29 Esophagus ANATOMY AND PHYSIOLOGY

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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)?

Cricopharyngeus muscle Signup and view all the answers

What relaxes to allow aspiration in a brainstem stroke?

Cricopharyngeus muscle Signup and view all the answers

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

Secondary peristalsis Signup and view all the answers

What initiates the swallow according to the text?

CNS Signup and view all the answers

What is the arterial blood supply of the cervical esophagus?

Inferior thyroid artery Signup and view all the answers

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

15 mm Hg Signup and view all the answers

Which muscle occludes the nasopharynx during swallowing?

Cricopharyngeus Signup and view all the answers

What is the most common cause of hiccoughs?

Gastric distention Signup and view all the answers

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

Myasthenia gravis Signup and view all the answers

What is the most common cause of a traction diverticulum?

Granulomatous disease Signup and view all the answers

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

Achalasia Signup and view all the answers

What is the primary treatment for isolated hypertensive LES?

Calcium channel blocker Signup and view all the answers

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

Diffuse esophageal spasm Signup and view all the answers

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

Zenker's diverticulum Signup and view all the answers

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

Achalasia Signup and view all the answers

What is the characteristic manometry finding in nutcracker esophagus?

High-amplitude peristaltic contractions (>180 mm Hg) Signup and view all the answers

What causes a Zenker's diverticulum to occur?

Increased pressure during swallowing Signup and view all the answers

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

Weakness in the upper esophageal sphincter Signup and view all the answers

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

Endoscopic resection Signup and view all the answers

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

PPI or Nissen Signup and view all the answers

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

Obesity Signup and view all the answers

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

Liver Signup and view all the answers

What is the preferred treatment approach for cervical esophageal cancer?

Definitive chemo-XRT Signup and view all the answers

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

Nodal spread Signup and view all the answers

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

Esophagectomy Signup and view all the answers

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

Transhiatal approach Signup and view all the answers

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

Right gastroepiploic artery Signup and view all the answers

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

NPO and drainage Signup and view all the answers

What is indicated for unresectable esophageal tumors?

Definitive chemo-XRT Signup and view all the answers

What is the prognosis for patients with malignant fistulas?

Poor with high mortality due to aspiration Signup and view all the answers

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

Defective Lower Esophageal Sphincter (LES) competence Signup and view all the answers

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

24-hour pH probe 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?

Nissen fundoplication Signup and view all the answers

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

Identification of the right crura Signup and view all the answers

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

Tight wrap Signup and view all the answers

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

Type I Signup and view all the answers

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

Type IV Signup and view all the answers

What is Schatzki's ring associated with?

(GERD) Gastroesophageal Reflux Disease Signup and view all the answers

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

Intestinal type columnar metaplasia Signup and view all the answers

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

Annually for 2 years, then every 3 years Signup and view all the answers

What symptoms are observed in paraesophageal hernias?

Chest pain, retching without vomiting, and dysphagia Signup and view all the answers

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

Dilatation of the ring and PPI therapy Signup and view all the answers

Which is the most common benign esophageal tumor?

Leiomyoma Signup and view all the answers

What is the most likely symptom of leiomyoma?

Dysphagia Signup and view all the answers

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

Excision via thoracotomy/VATS Signup and view all the answers

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

Alkali Signup and view all the answers

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

CXR Signup and view all the answers

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

Endoscopy Signup and view all the answers

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

Observation and conservative therapy Signup and view all the answers

Which site is the most common for iatrogenic esophageal perforations?

Left posterior lateral intrathoracic esophagus Signup and view all the answers

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

Boerhaave’s syndrome Signup and view all the answers

What sign on auscultation may indicate Boerhaave’s syndrome?

Mediastinal crunching Signup and view all the answers