Term
| describe the anatomy of the esophagus |
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Definition
| muscular tube that begins at cricoid cartilage and pharynx, transverses behind the aortic arch, enter the abdoment through the diaphragm |
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Term
| describe the musculature of the esophagus |
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Definition
upper 1/3 = skeletal muscle.
lower 2/3 = smooth muscle. |
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Term
| this propels food down the esophagus |
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Definition
| peristalsis, contraction and relaxation are coordinated |
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Term
| painful lump in the throat |
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Definition
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Term
| cause of hiccup (singuitus) |
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Definition
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Term
| other names for heartburn |
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Definition
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Term
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Definition
1 = sliding (MC)
2 = paraesophageal (rolling) |
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Term
| when is a sliding hernia significant? |
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Definition
| when gastric acid is refluxed into the lower esophagus |
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Term
| part of the gastric fundus herniates adjacent to the esophagus, reflux is uncommon, but the fundus can become incarcerated |
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Definition
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Term
| who is a hiatal hernia usually found in? |
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Definition
| women who have been pregnant, overweight men and women, and predisposes a pt to gastric reflux |
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Term
| how do you dx a hiatal hernia? |
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Definition
| EGD, upper GI series/barium swallow, pH monitoring of the distal esophagus, manometry |
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Term
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Definition
| epigastric burning, substernal pain/tightness (can be confused with an MI) |
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Term
| treatment of hiatal hernia |
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Definition
| 80% of pts respond to medical therapy = avoid gastric stimulants (coffee, chocolate, tobacco, alcohol), no food/drink within 3 hrs of bed, elevate HOB 30 degrees, weight loss, H2RA/PPI therapy, antacids |
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Term
| surgical tx of hiatal hernia |
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Definition
| reconstruction of the valve mechanism (nissen fundoplication, hill, belsey), laporoscopic approach |
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Term
| complications of hiatal hernia |
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Definition
| schatzki ring, barrett's esophagus |
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Term
| fibrotic ring at the LES from chronic reflux |
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Definition
| schatzki ring - may need to be dilated |
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Term
| epithelium changes to columnar from squamous at the LES from chronic reflux, precursor to esophageal cancer |
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Definition
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Term
| failure of the LES to relax, occurs at the distal esophageal circular musclar segment, results in progressive dilation of the esophagus |
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Definition
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Term
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Definition
most = unknown
some = Chagas disease |
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Term
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Definition
| regurg of undigested food, pts ingest large quantities of water to force the food down. |
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Term
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Definition
| xray with cineradiography = bird beak deformity, esophageal manometry |
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Term
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Definition
| calcium channel blockers, surgery (most reliable), esophageal myotomy |
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Term
| procedure involves incising the muscle layer of the lower esophagus to relieve the pressure at the LES, partial fundoplication is also performed. |
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Definition
| Laparoscopic Heller Myotomy |
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Term
| caused by a dysfunction of the cricopharyngeal muscle, usually affects elderly pts |
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Definition
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Term
| sxs of Zenker's diverticulum |
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Definition
| regurgitate recently swallowed food or pills, foul odor to breath |
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Term
| tx of Zenker's Diverticulum |
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Definition
| myotomy of the crico-pharyngeal muscle and excision or elevation of the diverticula |
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Term
| most esophageal cancers are what? |
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Definition
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Term
| 10% of esophageal cancer are what? |
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Definition
| adenocarcinoma - linked to Barrett's esophagus |
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Term
| where do esphageal cancer tumors originate? |
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Definition
| the fundus of the stomach and extend up into the esophagus, adjacent structures are easily invaded |
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Term
| sxs of esophageal cancer? |
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Definition
| dysphagia (solid foods first), odynophagia, constant midback-midchest pain, anorexia, wt loss, hoarseness |
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Term
| how do you dx esophageal cancer? |
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Definition
| barium contrast = apple core lesion, EGD with biopsy, CT for staging, endoscopic ultrasound, PET scan for mets |
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Term
| treatment of esophageal cancer |
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Definition
| surgical resection (possible laryngectomy, en bloc lymph node dissection), bring teh stomach up and form an anastamosis, RT, |
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Term
| what is the usual cause of esoohageal perforation? |
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Definition
| instrumentation (endoscopy, NG tube placement, biopsy, dilation, foreign body) |
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Term
| esophageal perforation after an episode of forceful vomiting or retching |
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Definition
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Term
| tx of esophageal perforation |
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Definition
| aggressive surgical intervention, mortality rate depends on time between the occurence and intervention. surgical drainage and repair |
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