Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
52 Cards in this Set
- Front
- 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
|
