretin, somatostatin, glucagon, CCK, Ethanol |
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Increasie LES |
- Aceytlcholine, gastrin, motilin, bombesin |
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a |
a |
