Podcast
Questions and Answers
What is the clinical feature of a Schatzki ring?
What is the clinical feature of a Schatzki ring?
Dysphagia lusoria is caused by an aberrant left subclavian artery.
Dysphagia lusoria is caused by an aberrant left subclavian artery.
False
What type of ring is a Schatzki ring classified as?
What type of ring is a Schatzki ring classified as?
Mucosal ring
The management for symptomatic treatment of a Schatzki ring includes _____ dilation.
The management for symptomatic treatment of a Schatzki ring includes _____ dilation.
Signup and view all the answers
Match the following features with the appropriate esophageal disorder.
Match the following features with the appropriate esophageal disorder.
Signup and view all the answers
What is the most common site for iatrogenic esophageal perforation?
What is the most common site for iatrogenic esophageal perforation?
Signup and view all the answers
Boerhaave syndrome is also known as spontaneous esophageal perforation.
Boerhaave syndrome is also known as spontaneous esophageal perforation.
Signup and view all the answers
What is the management approach for a stable patient with a small esophageal perforation?
What is the management approach for a stable patient with a small esophageal perforation?
Signup and view all the answers
A Type IV hernia involves __________ content other than the stomach.
A Type IV hernia involves __________ content other than the stomach.
Signup and view all the answers
Match the following management techniques to their appropriate situations:
Match the following management techniques to their appropriate situations:
Signup and view all the answers
Which type of esophageal cancer is most commonly found in the lower third of the esophagus?
Which type of esophageal cancer is most commonly found in the lower third of the esophagus?
Signup and view all the answers
Smoking is a significant risk factor for developing adenocarcinoma.
Smoking is a significant risk factor for developing adenocarcinoma.
Signup and view all the answers
Name one dietary factor that increases the risk of squamous cell carcinoma.
Name one dietary factor that increases the risk of squamous cell carcinoma.
Signup and view all the answers
Barrett's esophagus is primarily a risk factor for __________ cancer.
Barrett's esophagus is primarily a risk factor for __________ cancer.
Signup and view all the answers
Which of the following is NOT a risk factor for squamous cell carcinoma?
Which of the following is NOT a risk factor for squamous cell carcinoma?
Signup and view all the answers
Match the risk factors with the type of esophageal cancer they are associated with:
Match the risk factors with the type of esophageal cancer they are associated with:
Signup and view all the answers
Both squamous cell carcinoma and adenocarcinoma can be influenced by a history of radiation to the mediastinum.
Both squamous cell carcinoma and adenocarcinoma can be influenced by a history of radiation to the mediastinum.
Signup and view all the answers
What is one common risk factor for adenocarcinoma mentioned in the content?
What is one common risk factor for adenocarcinoma mentioned in the content?
Signup and view all the answers
What is one clinical feature associated with Mackler's triad?
What is one clinical feature associated with Mackler's triad?
Signup and view all the answers
Boerhaave syndrome is characterized by a split in the mucosa and submucosal layers.
Boerhaave syndrome is characterized by a split in the mucosa and submucosal layers.
Signup and view all the answers
What imaging study is preferred for stable patients suspected of having an esophageal perforation?
What imaging study is preferred for stable patients suspected of having an esophageal perforation?
Signup and view all the answers
In cases of Boerhaave Syndrome, the clinical features include ____________.
In cases of Boerhaave Syndrome, the clinical features include ____________.
Signup and view all the answers
Match the following syndromes with their key features:
Match the following syndromes with their key features:
Signup and view all the answers
What is the most common type of hiatal hernia?
What is the most common type of hiatal hernia?
Signup and view all the answers
A rolling/paraesophageal hernia is not considered life-threatening.
A rolling/paraesophageal hernia is not considered life-threatening.
Signup and view all the answers
What is the management for a symptomatic sliding hiatal hernia?
What is the management for a symptomatic sliding hiatal hernia?
Signup and view all the answers
The primary investigation used for diagnosing sliding hiatal hernia is a __________ swallow.
The primary investigation used for diagnosing sliding hiatal hernia is a __________ swallow.
Signup and view all the answers
Match the following types of hernias with their respective characteristics:
Match the following types of hernias with their respective characteristics:
Signup and view all the answers
Which artery is considered the dominant artery of the stomach?
Which artery is considered the dominant artery of the stomach?
Signup and view all the answers
The stomach can necrose if its blood vessels are ligated.
The stomach can necrose if its blood vessels are ligated.
Signup and view all the answers
Name one artery that branches from the splenic artery and supplies the stomach.
Name one artery that branches from the splenic artery and supplies the stomach.
Signup and view all the answers
The ______ is the part of the stomach where the esophagus connects.
The ______ is the part of the stomach where the esophagus connects.
Signup and view all the answers
Match each stomach part with its description:
Match each stomach part with its description:
Signup and view all the answers
What is the most common benign tumor of the esophagus?
What is the most common benign tumor of the esophagus?
Signup and view all the answers
Self-Expanding Metallic Stenting (SEMS) is indicated for benign esophageal tumors.
Self-Expanding Metallic Stenting (SEMS) is indicated for benign esophageal tumors.
Signup and view all the answers
What follow-up procedure is recommended after SEMS placement?
What follow-up procedure is recommended after SEMS placement?
Signup and view all the answers
The male to female ratio for Leiomyoma incidence is _____:1.
The male to female ratio for Leiomyoma incidence is _____:1.
Signup and view all the answers
Match the following complications with their descriptions:
Match the following complications with their descriptions:
Signup and view all the answers
What does T4b status indicate in esophageal cancer staging?
What does T4b status indicate in esophageal cancer staging?
Signup and view all the answers
In esophageal cancer staging, N1 status means there are no positive regional lymph nodes.
In esophageal cancer staging, N1 status means there are no positive regional lymph nodes.
Signup and view all the answers
What is the common management technique used for T1a esophageal cancer?
What is the common management technique used for T1a esophageal cancer?
Signup and view all the answers
The most common site for distant metastases in esophageal cancer is the _____
The most common site for distant metastases in esophageal cancer is the _____
Signup and view all the answers
Match the esophageal cancer T statuses to their descriptions:
Match the esophageal cancer T statuses to their descriptions:
Signup and view all the answers
What is the classification for esophageal cancer that involves the gastric junction?
What is the classification for esophageal cancer that involves the gastric junction?
Signup and view all the answers
R0 resection implies that there is gross disease left behind.
R0 resection implies that there is gross disease left behind.
Signup and view all the answers
What is the role of neoadjuvant therapy in the treatment of advanced esophageal cancer?
What is the role of neoadjuvant therapy in the treatment of advanced esophageal cancer?
Signup and view all the answers
What is the earliest and more common symptom associated with gastrointestinal issues?
What is the earliest and more common symptom associated with gastrointestinal issues?
Signup and view all the answers
A PET-CT scan is used for both diagnosing and overall staging of gastrointestinal diseases.
A PET-CT scan is used for both diagnosing and overall staging of gastrointestinal diseases.
Signup and view all the answers
What appearance is commonly identified on a barium swallow test in gastrointestinal examinations?
What appearance is commonly identified on a barium swallow test in gastrointestinal examinations?
Signup and view all the answers
Which type of esophagectomy is best for lymph node clearance?
Which type of esophagectomy is best for lymph node clearance?
Signup and view all the answers
The involvement of the left recurrent laryngeal nerve may lead to __________ and chronic cough.
The involvement of the left recurrent laryngeal nerve may lead to __________ and chronic cough.
Signup and view all the answers
The anastomosis site for the Ivor Lewis esophagectomy is the neck.
The anastomosis site for the Ivor Lewis esophagectomy is the neck.
Signup and view all the answers
What is the most common site for esophageal replacement?
What is the most common site for esophageal replacement?
Signup and view all the answers
Match the histological layers observed during endoscopic ultrasound with their descriptions:
Match the histological layers observed during endoscopic ultrasound with their descriptions:
Signup and view all the answers
The minimum number of lymph nodes that should be removed during esophagectomy is ________.
The minimum number of lymph nodes that should be removed during esophagectomy is ________.
Signup and view all the answers
Match the esophagectomy type with its characteristics:
Match the esophagectomy type with its characteristics:
Signup and view all the answers
Study Notes
Schatzki Ring
- A mucosal or submucosal ring in the lower esophagus
- Causes intermittent, non-progressive dysphagia
- Visualized on barium swallow
- Treated with balloon dilation or symptomatic management
Dysphagia Lusoria
- Esophageal compression due to an aberrant right subclavian artery
- Diagnosed with imaging studies focusing on vascular anatomy
Esophageal Cancer
- Squamous cell carcinoma (SCC) is the most common type overall, while adenocarcinoma is more prevalent in Western countries
- SCC is linked to smoking, alcohol, hot beverages, certain foods, and low socioeconomic status
- Adenocarcinoma is associated with obesity, gastroesophageal reflux, Barrett's esophagus, and scleroderma
-
Risk Factor Breakdown:
- Smoking, alcohol, hot beverages: Strongly associated with SCC
- Obesity and gastroesophageal reflux: Highly linked to adenocarcinoma
- Lye corrosive stricture, Plummer-Vinson syndrome: Strongly associated with SCC
- Barrett's esophagus: Highly associated with adenocarcinoma
Esophageal Perforation
- Iatrogenic perforation: Mainly caused by endoscopy, especially therapeutic procedures
- Spontaneous perforation: Also known as Boerhaave syndrome, occurs in the lower third of the esophagus, often after forceful vomiting against a closed glottis
-
Iatrogenic Features:
- Most commonly occurs in the upper third of the esophagus
- Associated with endoscopic procedures, lack of skill, and endoscopy in cancer patients
-
Boerhaave Syndrome Features:
- Often happens in alcoholics after vomiting with a closed glottis
- Presents with Mackler's Triad (chest pain, retching, subcutaneous emphysema)
- Hamman’s crunch (crackling on auscultation of the heart) may be heard
- Can be diagnosed using CECT (Contrast Enhanced Computed Tomography)
Mallory-Weiss Tear vs. Boerhaave Syndrome
- Mallory Weiss Tear: Occurs in the upper GI tract, typically in alcoholics with vomiting, involves a mucosal and submucosal tear, and presents with upper GI bleeding
- Boerhaave Syndrome: Occurs in the lower GI tract, presents with Mackler's Triad, involves a full-thickness esophageal perforation, and is often fatal if not treated promptly
Hiatal Hernia
- Sliding hiatal hernia: Most common type, involves upward sliding of Gastroesophageal (GE) junction, often asymptomatic, and may cause GERD
- Rolling/Paraesophageal hernia: Involves a portion of the stomach protruding through the hiatal opening into the thoracic cavity, GE junction remains normal, can lead to volvulus/necrosis, and always requires surgical repair
Stomach Anatomy
- Parts of the Stomach: Cardia, Fundus, Body, Antrum, Pylorus
-
Blood Supply of Stomach:
- Aorta: Right and left hepatic arteries, Hepatic artery proper, Right gastric artery, Left gastric artery, Gastroduodenal artery, Common hepatic artery, Splenic artery, Left gastroepiploic artery, Right gastroepiploic artery
- Submucosal anastomosis prevents stomach necrosis even if vessels are ligated
- Left gastric artery: Branch of celiac axis, dominant artery supplying stomach
- Right gastric artery: Branch of common hepatic artery
- Left gastroepiploic artery: Branch of splenic artery
- Right gastroepiploic artery: Branch of gastroduodenal artery
Esophageal Cancer Staging
-
TNM Staging
- T (Tumor): Describes the size and extent of the tumor
- N (Nodes): Indicates the presence and number of lymph node metastases
- M (Metastases): Determines whether there are distant metastases
-
Sievert Classification:
- Type I: Esophageal cancer
- Type II: Esophageal cancer
- Type III: Gastric cancer
Esophageal Cancer Treatment
- T1a: Endoscopic mucosal resection (EMR) is the preferred treatment
- T1b N0/Ta N0: Esophagectomy is typically required
- T3 N1/T3/T4: Advanced stage, treated with neoadjuvant chemotherapy & radiotherapy (chemoradiotherapy)
- Clinical Esophageal Tumors: Definitive chemoradiotherapy
-
Esophagectomy:
- Margins: 10 cm proximal margin, 5 cm distal margin to prevent recurrence
- Resection Types: R0 (complete removal), R1 (microscopic disease remaining), R2 (gross disease remaining)
- Esophageal Replacement: Stomach tube is the most common and preferred replacement, followed by colon or jejunum if the stomach is involved
- Complications: Atelectasis, pneumonia, anastomotic leak (neck anastomosis is more dangerous), RLN injury, chylothorax
Types of Esophagectomy
- Trans-hiatal (Orringer): For lower third esophageal cancer, involves midline abdominal and left-sided neck incisions, anastomosis performed in the neck
- Ivor Lewis: For middle third esophageal cancer, involves midline abdominal and right thoracic incisions, anastomosis performed in the thorax
- McKeown's (3 Field Esophagectomy): For middle third esophageal cancer, involves midline abdominal, right thoracic, and left neck incisions, anastomosis performed in the neck, preferred for lymph node clearance
Esophageal Cancer - SEMS
- Self-Expanding Metallic Stents (SEMS): Used primarily for malignant tracheo-esophageal fistulas
- Indications: Alleviate symptoms associated with the fistula, such as cough and pneumonia
- Complications: Stent migration, bleeding, tumor regrowth into the stent
- Prognostic Factors: Tumor depth significantly influences prognosis
- Follow-up: Endoscopy is usually recommended every 3-6 months to monitor the stent and tumor growth
Benign Esophageal Tumors
- Leiomyoma: Most common benign tumor of the esophagus, found in the mid-distal esophagus, occurs more frequently in males
- Clinical Features: Often asymptomatic, large tumors can cause dysphagia
- Investigation: Barium swallow demonstrates a "punched-out" appearance
- Management: Enucleation (surgical removal) or STER (Submucosal tunneling & endoscopic resection)
Esophageal Cancer Clinical Features
- Early Symptoms: Progressive dysphagia, initially affecting solids more than liquids
- Advanced Disease Manifestations: Weight loss, malignant fistula with trachea, left recurrent laryngeal nerve (Lt RLN) involvement leading to chronic cough and hoarseness
Esophageal Cancer Investigations
- Definitive Diagnosis: Endoscopic biopsy
-
Overall Staging:
- PET-CT: Utilized for complete staging, uses 18-FDG
-
T & N Stage:
- EUS: Endoscopic ultrasound
- Barium swallow: May reveal a "rat tail" or "apple core" appearance
Esophageal Cancer Images and Annotations
- Barium swallow (Rat Tail appearance): Shows shouldering effect and irregular margins
- Endoscopic USG: Alternating hypo and hyper bands on the ultrasound image
Esophageal Cancer Histology Table
- EUS layers correspond to histological layers:
- 1: Mucosa
- 2: Deep mucosa
- 3: Muscularis mucosa
- 4: Submucosa
- 5: Muscularis propria
- Serosa
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz covers key conditions affecting the esophagus, including Schatzki Ring, Dysphagia Lusoria, and Esophageal Cancer. It details risk factors, diagnosis methods, and treatment options for these disorders. Test your knowledge about esophageal health and related cancers.
