Surgery II Exam 1
What are the main components of the Esophagus? - ANS Mucosa
Submucosa
Muscularis Mucosa
Muscularis Propria (circular and longitudinal muscle)
No Serosa --> normally acts as fascia around a muscle that contains the spread of disease (this
meANS esophageal malignancies spread easier)
- Distinguishes esophagus from the rest of the GI tract
How is the blood supply to the Esophagus organized? - ANS In Fourths - Upper ES and Lower ES
Arteries:
Cervical esophagus --> thyrocervical trunk, inferior thyroid artery
Thoracic esophagus --> esophageal arteries
Distal esophagus --> gastric blood supply
How do esophageal varices form? - ANS In the lower part of the esophagus there is a combination of
portal and systemic drainage --> if have obstruction here then portal HTN increases blood supply to
this area and leads to esophageal varices that bleed like crazy
Explain the anatomy of the esophagus - ANS There are upper, middle and lower pharyngeal
sphincters --> as one contracts, the other relaxes (peristalsis)
Esophagus is 25 cm
- Cervical portion
- Upper thoracic
- Mid thoracic
- Distal esophagus
,What muscle relaxes as the lower pharyngeal sphincter pushes the bolus of food through? - ANS
Cricopharyngeal muscle
What is important about the distal esophagus? - ANS This is close to the gastroesophageal junction
which is where there is the transition from squamous epithelium to columnar epithelium
Which layer of muscle does the esophagus not have that the stomach does have? - ANS No oblique
muscle (stomach does more churning, whereas esophagus is a peristaltic organ)
What is Killian's triangle? - ANS This is an area of weak muscular coverage in the esophagus
Can get false diverticulum (Zenker's) -- herniation of mucosa d/t increased intraluminal pressure
What is manometry used for? - ANS Diagnostic test for esophageal motility disorders
Shows progressive peristaltic function of the esophagus and barium going through
What are the different diagnostic methods for esophageal disorders? - ANS Endoscopy -- best and
mc
CT
Manometry
24 hr pH monitoring
Endoscopic ultrasound
Barium swallow/esophagram
What are the functional disorders of the esophagus? - ANS Disordered Motility
,Achalasia
GERD/Barrett's
What is diffuse esophageal spasm commonly confused with? - ANS MI
What are the symptoms of diffuse esophageal spasm? - ANS Crushing chest pain
Dysphagia
What is seen on esophagogram of diffuse esophageal spasm? - ANS Corkscrew esophagogram
What medication relieves diffuse esophageal spasm? - ANS Nitroglycerin
What type of medication is used 1st line to treat diffuse esophageal spasm? - ANS Calcium Channel
Blockers
What surgical procedure may be performed for the treatment of diffuse esophageal spasm? - ANS
Myotomy -- disrupts the continuity of esophagus to relax the muscle
Used if medication fails
What is Achalasia? - ANS Achalasia is a disorder that makes it difficult for food and liquid to pass into
the stomach (LES fails to relax)
Neuromuscular discord problem!
What is the typical presentation of Achalasia? - ANS Middle aged adults
Progressive dysphagia (solids>liquids, or both)
Chest pain
Weight loss
, Respiratory symptoms (cough, nocturnal aspiration)
What is the rarity of Achalasia? - ANS Rare (1:100,000)
What are some possible etiologies of Achalasia? - ANS Unknown etiology (idiopathic, auto immune,
infectious - viral, parasitic)
What are the diagnostic methods for Achalasia? - ANS Barium swallow
EGD
Manometry
What is a characteristic finding in achalasia on barium swallow? - ANS Bird beak appearance of lower
esophagus --> dilated megaesophagus that narrows to bird beak
What are the treatment options for Achalasia? - ANS Endoscopic:
- Balloon dilatation (easiest, doesn't last long term so end up w/ repeat dilations)
- Botox injection (doesn't last forever, repeat injection leads to adhesions and makes more difficult
to perform myotomy if needed)
- POEM (newer procedure)
Surgical:
- Heller myotomy (definitive, best and longest acting treatment)
What is GERD? - ANS A condition where stomach contents leak into the esophagus, causing irration
What are the sxs of GERD? - ANS Regurgitation
Heartburn
Chest pain
Asthma
Laryngitis
Cough
What are the main components of the Esophagus? - ANS Mucosa
Submucosa
Muscularis Mucosa
Muscularis Propria (circular and longitudinal muscle)
No Serosa --> normally acts as fascia around a muscle that contains the spread of disease (this
meANS esophageal malignancies spread easier)
- Distinguishes esophagus from the rest of the GI tract
How is the blood supply to the Esophagus organized? - ANS In Fourths - Upper ES and Lower ES
Arteries:
Cervical esophagus --> thyrocervical trunk, inferior thyroid artery
Thoracic esophagus --> esophageal arteries
Distal esophagus --> gastric blood supply
How do esophageal varices form? - ANS In the lower part of the esophagus there is a combination of
portal and systemic drainage --> if have obstruction here then portal HTN increases blood supply to
this area and leads to esophageal varices that bleed like crazy
Explain the anatomy of the esophagus - ANS There are upper, middle and lower pharyngeal
sphincters --> as one contracts, the other relaxes (peristalsis)
Esophagus is 25 cm
- Cervical portion
- Upper thoracic
- Mid thoracic
- Distal esophagus
,What muscle relaxes as the lower pharyngeal sphincter pushes the bolus of food through? - ANS
Cricopharyngeal muscle
What is important about the distal esophagus? - ANS This is close to the gastroesophageal junction
which is where there is the transition from squamous epithelium to columnar epithelium
Which layer of muscle does the esophagus not have that the stomach does have? - ANS No oblique
muscle (stomach does more churning, whereas esophagus is a peristaltic organ)
What is Killian's triangle? - ANS This is an area of weak muscular coverage in the esophagus
Can get false diverticulum (Zenker's) -- herniation of mucosa d/t increased intraluminal pressure
What is manometry used for? - ANS Diagnostic test for esophageal motility disorders
Shows progressive peristaltic function of the esophagus and barium going through
What are the different diagnostic methods for esophageal disorders? - ANS Endoscopy -- best and
mc
CT
Manometry
24 hr pH monitoring
Endoscopic ultrasound
Barium swallow/esophagram
What are the functional disorders of the esophagus? - ANS Disordered Motility
,Achalasia
GERD/Barrett's
What is diffuse esophageal spasm commonly confused with? - ANS MI
What are the symptoms of diffuse esophageal spasm? - ANS Crushing chest pain
Dysphagia
What is seen on esophagogram of diffuse esophageal spasm? - ANS Corkscrew esophagogram
What medication relieves diffuse esophageal spasm? - ANS Nitroglycerin
What type of medication is used 1st line to treat diffuse esophageal spasm? - ANS Calcium Channel
Blockers
What surgical procedure may be performed for the treatment of diffuse esophageal spasm? - ANS
Myotomy -- disrupts the continuity of esophagus to relax the muscle
Used if medication fails
What is Achalasia? - ANS Achalasia is a disorder that makes it difficult for food and liquid to pass into
the stomach (LES fails to relax)
Neuromuscular discord problem!
What is the typical presentation of Achalasia? - ANS Middle aged adults
Progressive dysphagia (solids>liquids, or both)
Chest pain
Weight loss
, Respiratory symptoms (cough, nocturnal aspiration)
What is the rarity of Achalasia? - ANS Rare (1:100,000)
What are some possible etiologies of Achalasia? - ANS Unknown etiology (idiopathic, auto immune,
infectious - viral, parasitic)
What are the diagnostic methods for Achalasia? - ANS Barium swallow
EGD
Manometry
What is a characteristic finding in achalasia on barium swallow? - ANS Bird beak appearance of lower
esophagus --> dilated megaesophagus that narrows to bird beak
What are the treatment options for Achalasia? - ANS Endoscopic:
- Balloon dilatation (easiest, doesn't last long term so end up w/ repeat dilations)
- Botox injection (doesn't last forever, repeat injection leads to adhesions and makes more difficult
to perform myotomy if needed)
- POEM (newer procedure)
Surgical:
- Heller myotomy (definitive, best and longest acting treatment)
What is GERD? - ANS A condition where stomach contents leak into the esophagus, causing irration
What are the sxs of GERD? - ANS Regurgitation
Heartburn
Chest pain
Asthma
Laryngitis
Cough
