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Esophagus

Esophagus. Pimp Session…. The esophagus has no _______. Serosa. It has an inner ____ muscle layer and an outer _____ muscle layer. Circular Longitudinal. Surgical approach to the upper thoracic esoph is via what incision?. Right thoracotomy – avoids the aorta.

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Esophagus

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  1. Esophagus Pimp Session…

  2. The esophagus has no _______. Serosa.

  3. It has an inner ____ muscle layer and an outer _____ muscle layer. • Circular • Longitudinal

  4. Surgical approach to the upper thoracic esoph is via what incision? Right thoracotomy – avoids the aorta

  5. Surgical approach to lower thoracic esoph? • Left thoracotomy

  6. Thoracic duct drains into what? • Left subclavian vein

  7. What is the conservative management of a thoracic duct leak? NPO, TPN, give short and medium FAs, avoid long chain FAs. • Short and medium chain fatty acids enter the portal system directly. • Long chain fatty acids enter the lymphatics and travel via the thoracic duct

  8. Abdominal esoph is supplied by what arteries? • Left gastric • Inferior phrenics

  9. The cervical esophagus is supplied by what artery? • Inferior thyroid artery

  10. Normal LES pressure? • 10-20 at rest

  11. Most common site of esoph perforation during EGD? • Cricopharyngeus muscle

  12. 3 anatomic narrowings: • Cricopharyngeus muscle • Compression of L mainstem bronchus and aortic arch • Diaphragm

  13. Aspiration with brainstem stroke is caused by what? • Failure of UES to relax

  14. Normal UES pressure at rest? • 60

  15. Normal LES pressure at rest? • 15

  16. Procedure of choice to eval dysphagia? • Barium swallow

  17. Plummer Vinson syndrome • Cervical esophageal dysphagia • Cervical esoph web • Fe-def anemia • Treat with dilation and Fe

  18. Treatment of Zenker’s Diverticulum? • Cricopharyngeal myotomy

  19. Achalasia gives you an increase risk of what kind of cancer? • Squamous cell

  20. Achalasia • Dec ganglion cells, Auerbach’s plexus • Aperistalsis, Failure of LES to relax • Bird’s beak on Ba swallow • Tx: lap vs thoracoscopic Heller myotomy

  21. What is the main blood supply to stomach when performing a transhiatal esophagectomy? • Right gastroepiploic artery

  22. What type of cancer is associated with Barrett’s? • Adenocarcinoma

  23. What’s the difference between Mallory Weiss and Boerhaave’s? • Mallory Weiss – esoph tear, usually from retching (not rupture) leads to bleeding. • Boerhaave’s – esoph perf

  24. What do you see on manometry for DES? • Hypertonic, simultaneous contractions

  25. What do you see on manometry for Nutcracker? • Normal peristalsis • High amplitude and duration of contractions.

  26. What do you see on manometry for DES? • Hypertonic, simultaneous contractions

  27. What do you see on manometry for Nutcracker? • Normal peristalsis • High amplitude (>180 mm Hg) and duration of contractions (>6 sec).

  28. What is pseudoachalasia? • Cancer, distal stricture, or tumor of cardia mimicking achalasia.

  29. Alkali esoph: ______ necrosis • Liquefactive necrosis – worse than acid

  30. Acid injury - ______necrosis • Coagulative

  31. How hypertensive is a “hypertensive LES”? • >45 mm Hg

  32. What’s the manometry for “Vigorous” Achalasia? • Partial or absent LES relaxation • And • Repetitive simultaneous contractions (like DES)

  33. What are the indications to operate on paraesophageal hernias? • Ha Ha – trick question!! • Presence of paraesoph hernia is the indication to fix it operatively, for the purpose of the ABSITE.

  34. GISTs – mutation of what oncogene... • C-kit

  35. What esoph leiomyomas get operated on? • >5 cm • Symptomatic

  36. What surgery do you do? • Enucleation

  37. What’s the treatment for high-grade dysplasia? • Esophagectomy • After dx confirmed by 2 pathologists.

  38. Type I-IV hernias? • I – sliding hernia • II – paraesophageal (nml GE junction) • III - combined • IV – colon, spleen or some other organ

  39. Where is a Schatzki’s ring? • Distal esophagus • Assoc with hiatal hernia and GERD • Treat with dilation, may need antireflux procedure.

  40. Where’s a vascular ring? • Abnormality causing a vascular ring external to and compressing the esophagus (or trach)– treat with ligation.

  41. What is the gold-standard test for GERD? • pH probe

  42. What causes epiphrenic diverticula? • Esoph motility disorder • Distal 10 cm of esoph • Treat with diverticulectomy and long esoph myotomy on the opposite side.

  43. Procedure to lengthen esophagus? • Collis gastroplasty

  44. Mechanism of action of omeprazole? • Blocks H/K ATPase

  45. Type I error • Rejects null hypothesis incorrectly • Falsely assume there is a difference when no difference exists.

  46. Type II error: • Accepts null hypothesis incorrectly. • Because of small sample size • Treatments are interpreted as equal when there is actually a difference.

  47. Type III error • Conclusions not supported by data

  48. Null hypothesis: • Hypothesis that no difference exists.

  49. 95% Confidence Interval – when is it not statistically significant. • If it includes 1 – it is NOT statistically significant. • The farther from 1 the greater the correlation.

  50. Most frequently occurring value... • Mode

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