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Surgery Pg No 136 -145
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Surgery Pg No 136 -145

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Questions and Answers

Which of the following is NOT part of the classical triad associated with esophageal issues?

  • Weight Loss
  • Chest Pain (correct)
  • Dysphagia
  • Regurgitation

    • The most common complication of esophageal issues is aspiration pneumonia.

    True

    What is the major feature that distinguishes Achalasia II from Achalasia I?

    Presence of pan esophageal pressurization in ≥ 20% swallows.

    The scoring system that assesses esophageal symptoms is called the ________ Score.

    <p>Achalasia-Eckardt</p> Signup and view all the answers

    Match the type of achalasia with its description:

    <p>Achalasia I = 100% failed peristalsis without PAN Achalasia II = 100% failed peristalsis with PAN in ≥ 20% swallows Achalasia III = ≥ 20% swallows with premature spastic contractions</p> Signup and view all the answers

    Which of the following is true regarding the indications for using Botox in gastrointestinal surgery?

    <p>Indicated for elderly patients with co-morbidities.</p> Signup and view all the answers

    The risk of perforation during balloon dilation is higher with balloons larger than 30 mm.

    <p>True</p> Signup and view all the answers

    What is the primary complication associated with Heller's myotomy?

    <p>GERD</p> Signup and view all the answers

    In achalasia Type 2, the best management option is __________.

    <p>Heller's myotomy and Pneumatic dilation</p> Signup and view all the answers

    Match the types of achalasia with their best management options:

    <p>Type 1 = Heller's myotomy Type 2 = Heller's + Pneumatic dilation Type 3 = POEM</p> Signup and view all the answers

    What is the most common symptom associated with Zenker's Diverticulum?

    <p>Regrugitation</p> Signup and view all the answers

    Zenker's Diverticulum is also known as crico-pharyngeal achalasia.

    <p>True</p> Signup and view all the answers

    Name one of the surgical management options indicated for large (>2 cm) symptomatic Zenker's Diverticulum.

    <p>Diverticulectomy</p> Signup and view all the answers

    The most common complication of Zenker's Diverticulum is ________ pneumonia.

    <p>aspiration</p> Signup and view all the answers

    Match the following clinical features with their description related to Zenker's Diverticulum:

    <p>Regurgitation = Earliest symptom Halitosis = Bad oral odor Dysphagia = Difficulty swallowing Aspiration pneumonia = Most common complication</p> Signup and view all the answers

    What is the primary clinical feature of Schatzki Ring?

    <p>Intermittent, non-progressive dysphagia</p> Signup and view all the answers

    Dysphagia Lusoria is caused by compression from an aberrant left subclavian artery.

    <p>False</p> Signup and view all the answers

    What diagnostic investigation is typically used for Schatzki Ring?

    <p>Barium swallow</p> Signup and view all the answers

    Schatzki Ring is defined as a _____ > _____ ring.

    <p>mucosal, submucosal</p> Signup and view all the answers

    Match the following terms with their descriptions:

    <p>Schatzki Ring = Lower esophageal mucosal ring causing dysphagia Dysphagia Lusoria = Esophageal compression by aberrant right subclavian artery Balloon dilation = Management for Schatzki Ring Barium swallow = Investigation for Schatzki Ring</p> Signup and view all the answers

    What is the primary goal of treatment in gastrointestinal and abdominal surgery related to eosinophilia?

    <p>Decrease eosinophilia</p> Signup and view all the answers

    What type of esophageal cancer is most commonly found in the lower third of the esophagus?

    <p>Adenocarcinoma</p> Signup and view all the answers

    The primary goal of treating eosinophilia is to increase the eosinophil count in the body.

    <p>False</p> Signup and view all the answers

    Squamous cell carcinoma has a strong association with hot beverages.

    <p>True</p> Signup and view all the answers

    What is the key focus of treatment in gastrointestinal surgery concerning eosinophilia?

    <p>Decrease eosinophilia</p> Signup and view all the answers

    The treatment goal in gastrointestinal and abdominal surgery regarding eosinophilia is to ________ eosinophilia.

    <p>decrease</p> Signup and view all the answers

    Which dietary deficiency is linked to an increased risk of squamous cell carcinoma?

    <p>fresh green vegetables, fruits (Vitamin E &amp; Selenium)</p> Signup and view all the answers

    Match the terms with their descriptions:

    <p>Eosinophilia = An increase in eosinophils in the bloodstream Gastrointestinal surgery = Surgical procedures related to the digestive system Abdominal surgery = Surgery performed on organs within the abdominal cavity Treatment goal = Objective intended to achieve during medical care</p> Signup and view all the answers

    Obesity is primarily a risk factor for ________ esophageal carcinoma.

    <p>adenocarcinoma</p> Signup and view all the answers

    Match the risk factor with its associated esophageal cancer type:

    <p>Smoking = Squamous cell carcinoma Barrett's esophagus = Adenocarcinoma Tylosis = Squamous cell carcinoma Gastro-esophageal reflux = Adenocarcinoma</p> Signup and view all the answers

    Which of the following is NOT a risk factor for adenocarcinoma?

    <p>History of upper aerodigestive malignancy</p> Signup and view all the answers

    Chewing betel nut is associated with an increased risk of adenocarcinoma.

    <p>False</p> Signup and view all the answers

    List one risk factor for adenocarcinoma that is not a risk factor for squamous cell carcinoma.

    <p>Gastro-esophageal reflux</p> Signup and view all the answers

    What is a key feature of Mackler's triad?

    <p>Chest pain</p> Signup and view all the answers

    Boerhaave syndrome typically presents with upper gastrointestinal hemorrhage.

    <p>False</p> Signup and view all the answers

    What imaging study is preferred for a stable patient suspected of having esophageal perforation?

    <p>CT Scan (CECT)</p> Signup and view all the answers

    A __________ is a split in the mucosa & submucosal layers associated with a Mallory Weiss tear.

    <p>tear</p> Signup and view all the answers

    Match the following conditions with their respective characteristics:

    <p>Mallory Weiss Tear = Alcoholic with vomiting Boerhaave Syndrome = Perforation in lower GI Mackler's Triad = Chest pain, retching, subcutaneous emphysema</p> Signup and view all the answers

    What is the most common type of hiatal hernia?

    <p>Sliding hiatal hernia</p> Signup and view all the answers

    A rolling hiatal hernia requires surgical management in all patients.

    <p>True</p> Signup and view all the answers

    What is the primary clinical feature associated with a sliding hiatal hernia?

    <p>GERD</p> Signup and view all the answers

    The most common congenital diaphragmatic hernia is called the __________ hernia.

    <p>Bochdalek</p> Signup and view all the answers

    Match the type of hiatal hernia with its respective characteristics:

    <p>Sliding Hiatal Hernia = Asymptomatic, GERD Rolling/Paraesophageal Hernia = Requires surgery, can lead to necrosis Bochdalek Hernia = Most common congenital hernia Fundoplication = Surgical management for large symptoms</p> Signup and view all the answers

    What is the primary management strategy for a Type III hernia?

    <p>Governed by the rolling component</p> Signup and view all the answers

    Iatrogenic esophageal perforations are more common in the lower third of the esophagus.

    <p>False</p> Signup and view all the answers

    What condition is also known as Boerhaave syndrome?

    <p>Spontaneous esophageal perforation</p> Signup and view all the answers

    In the case of an iatrogenic esophageal perforation, you should avoid using a ________ NG tube to prevent increased perforation risk.

    <p>blind</p> Signup and view all the answers

    Match the following terms with their descriptions:

    <p>Iatrogenic perforation = Occurs post-endoscopy Spontaneous perforation = Associated with vomiting against closed glottis Type IV hernia = Paraesophageal hernia with content other than stomach Endoscopic sealing = Use of clips or SEMS for perforation management</p> Signup and view all the answers

    Which of the following features characterizes Distal Esophageal Spasm (DES)?

    <p>Repetitive, simultaneous contractions</p> Signup and view all the answers

    Barium swallow can show a 'rosary bead' appearance in patients with DES.

    <p>True</p> Signup and view all the answers

    What is the primary treatment that shows a very good response for Distal Esophageal Spasm?

    <p>POEM</p> Signup and view all the answers

    The type of diverticulum located in the upper esophagus is known as __________.

    <p>Zenker's</p> Signup and view all the answers

    What is a common feature in patients presenting with esophageal motility disorders?

    <p>Nocturnal cough</p> Signup and view all the answers

    Match the types of esophageal diverticula with their locations:

    <p>Zenker's = Upper esophagus Para-bronchial = Mid esophagus Epiphrenic = Lower esophagus Pulsion = Higher pressure diverticula</p> Signup and view all the answers

    Endoscopy is a diagnostic procedure used to investigate both achalasia and esophageal cancer.

    <p>True</p> Signup and view all the answers

    List one potential cause of Zenker's diverticulum.

    <p>TB or Histoplasmosis</p> Signup and view all the answers

    Study Notes

    Schatzki Ring

    • Mucosal or submucosal ring in the lower esophagus.
    • Causes intermittent, non-progressive dysphagia.
    • Diagnosed with barium swallow.
    • Managed with symptomatic treatment or balloon dilation.

    Dysphagia Lusoria

    • Esophageal compression from an aberrant right subclavian artery.

    Achalasia

    • Classical Triad: Dysphagia (initially liquids, then solids), weight loss, regurgitation.
    • Other Symptoms: Heartburn, nocturnal cough, post-prandial choking.
    • Complications: Aspiration pneumonia (most common), lung abscess.
    • Investigations: Manometry (increased lower esophageal sphincter pressure, failure of relaxation), endoscopy (to rule out cancer), barium swallow.
    • Chicago Classification: Categorizes achalasia based on manometric findings (peristalsis, lower esophageal sphincter pressure).
    • Achalasia-Eckardt Score: 4-parameter scoring system (weight loss, dysphagia, retrosternal pain, regurgitation) for severity assessment.
    • Management: Botox injections (effective but high recurrence, best for elderly with comorbidities), pneumatic dilation (effective, risk of perforation reduced with balloon <30mm, best responders: age >45, female, previously undilated esophagus, Type A achalasia), Heller’s myotomy (surgical, best for Type 1), POEM (peroral endoscopic myotomy, best for Type 3 and spastic conditions), Heller's myotomy + pneumatic dilation (Type 2 achalasia). Heller's myotomy may cause GERD, which can be prevented with fundoplication. POEM has a higher risk of GERD.

    Distal Esophageal Spasm (DES)

    • Less common than achalasia; females > males.
    • Motor abnormality of the lower two-thirds of the esophageal body.
    • High-amplitude, repetitive, simultaneous contractions.
    • Diagnosed with ECG (to rule out angina), barium swallow (rosary bead/corkscrew appearance), and manometry.
    • Treated with POEM or calcium channel blockers/nitrates.

    Approach to Motility Disorders

    • Consider achalasia, cancer, DES, and angina in the differential diagnosis. Workup depends on the suspected condition and includes endoscopy, manometry, barium swallow, and ECG.

    Esophageal Diverticula

    • Zenker's (pharyngoesophageal): Pulsion diverticulum, usually false, located in the upper esophagus; associated with increased risk of squamous cell carcinoma. Management includes diverticulectomy and cricopharyngeal myotomy for symptomatic, large diverticula (>2cm).
    • Mid-esophageal (para-bronchial): Traction diverticula.
    • Lower esophageal (epiphrenic): Pulsion diverticula, often false.

    Esophageal Cancers

    • Squamous cell carcinoma (SCC): More common globally, often associated with smoking, alcohol, hot beverages, N-nitroso compounds, chewing betel nut.
    • Adenocarcinoma: More common in Western world; associated with obesity, GERD, Barrett's esophagus.
    • Risk factors vary based on the type of esophageal cancer (see table).

    Zenker's Diverticulum

    • Also known as cricopharyngeal achalasia.
    • Outpouching through Killian's triangle.
    • Early symptom is regurgitation, followed by halitosis and dysphagia.
    • Aspiration pneumonia is a major complication.
    • Diagnosed with barium swallow.
    • Large or symptomatic diverticula are managed surgically with diverticulectomy and cricopharyngeal myotomy.

    Other Hernias

    • Type III: Mixed sliding and rolling hiatal hernia. Management depends on the rolling component.
    • Type IV: Paraesophageal hernia with content other than the stomach.

    Esophageal Perforation

    • Iatrogenic (post-endoscopy): Most common in the upper third; risk factors include therapeutic endoscopy, lack of skill, and endoscopic procedures in patients with cancer. Treatment depends on the stability of the perforation; stable patients with small perforations may be treated conservatively (NPO, IV fluids, antibiotics, pain management); unstable patients or those with large perforations might require endoscopic sealing or surgical repair.

    • Spontaneous (Boerhaave syndrome): Most common in the lower third (left posterolateral wall); usually involves vomiting against a closed glottis.

    • Mackler's triad: chest pain, retching, subcutaneous emphysema

    • Mallory-Weiss tear: Mucosal and submucosal layer split, typically in the upper GI tract; presents with upper GI bleeding.

    • Boerhaave syndrome: Perforation of the lower GI tract; presents with Mackler's triad (chest pain, retching, subcutaneous emphysema); Hamman's crunch (mediastinal crackling) may be auscultated.

    • Investigations: Stable patients: CECT. Unstable patients: Contrast study (Iohexol preferred over barium to avoid artifacts if leakage is present).

    • Treatment goals: Seal the perforation, drain fluid/pus and provide adequate nutrition.

    Hiatal Hernia

    • Sliding (Type I): Most common type; upward sliding of the gastroesophageal junction; usually asymptomatic or presents with GERD; managed symptomatically for smaller hernias; large hernias may require fundoplication.
    • Rolling/Paraesophageal (Type II): Portion of the stomach herniates into the thoracic cavity; gastroesophageal junction remains normal; requires surgical repair to prevent volvulus/necrosis.

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    Description

    Test your knowledge on various esophageal disorders including Schatzki Ring, Dysphagia Lusoria, and Achalasia. This quiz covers symptoms, diagnosis, and management strategies for these conditions. Perfect for medical students and healthcare professionals looking to enhance their understanding.

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