[07.03] Surgical Diseases of the Esophagus V2.pdf

Dysphagia

What term is defined as difficulty swallowing or the feeling of food being stuck in the throat?

Odynophagia

What is the clinical term for pain experienced upon swallowing?

Regurgitation

What term describes the casting up of previously swallowed food?

Cervical, thoracic, and distal thoracic

What are the three primary anatomical divisions of the esophagus?

Upper esophageal sphincter (UES)

What functional role does the cervical esophagus serve?

Lower esophageal sphincter (LES)

What functional role does the distal thoracic esophagus serve?

Transit tube for food

What is the primary function of the bulk of the thoracic esophagus?

15 cm

What is the distance from the incisor teeth to the upper esophageal sphincter?

40 cm (Male) and 38 cm (Female)

What is the average distance from the incisors to the lower esophageal sphincter for both sexes?

C6-T1

At what vertebral level is the cricoid cartilage and upper esophageal sphincter located?

T10-T12

At what vertebral level is the gastric orifice located?

Three

How many anatomical narrowings are found in the esophagus?

Cricopharyngeus muscle

What specific muscle creates the first and narrowest esophageal narrowing?

1.5 cm

What is the diameter of the narrowest portion of the esophagus?

Foreign bodies

The first narrowing is the most common site for what to get stuck?

Left main bronchus and aortic arch

The second narrowing of the esophagus is caused by indentations from which two structures?

1.6 cm

What is the diameter of the second esophageal narrowing?

Gastroesophageal sphincter

Which structure defines the level of the third narrowing?

1.6 cm to 1.9 cm

What is the diameter range of the third esophageal narrowing?

Inner circular and outer longitudinal muscles

What are the two muscle layers that make up the bulk of the esophageal mass?

Serosa

Which anatomical layer is notably absent in the esophagus, unlike other parts of the GI tract?

Surgical anastomosis leaks

The lack of a serosal layer makes the esophagus particularly prone to what complication after surgery?

Striated (voluntary) muscle

What type of muscle is the esophagus composed of above the tracheal bifurcation?

Smooth (involuntary) muscle

What type of muscle makes up the entire esophagus caudal to the tracheal bifurcation?

Initial movement

Which portion of the swallowing process is considered voluntary?

Second portion

Which part of swallowing is considered involuntary?

Z-line

What is the name of the junction where the squamous mucosa meets the columnar mucosa?

Squamous mucosa

What type of mucosal epithelium is found proximal to the Z-line?

Columnar mucosa

What type of mucosal epithelium is found distal to the Z-line?

Barrett’s Esophagus

What is the term for the conversion of squamous to columnar epithelium above the gastroesophageal junction?

Longstanding GERD

Barrett’s Esophagus is a common complication in patients with what chronic condition?

Segmental

How is the arterial blood supply of the esophagus characterized?

Inferior thyroid artery

Which artery provides the primary blood supply to the cervical segment of the esophagus?

Bronchial and esophageal arteries

Which two sets of arteries supply the thoracic segment of the esophagus?

Ascending branch of the left gastric artery

What is the primary arterial supply for the abdominal segment of the esophagus?

Esophageal devascularization

During surgery, what must be meticulously avoided to prevent necrosis and anastomotic leaks?

Inferior thyroid veins

Which veins drain the proximal portion of the esophagus?

Azygos and hemiazygos veins

Which two major venous systems drain the thoracic esophagus into the superior vena cava?

Coronary vein

Which vein connects the systemic and portal circulations at the gastroesophageal junction?

Esophageal varices

The coronary vein is the anatomical reason for the formation of what in patients with portal hypertension?

Vagus nerve

Which nerve richly innervates the esophagus?

Recurrent laryngeal nerve

Which nerve controls the cricopharyngeus and the upper esophageal sphincter?

Hoarseness, swallowing problems, and food aspiration

Damage to the recurrent laryngeal nerve during surgery can cause which three major symptoms?

Far from the primary tumor site

How can malignancy spread due to the rich lymphatic supply of the esophagus?

Unresectable (non-curative)

What is the surgical status of a lesion if cervical lymphadenopathy is present?

Intentional (suicide)

In the adult population, what is the most common reason for caustic ingestion?

Acid

Which type of caustic substance causes an immediate burning sensation and reflex aversion?

Alkali

Which type of caustic substance has a less immediate burning sensation, leading to larger volumes being ingested?

Coagulative necrosis

What specific type of tissue damage is produced by acid ingestion?

Liquefactive (dissolves tissue)

What is the effect of alkali on esophageal tissue?

Alkali

Which type of caustic material has a higher likelihood of causing perforation due to deeper penetration?

Empyema, septicemia, and peritonitis

If caustic perforation occurs, what three serious infections may result?

Strictures and a 1,000-fold risk of cancer

What are two major long-term effects of surviving the acute phase of caustic injury?

Acute necrotic phase

Which phase of caustic injury starts at ingestion and lasts 1 to 4 days?

Ulceration and granulation phase

Which phase of caustic injury occurs between 3-5 days and 10-12 days post-ingestion?

Ulceration and granulation phase

During which phase is the esophageal wall at its weakest and most prone to perforation during instrumentation?

Cicatrization and scarring

Which phase of caustic injury begins 3 weeks post-injury and can lead to lumen obstruction?

Liquid sosa (Liquid Lye)

What is the most common commercial alkali agent used in the Philippines?

Muriatic acid (Hydrochloric acid)

What is the most common commercial acid agent used in the Philippines?

Niguarda 90

What is the name of the endoscopic classification system used for caustic burns?

Grade 4

Which Niguarda score indicates black mucosa, deep ulcers, and impending perforation?

Hypersalivation, fever, and pain

List three acute clinical manifestations of caustic ingestion.

Possible penetration or perforation

Fever and systemic manifestations in a caustic injury patient should alert the clinician to what?

Quiescence (2nd phase)

In which phase of caustic injury does the patient appear okay and lack dysphagia?

Within two months

In 80% of caustic cases, within what timeframe do strictures typically develop?

Oropharyngeal chemical burns and airway obstruction

During the acute phase physical exam, what should the mouth and tongue be inspected for?

Signs of shock (tachycardia, hypotension)

What should be checked in the vital signs of a caustic injury patient?

Septicemia

Fever combined with signs of shock and high WBC count indicates the patient is entering what state?

Crepitation and tenderness

What two findings on neck palpation indicate cervical esophageal perforation?

Pleural effusion and pneumothorax

Which two respiratory findings suggest the esophagus has ruptured into the thoracic cavity?

Generalized tenderness, guarding, and rigidity

What three findings constitute "signs of an acute abdomen" requiring immediate surgery?

Lower esophageal sphincter (LES)

In GERD, gastric contents reflux into the esophagus through which structure?

Males

Esophagitis and Barrett’s esophagus are more common in which sex?

Spicy/fatty foods, chocolate, alcohol, and caffeine

Heartburn in GERD is often aggravated by which four types of intake?

Supine (lying down)

In what body position is GERD-related heartburn typically at its worst?

Permanent attenuation of the collar sling musculature

What is the anatomical lesion associated with GERD pathophysiology?

Decreased tone of the LES

What is the primary pathophysiological mechanism of GERD?

Erosive esophagitis (31%)

What is the most common esophageal complication of GERD?

Adult-onset asthma

Which respiratory condition is often found to be caused by GERD?

Pulmonary fibrosis

Repeated lung insult from GERD aspiration can lead to what condition?

Adenocarcinoma

Most cases of which type of esophageal cancer arise from Barrett's Esophagus?

40-fold

How much higher is the risk of adenocarcinoma in Barrett's patients compared to the general population?

Achalasia

What is the most common primary esophageal motor disorder?

Absence of peristalsis and non-relaxing LES

Achalasia is characterized by which two motility failures?

Increased LES tone

Unlike GERD, how is the muscle tone of the LES described in achalasia?

Myenteric plexus and vagus nerve

Achalasia is caused by degenerative changes in the ganglia of which structures?

Vomiting immediately after eating and weight loss

What are two symptoms of achalasia that result from long-term disrupted food transit?

Bird’s Beak sign

What is the classic barium swallow finding for achalasia?

Diffuse Esophageal Spasm (DES)

Which motility disorder is characterized by uncoordinated, intense, or prolonged contractions?

Corkscrew pattern

What is the characteristic barium swallow finding for Diffuse Esophageal Spasm?

Chest pain

What symptom is more prominent than dysphagia in patients with Diffuse Esophageal Spasm?

Drinking hot or cold beverages

Intermittent retrosternal pain in DES is often associated with eating quickly or what else?

Females

Which sex has a higher predilection for Diffuse Esophageal Spasm?

Pulsion and Traction

What are the two general types of esophageal diverticula?

Motility disorders and failure of LES relaxation

Pulsion diverticula are associated with what conditions?

Tuberculosis (TB) and inflammatory lymph nodes

Traction diverticula are associated with which inflammatory conditions?

Epiphrenic

What is the term for a diverticulum located in the lower esophagus?

Manometry

Which diagnostic test shows increased luminal pressure during swallowing in lower esophageal diverticula?

Stomach, colon, or jejunum

After esophageal resection, which three organs can be used for reconstruction?

Stage IV

Which cancer stage has a 5-year survival rate of only 0-5%?