29 Esophagus ANATOMY AND PHYSIOLOGY
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Questions and Answers

What is the major blood supply for the thoracic esophagus?

  • Left gastric and inferior phrenic arteries
  • Hemi-azygous and azygous veins
  • Inferior thyroid artery
  • Vessels directly off the aorta (correct)
  • Which nerve, when left undivided after vagotomy, can cause persistently high acid levels postoperatively?

  • Hemi-azygous and azygous veins
  • Right vagus nerve (correct)
  • Left vagus nerve
  • Recurrent laryngeal nerve
  • What is the normal pressure at rest in the upper esophageal sphincter (UES)?

  • 15 mm Hg
  • 30 mm Hg
  • 40 mm Hg
  • 60 mm Hg (correct)
  • What is the most common site of esophageal perforation, usually occurring with esophagogastroduodenoscopy (EGD)?

    <p>Cricopharyngeus muscle</p> Signup and view all the answers

    What relaxes to allow aspiration in a brainstem stroke?

    <p>Cricopharyngeus muscle</p> Signup and view all the answers

    Which type of peristalsis occurs with incomplete emptying and esophageal distention?

    <p>Secondary peristalsis</p> Signup and view all the answers

    What initiates the swallow according to the text?

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

    What is the arterial blood supply of the cervical esophagus?

    <p>Inferior thyroid artery</p> Signup and view all the answers

    What is the normal pressure with food bolus in the upper esophageal sphincter (UES)?

    <p>15 mm Hg</p> Signup and view all the answers

    Which muscle occludes the nasopharynx during swallowing?

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

    What is the most common cause of hiccoughs?

    <p>Gastric distention</p> Signup and view all the answers

    Which condition presents with liquids being more difficult to swallow than solids?

    <p>Myasthenia gravis</p> Signup and view all the answers

    What is the most common cause of a traction diverticulum?

    <p>Granulomatous disease</p> Signup and view all the answers

    Which condition is characterized by a bird’s beak appearance on manometry?

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

    What is the primary treatment for isolated hypertensive LES?

    <p>Calcium channel blocker</p> Signup and view all the answers

    Which condition is associated with frequent high amplitude, non-peristaltic, unorganized contractions on manometry?

    <p>Diffuse esophageal spasm</p> Signup and view all the answers

    In which type of diverticulum is the cricopharyngeal muscle divided using endoscopy?

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

    Which condition can be managed with Heller myotomy if other treatments fail?

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

    What is the characteristic manometry finding in nutcracker esophagus?

    <p>High-amplitude peristaltic contractions (&gt;180 mm Hg)</p> Signup and view all the answers

    What causes a Zenker's diverticulum to occur?

    <p>Increased pressure during swallowing</p> Signup and view all the answers

    What is the primary cause of dysphagia in myasthenia gravis and muscular dystrophy?

    <p>Weakness in the upper esophageal sphincter</p> Signup and view all the answers

    What is the primary treatment for high-grade dysplasia (HGD) in Barrett's esophagus?

    <p>Endoscopic resection</p> Signup and view all the answers

    What is the recommended treatment for uncomplicated Barrett’s esophagus (no dysplasia)?

    <p>PPI or Nissen</p> Signup and view all the answers

    What is NOT a risk factor for squamous cell carcinoma of the esophagus?

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

    What is the most common site of metastases for adenocarcinoma of the esophagus?

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

    What is the preferred treatment approach for cervical esophageal cancer?

    <p>Definitive chemo-XRT</p> Signup and view all the answers

    Which factor is the most important for prognosis in a patient without systemic metastases?

    <p>Nodal spread</p> Signup and view all the answers

    What is the primary surgical treatment for tumors invading the submucosa of the esophagus?

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

    Which approach may have lower morbidity from esophageal leaks following surgery?

    <p>Transhiatal approach</p> Signup and view all the answers

    What is the primary blood supply to the stomach after replacing the esophagus?

    <p>Right gastroepiploic artery</p> Signup and view all the answers

    What is the first-line management for chylothorax following esophagectomy?

    <p>NPO and drainage</p> Signup and view all the answers

    What is indicated for unresectable esophageal tumors?

    <p>Definitive chemo-XRT</p> Signup and view all the answers

    What is the prognosis for patients with malignant fistulas?

    <p>Poor with high mortality due to aspiration</p> Signup and view all the answers

    What is the most common defect in Gastroesophageal Reflux Disease (GERD)?

    <p>Defective Lower Esophageal Sphincter (LES) competence</p> Signup and view all the answers

    What is the best test to diagnose Gastroesophageal Reflux Disease (GERD)?

    <p>24-hour pH probe</p> Signup and view all the answers

    What surgical procedure is indicated for GERD when there is failure of medical treatment, avoidance of lifetime meds, or refractory complications?

    <p>Nissen fundoplication</p> Signup and view all the answers

    What is the key maneuver for identifying the left crura during Nissen fundoplication?

    <p>Identification of the right crura</p> Signup and view all the answers

    What is the most common cause of dysphagia following Nissen fundoplication?

    <p>Tight wrap</p> Signup and view all the answers

    What type of hiatal hernia involves the sliding of the gastroesophageal junction above the diaphragm?

    <p>Type I</p> Signup and view all the answers

    Which type of hiatal hernia requires repair due to the risk of gastric incarceration?

    <p>Type IV</p> Signup and view all the answers

    What is Schatzki's ring associated with?

    <p>(GERD) Gastroesophageal Reflux Disease</p> Signup and view all the answers

    What type of metaplasia in Barrett's esophagus is predisposed to esophageal cancer?

    <p>Intestinal type columnar metaplasia</p> Signup and view all the answers

    How often should Barrett's esophagus be surveilled with endoscopy and biopsies if no dysplasia is detected?

    <p>Annually for 2 years, then every 3 years</p> Signup and view all the answers

    What symptoms are observed in paraesophageal hernias?

    <p>Chest pain, retching without vomiting, and dysphagia</p> Signup and view all the answers

    What is recommended for the treatment of Schatzki's ring associated with GERD?

    <p>Dilatation of the ring and PPI therapy</p> Signup and view all the answers

    Which is the most common benign esophageal tumor?

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

    What is the most likely symptom of leiomyoma?

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

    What is the recommended management for a leiomyoma larger than 5 cm or causing symptoms?

    <p>Excision via thoracotomy/VATS</p> Signup and view all the answers

    Which type of caustic substance causes deep liquefaction necrosis in the esophagus?

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

    What is the recommended initial diagnostic test for suspected esophageal perforations?

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

    What is the best test to assess esophageal lesions in caustic esophageal injury?

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

    What would be the management for a contained esophageal perforation that is self-draining with no systemic effects?

    <p>Observation and conservative therapy</p> Signup and view all the answers

    Which site is the most common for iatrogenic esophageal perforations?

    <p>Left posterior lateral intrathoracic esophagus</p> Signup and view all the answers

    Which condition is characterized by forceful vomiting followed by chest pain and often a history of ETOH?

    <p>Boerhaave’s syndrome</p> Signup and view all the answers

    What sign on auscultation may indicate Boerhaave’s syndrome?

    <p>Mediastinal crunching</p> Signup and view all the answers

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