Download presentation
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
51
Middle value of set of data – (50th %ile)
Median
52
2 types of qualitative variables...
Nominal Named – (color) Ordinal On a scale – (pain from 1-10)
53
Prevalence # of people having disease in population
54
Incidence # of newly diagnosed cases in a population over period of time (usually a year)
55
What’s power? Probability of making the correct conclusion.
1 – probability of Type II error Larger sample size increases power of test.
56
What’s relative risk? Incidence in exposed/incidence in unexposed.
57
What’s sensitivity? Ability to detect disease. TP/(TP+FN)
Positive test Negative test Has disease TP FN No disease FP TN What’s sensitivity? Ability to detect disease. TP/(TP+FN)
58
What’s specificity? Ability to state that no disease was present
Positive test Negative test Has disease TP FN No disease FP TN What’s specificity? Ability to state that no disease was present TN/(TN+FP)
59
What’s PPV? Positive test Negative test Has disease TP FN No disease FP TN Likelihood that with a positive result, the patient actually has the disease. TP/(TP+FP)
60
Positive test Negative test Has disease TP FN No disease FP TN What’s NPV? Likelihood that with a negative result the patient really doesn’t have disease. TN/(TN+FN)
61
What’s accuracy? (TP+TN)/(TP+TN+FP+FN) Positive test Negative test
Has disease TP FN No disease FP TN What’s accuracy? (TP+TN)/(TP+TN+FP+FN)
62
Esoph cancer with palpable supraclavicular node. What’s the treatment?
M1 disease – unresectable Chemoradiation.
63
Clinical signs of unresectability for esoph cancer?
Hoarseness, Horner’s syn, phrenic nerve involvement, malignant pleural effusion, malignant fistula, airway invasion, vertebral invasion.
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.