EsophagusBasicScience.ppt

1、EsophagusBasic Science,Scott Nguyen, MD Daniel Herron, MD September 8, 2005,With regard to the anatomy of the esophagus, which of the following statements are true?,The outer muscular layer of the upper thoracic esophagus lies adjacent to the membranous portion of the trachea In patients with cirrho

2、sis with portal hypertension, venous drainage flows through the azygus system. The cervical and lowest portion of the thoracic esophagus lie slightly to the left of the midline. The left and right vagal plexi are intimately attached to the esophagus and emerge as two main anterior and posterior trun

3、ks just above the esophageal hiatus The thoracic duct travels from right to left at the upper third of the esophagus All of the above,Anatomy,Pharyngoesophageal segment Cervical esophagus Thoracic segment Intraabdominal segment,The most important aspect of an operation for a correction of a Zenkers

4、Diverticulum is:,Resection of the Diverticulum Pexy of the Diverticulum Cricomyotomy Cervical Drainage,A 55 year old male experiences heartburn after meals and during the night. He has esophageal manometry. The finding that could explain his symptoms is:,Failure of the LES to relax with swallowing P

5、eristaltic contraction from 20-100 Hg following relaxation Resting LES pressures less than 6 mm Hg A LES measuring 4 cm,Esophageal Physiology,Which of the following tests is the most sensitive for detection of GE reflux?,Barium Swallow Manometry 24 Hour pH monitoring Acid perfusion (Berstein Test) S

6、tandard acid reflux test,Lower Esophageal Sphincter,Components Intrinsic distal esophageal muscles tonically contracted Muscular Sling fibers of the gastric cardia Diaphragmatic crura Transmitted pressure of the abdominal cavity,pH Monitoring,Calculate % time that pH 4 at distal esophagus,Manometry,

7、Other tests,Recognized complications of GE reflux DO NOT include which of the following?,Ulcer Aspiration Columnar epithelium-lined esophagus Motility disturbance Zenkers Diverticulum Stricture Laryngeal inflammation,Which of the following are NOT related to the nonsurgical therapy of reflux?,Algini

8、c acid Prokinetic agents Living at higher altitudes Low fat meals Proton pump inhibitors,Surgery for GERD,With regard to Barretts esophagus, which of the following statements are NOT true?,It is congenital in orgin The columnar lining may be discontinuous with the gastric epithelium It is associated

9、 with an increased risk of cancer of the esophagus Surgical indications are those for reflux. Esophageal resection is indicated when severe dysplasia is present,Barretts Esophagus,Which of the following are effects of antireflux operations on Barretts esophagus?,Regression of esophagitis Prevention

10、of further columnar metaplasia Regression of columnar esophageal lining Prevention of malignancy All of the above A and B only,Early dysphagia following a Nissen Fundoplication is usually due to:,Too tight a gastric wrap Undetected perforation Slipped Nissen Traumatic edema,Which of the following fa

11、ctors are associated with adenocarcinoma of the esophagus? (2 answers allowed),Achalasia Corrosive stricture Barretts esophagus Ectopic gastric mucosa Upper esophageal web,Esophageal Cancer,Squamous Cell Carcinoma Adenocarcinoma,Esophageal Cancer,Survival,Stage 5yr I 50-94% II15-65% III 6-23% IV 5%

12、Only 50% elligible for curative resection at presentation,Surgical Options,Ivor Lewis Procedure Left Thoracoabdominal approach Transhiatal Combined Thoracoscopic / Laparoscopic,Ivor Lewis,Left Thoracoabdominal Approach,Transhiatal approach,Other operations,Combined thoracoscopic / laparotomy Combine

13、d thoracoscopic / laparoscopic Laparoscopic transhiatal,Which of the following are FALSE statements regarding esophageal cancer?,Presents w/ dysphagia and weight loss Diagnosis confirmed w/ barium esophagram and endoscopic biopsy Lymph nodes usually involved No submucosal spread Exploration is most

14、important determinant of resectability,Blood supply to the stomach in a transhiatal esophagectomy is provided by:,The Left gastric artery The left gastroepiploic artery The splenic artery The right gastroepiploic artery,A 55 year old pt presents w/ dysphagia. A barium swallow identifies a smooth fil

15、ling defect with the mucosa intact in the distal esophagus. Appropriate treatment is:,Total esophagectomy Distal esophagectomy Enucleation of the Lesion Endoscopic drainage,After diagnostic esophagoscopy, a patient complains of odynophagia and chest pain, but results of a water-soluble contrast swal

16、low are negative. Which of the following apply?,Discharge if the EKG is negative Barium in the chest is devastating Esophageal manometry should be performed immediately Repeated swallow with barium,Esophageal Perforation,Esophageal tube suction, IV, antibiotics Chest tube, esophageal suction, IVs, a

17、nd antibiotics Closure of perforation, chest tube, IVs, and antibiotics Esophagectomy and esophagogastrostomy,12 hours following esophagoscopy and biopsy of an obstructing esophageal cancer, the pt presents w/ fever substernal chest pain. Esophagram reveals perforation of the distal esophagus. Appropriate treatment is:,A 22 year male is st