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Type of epithelium covering the esophagus
Squamous
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Blood supply of esophagus
Vessels directly off the aorta
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Blood supply of the cervical esophagus
Inferior thyroid artery
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Blood supply of the abdominal esophagus
Left gastric and inferior phrenic arteries
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Muscle type in upper esophagus
Striated
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Muscle type in lower esophagus
Smooth
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Nerve that travels on the posterior stomach; becomes celiac plexus
Right vagus
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Nerve that travels on the anterior stomach; goes to liver and biliary tree
Left vagus nerve
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Position of thoracic duct
Travels from right to left chest at upper 1/3 of mediastinum; inserts into left subclavian vein
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Location and muscle making up UES
15 cm from incisors, cricopharyngeus muscle
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innervation of UES
recurrent laryngeal
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normal UES pressure with food bolus
12-14 mmHg
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normal UES pressure at rest
50-70 mmHg
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most common site of esophageal perforation
cricopharyngeus
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location of LES
40cm from incisors
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anatomic areas of esophageal narrowing (3)
cricopharyngeus, by left mainstem and aortic arch, diaphragm
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normal LES resting pressure
10-20 mmHg
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side of approach to access the cervical esophagus
left
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side of approach to access upper thoracic esophagus
right
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side of approach to access lower thoracic esophagus
left
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causes of hiccups (4)
gastric distension, temperature changes, ETOH, tobacco
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causes of secondary esophageal dysfunction (4)
systemic disease, GERD, scleroderma, polymyositis
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procedure of choice for heartburn
endoscopy
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procedure of choice for dysphagia and odynophagia
barium swallow
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swallowing disorders where liquids are worse than solids
pharyngoesophageal disorders
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pathology caused by increased pressure during swallowing
zenker�s diverticulum
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EGD in Zenker�s patient?
Increased perforation risk
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Treatment of Zenkers
Cricopharyngeal myotomy
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True diverticula in esophagus due to inflammation, granulomatous disease or tumor
Traction diverticulum
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Diverticulum common in distal esophagus; associated with esophageal motility disorders
Epiphrenic diverticulum
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Treatment of epiphrenic diverticulum
Diverticulectomy, long esophageal myotomy on opposite side of esophagus
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Failure of peristalsis and lack of LES relaxation after food bolus
Achalasia
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Workup of dysphagia
EGD, barium swallow, manometry
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Medical treatment of achalasia (3)
Calcium channel blockers, LES dilation, BoTox, nitrates
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Esophageal dysmotility characterized by frequent strong body contractions of inc amplitude and duration, with normal LES tone
Diffuse esophageal spasm
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Treatment of diffuse esophageal spasm
Calcium channel blocker, nitrates, antispasmodics
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Fibrous replacement of smooth muscle in esophagus
Scleroderma
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Treatment of scleroderma
Esophagectomy
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Surgical indications for GERD (4)
Stricture, esophagitis, Barrett�s, cancer
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Fundoplication performed from chest
Belsey
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360 degree fundoplication used to treat GERD
Nissen
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Surgical elongation of a brachyesophagus
Collis gastroplasty
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Sliding hernia from dilation of hiatus
Type I hiatal hernia
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Paraesophageal hernia with hole in diaphragm alongside the esophagus (nL GE junction)
Type II hiatal hernia
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Dilation of hiatus + hole in diaphragm alongside
Type III hiatal hernia
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Entire stomach in chest + other organs
Type IV hiatal hernia
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Squamous to columnar metaplasia of esophagus
Barretts
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Esophageal spread pattern
Along submucosal lymphatic channels
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Symptoms indicating unresectability of esophageal ca (7)
Hoarseness, horner�s syndrome, phrenic nerve involvement, pleural effusion, fistula, airway invasion, vertebral invasion
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Most common esophageal cancer
Adenocarcinoma
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Common esophageal ca in lower esophagus
Adenocarcinoma
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Common esophageal ca in upper esophagus
Squamous cell carcinoma
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Primary blood supply to stomach after esophagectomy
Right gastroepiploic artery
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Esophagectomy with neck and abdominal incision
Transhiatal
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Esophagectomy with abdominal and right thoracotomy
Ivor lewis
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Esophageal operation when preserved gastric function is desirable
Colonic interposition
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Most common benign esophageal tumor
Leiomyoma
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Biopsy leiomyoma?
No, can form scar and make resection difficult
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2nd most common benign tumor of esophagus
esophageal polyp
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mode of injury after alkali ingestion
liquifaction necrosis
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mode of injury after acid ingestion
coagulation necrosis
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area of most perforations during EGD
cricopharyngeus
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criteria for nonsurgical management of esophageal perforation (3)
contained perforation, self-draining, no systemic effect
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forceful vomiting causing perforation of esophagus
Boerhaave�s syndrome
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Mediastinal crunching on auscultation
Hartmann�s sign
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Diagnosis method for boerhaave�s
Gastrograffin swallow
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Surgical treatment of Boerhaave�s
Left thoracotomy, longitudinal myotomy, primary repair
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