PowerPoint Presentation

EsophagusPimp SessionThe esophagus has no _______.Serosa.It has an inner ____ muscle layer and an outer _____ muscle layer.CircularLongitudinalSurgical approach to the upper thoracic esoph is via what incision?Right thoracotomy avoids the aortaSurgical approach to lower thoracic esoph?Left thoracotomyThoracic duct drains into what?Left subclavian veinWhat 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 ductAbdominal esoph is supplied by what arteries?Left gastricInferior phrenicsThe cervical esophagus is supplied by what artery?Inferior thyroid arteryNormal LES pressure?10-20 at restMost common site of esoph perforation during EGD?Cricopharyngeus muscle3 anatomic narrowings:Cricopharyngeus muscleCompression of L mainstem bronchus and aortic archDiaphragm

Aspiration with brainstem stroke is caused by what?Failure of UES to relaxNormal UES pressure at rest?60Normal LES pressure at rest?15Procedure of choice to eval dysphagia?Barium swallowPlummer Vinson syndromeCervical esophageal dysphagiaCervical esoph webFe-def anemiaTreat with dilation and FeTreatment of Zenkers Diverticulum?Cricopharyngeal myotomyAchalasia gives you an increase risk of what kind of cancer?Squamous cellAchalasiaDec ganglion cells, Auerbachs plexusAperistalsis, Failure of LES to relaxBirds beak on Ba swallowTx: lap vs thoracoscopic Heller myotomyWhat is the main blood supply to stomach when performing a transhiatal esophagectomy?Right gastroepiploic arteryWhat type of cancer is associated with Barretts?AdenocarcinomaWhats the difference between Mallory Weiss and Boerhaaves?Mallory Weiss esoph tear, usually from retching (not rupture) leads to bleeding.Boerhaaves esoph perfWhat do you see on manometry for DES?Hypertonic, simultaneous contractionsWhat do you see on manometry for Nutcracker?Normal peristalsisHigh amplitude and duration of contractions.

What do you see on manometry for DES?Hypertonic, simultaneous contractionsWhat do you see on manometry for Nutcracker?Normal peristalsisHigh amplitude (>180 mm Hg) and duration of contractions (>6 sec).

What is pseudoachalasia?Cancer, distal stricture, or tumor of cardia mimicking achalasia. Alkali esoph: ______ necrosisLiquefactive necrosis worse than acidAcid injury - ______necrosisCoagulativeHow hypertensive is a hypertensive LES?>45 mm HgWhats the manometry for Vigorous Achalasia?Partial or absent LES relaxationAndRepetitive simultaneous contractions (like DES)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.GISTs mutation of what oncogene...C-kitWhat esoph leiomyomas get operated on?>5 cmSymptomaticWhat surgery do you do?Enucleation

Whats the treatment for high-grade dysplasia?EsophagectomyAfter dx confirmed by 2 pathologists.Type I-IV hernias?I sliding herniaII paraesophageal (nml GE junction)III - combinedIV colon, spleen or some other organWhere is a Schatzkis ring?Distal esophagusAssoc with hiatal hernia and GERDTreat with dilation, may need antireflux procedure.Wheres a vascular ring?Abnormality causing a vascular ring external to and compressing the esophagus (or trach) treat with ligation.What is the gold-standard test for GERD?pH probeWhat causes epiphrenic diverticula?Esoph motility disorderDistal 10 cm of esophTreat with diverticulectomy and long esoph myotomy on the opposite side.Procedure to lengthen esophagus?Collis gastroplastyMechanism of action of omeprazole?Blocks H/K ATPaseType I errorRejects null hypothesis incorrectlyFalsely assume there is a difference when no difference exists.Type II error:Accepts null hypothesis incorrectly.Because of small sample sizeTreatments are interpreted as equal when there is actually a difference.Type III errorConclusions not supported by dataNull hypothesis:Hypothesis that no difference exists.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.Most frequently occurring value...ModeMiddle value of set of data (50th %ile)Median2 types of qualitative variables...NominalNamed (color)

OrdinalOn a scale (pain from 1-10)Prevalence# of people having disease in populationIncidence# of newly diagnosed cases in a population over period of time (usually a year)Whats power?Probability of making the correct conclusion.1 probability of Type II errorLarger sample size increases power of test.Whats relative risk?Incidence in exposed/incidence in unexposed.Whatssensitivity?Ability to detect disease.TP/(TP+FN)Positive testNegative testHas diseaseTPFNNo diseaseFPTNPositive testNegative testHas diseaseTPFNNo diseaseFPTNAbility to state that no disease was presentTN/(TN+FP)Whats specificity?Whats PPV?Positive testNegative testHas diseaseTPFNNo diseaseFPTNLikelihood that with a positive result, the patient actually has the disease.TP/(TP+FP)Whats NPV?Likelihood that with a negative result the patient really doesnt have disease.TN/(TN+FN)Positive testNegative testHas diseaseTPFNNo diseaseFPTNWhats accuracy?(TP+TN)/(TP+TN+FP+FN)Positive testNegative testHas diseaseTPFNNo diseaseFPTNEsoph cancer with palpable supraclavicular node. Whats the treatment?M1 disease unresectableChemoradiation.Clinical signs of unresectability for esoph cancer?Hoarseness, Horners syn, phrenic nerve involvement, malignant pleural effusion, malignant fistula, airway invasion, vertebral invasion.