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52 Cards in this Set

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  • Back
Which muscle defines the upper esophageal sphincter (UES)?
Cricopharyngeus muscle
Contraction of UES
Occurs 0.5 seconds after relaxation to prevent regurgitation
Surgical approach to cervical esophagus
Left thoracotomy

**Left-sided deviation of esophagus in this region
Surgical approach to mid-thoracic esophagus
Right thoracotomy

**Avoids aortic arch
Surgical approach to lower thoracic esophagus
Left thoraco-abdominal incision
Histology of the esophagus
Stratified squamous epithelium
True or False: There is no serosal covering in the esophagus
True
Blood supply of cervical esophagus
Inferior thyroid artery

**Venous drainage by inferior thyroid veins
Blood supply of thoracic esophagus
1) Bronchial arteries
2) Aorta

**Venous drainage by bronchial veins, azygos, and hemiazygos veins
Blood supply of abdominal esophagus
1) Left gastric artery
2) Inferior phrenic artery

**Venous drainage by coronary vein
Sympathetic innervation to the esophagus
Branches of celiac ganglion
Factors that induce LES relaxation
1) Secretin
2) Cholecystokinin / Fatty meals
3) VIP
4) alpha-Adrenergic antagonists
5) Gastric acidification
GI histology near GE junction
Columnar epithelium
Most common histologic type of cancer of GI tract
Adenocarcinoma
Pathophysiology of GERD
Inappropriate relaxation of the LES at rest
Symptoms of GERD
1) Retrosternal chest pain (or epigastric)
2) Laryngitis / hoarseness
3) Non-productive cough (chemical irritation of bronchi)
4) Wheezing / SOB (especially at night)
Long-term complications of GERD
1) Peptic stricture
2) Barrett's esophagus
3) Adenocarcinoma
Peptic stricture
Complication of long-standing GERD
-Narrowing of LES
-Dysphagia (solids > liquids)
Medical management of GERD
Proton pump inhibitors (i.e., omeprazole)
H2 receptor blockers (i.e., cimetidine)
Magnesium hydroxide (buffer acid)
Metoclopramide (Reglan) or Erythromycin
Antibiotic therapy (for H. pylori)
Side effect of Magnesium Hydroxide
Osmotic diarrhea
Side effects of Cimetidine
1) Gynecomastia in men
2) Confusion in the elderly
3) Inhibits cytochrome P450
Test of choice to evaluate structural changes in the esophagus
Barium esophagram
**Also best test to define surgical anatomy
Barium swallow is the initial test for evaluating…
1) Dysphagia
2) Suspected esophageal mass lesions
Endoscopic ultrasound is useful for…
Evaluation and staging of patients with mass lesions of the esophagus
The only test that can evaluate oropharyngeal phase of swallowing
Cinematographic esophagram
**Low sensitivity for detecting small mucosal abnormalities
Esophageal manometry
Evaluates esophageal body and sphincter contractile function
Used to evaluate degree of acid reflux into distal esophagus
Esophageal pH probe monitor
Which endoscopy requires general anesthesia?
Rigid endoscopy
**Better than flexible for retrieving swallowed foreign objects
MC esophageal motility disorder
Achalasia
Characteristics of Achalasia
1) Esophageal aperistalsis and dilation
2) Failure of LES relaxation
3) Dysphagia of liquids > solids
4) Regurgitation of undigested food
Underlying pathology of achalasia
Degenerative changes in Auerbach’s plexus (myenteric plexus) of esophagus
Achalasia in 3rd world countries
Associated with Chagas’ disease (T. cruzi)
Barium swallow presentation of achalasia
1) Bird’s beak appearance
2) Proximal esophageal dilation
Medical tx of achalasia
1) Nitrates
2) Calcium channel blockers
Mechanical tx of achalasia
Dilation of the LES (rigid or pneumatic devices)
**Risk of rupturing the esophagus
Surgical tx of achalasia
Myotomy (muscle division) to disrupt hypertensive LES smooth muscle
Hallmark symptoms of esophageal spasm syndromes
1) Chest pain that radiates to the back, neck, ears, jaws or arms
2) Dysphagia for both liquids and solids
Gold standard for diagnosis of esophageal spasm
Esophageal manometry
Medical tx of esophageal spasms
1) Nitrates
2) Calcium blockers
3) Sedatives & muscle relaxants
Surgical tx of esophageal spasms
Long esophageal myotomy
**Reserved for pts with incapacitating dysphagia
Effects of Scleroderma on the GI tract
1) Smooth muscle atrophy
2) Collagen deposition
Peristalsis in patients with Scleroderma
Normal in proximal esophagus
Diminishes in distal esophagus
**Related to content of smooth muscle in esophagus
Most common esophageal diverticulum
Zenker’s diverticulum
Zenker’s Diverticulum
1) Proximal to cricopharyngeus muscle
2) Dysphagia, regurg, choking, halitosis
3) Dx by barium esophagram
4) Tx with cricopharyngeal myotomy and resection if larger than 2cm
Effects of nitrates and calcium channel blockers on GI tract
Smooth muscle relaxation
Schatzki Ring
Thin submucosal circumferential ring in distal esophagus

*Presents as episodic symptoms of food "getting stuck" in esophagus
*Tx is dilation of the ring w/ endoscopy
**Type I hiatal hernia associated
Plummer-Vinson Syndrome
Esophageal webs in UPPER esophagus (common in women)
Associated with iron-deficiency anemia
Risk for squamous cell cancer of esophagus
Risk factors for SCC of the esophagus
1) Smoking
2) EtOH consumption
3) Long-standing achalasia
4) Previous caustic injuries
5) HPV infection
6) Nitrosamines
Sister Mary Joseph Nodule
Palpable nodule bulging into the umbilicus as a result of metastasis of a malignant cancer in the pelvis or abdomen
MCC of esophagitis
GERD

**2nd MCC are infectious agents
Treatment of HIV-induced esophageal ulcer
Prednisone
Boerhaave Syndrome
Rupture of the esophagus caused by forceful retching