Pimp Session Slide 2 The esophagus has no _______. Serosa. Slide
3 It has an inner ____ muscle layer and an outer _____ muscle
layer. Circular Longitudinal Slide 4 Surgical approach to the upper
thoracic esoph is via what incision? Right thoracotomy avoids the
aorta Slide 5 Surgical approach to lower thoracic esoph? Left
thoracotomy Slide 6 Thoracic duct drains into what? Left subclavian
vein Slide 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 Slide 8 Abdominal esoph is supplied by what
arteries? Left gastric Inferior phrenics Slide 9 The cervical
esophagus is supplied by what artery? Inferior thyroid artery Slide
10 Normal LES pressure? 10-20 at rest Slide 11 Most common site of
esoph perforation during EGD? Cricopharyngeus muscle Slide 12 3
anatomic narrowings: Cricopharyngeus muscle Compression of L
mainstem bronchus and aortic arch Diaphragm Slide 13 Aspiration
with brainstem stroke is caused by what? Failure of UES to relax
Slide 14 Normal UES pressure at rest? 60 Slide 15 Normal LES
pressure at rest? 15 Slide 16 Procedure of choice to eval
dysphagia? Barium swallow Slide 17 Plummer Vinson syndrome Cervical
esophageal dysphagia Cervical esoph web Fe-def anemia Treat with
dilation and Fe Slide 18 Treatment of Zenkers Diverticulum?
Cricopharyngeal myotomy Slide 19 Achalasia gives you an increase
risk of what kind of cancer? Squamous cell Slide 20 Achalasia Dec
ganglion cells, Auerbachs plexus Aperistalsis, Failure of LES to
relax Birds beak on Ba swallow Tx: lap vs thoracoscopic Heller
myotomy Slide 21 What is the main blood supply to stomach when
performing a transhiatal esophagectomy? Right gastroepiploic artery
Slide 22 What type of cancer is associated with Barretts?
Adenocarcinoma Slide 23 Whats the difference between Mallory Weiss
and Boerhaaves? Mallory Weiss esoph tear, usually from retching
(not rupture) leads to bleeding. Boerhaaves esoph perf Slide 24
What do you see on manometry for DES? Hypertonic, simultaneous
contractions Slide 25 What do you see on manometry for Nutcracker?
Normal peristalsis High amplitude and duration of contractions.
Slide 26 What do you see on manometry for DES? Hypertonic,
simultaneous contractions Slide 27 What do you see on manometry for
Nutcracker? Normal peristalsis High amplitude (>180 mm Hg) and
duration of contractions (>6 sec). Slide 28 What is
pseudoachalasia? Cancer, distal stricture, or tumor of cardia
mimicking achalasia. Slide 29 Alkali esoph: ______ necrosis
Liquefactive necrosis worse than acid Slide 30 Acid injury -
______necrosis Coagulative Slide 31 How hypertensive is a
hypertensive LES? >45 mm Hg Slide 32 Whats the manometry for
Vigorous Achalasia? Partial or absent LES relaxation And Repetitive
simultaneous contractions (like DES) Slide 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. Slide 34 GISTs mutation
of what oncogene... C-kit Slide 35 What esoph leiomyomas get
operated on? >5 cm Symptomatic Slide 36 What surgery do you do?
Enucleation Slide 37 Whats the treatment for high- grade dysplasia?
Esophagectomy After dx confirmed by 2 pathologists. Slide 38 Type
I-IV hernias? I sliding hernia II paraesophageal (nml GE junction)
III - combined IV colon, spleen or some other organ Slide 39 Where
is a Schatzkis ring? Distal esophagus Assoc with hiatal hernia and
GERD Treat with dilation, may need antireflux procedure. Slide 40
Wheres a vascular ring? Abnormality causing a vascular ring
external to and compressing the esophagus (or trach) treat with
ligation. Slide 41 What is the gold-standard test for GERD? pH
probe Slide 42 What causes epiphrenic diverticula? Esoph motility
disorder Distal 10 cm of esoph Treat with diverticulectomy and long
esoph myotomy on the opposite side. Slide 43 Procedure to lengthen
esophagus? Collis gastroplasty Slide 44 Mechanism of action of
omeprazole? Blocks H/K ATPase Slide 45 Type I error Rejects null
hypothesis incorrectly Falsely assume there is a difference when no
difference exists. Slide 46 Type II error: Accepts null hypothesis
incorrectly. Because of small sample size Treatments are
interpreted as equal when there is actually a difference. Slide 47
Type III error Conclusions not supported by data Slide 48 Null
hypothesis: Hypothesis that no difference exists. Slide 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. Slide 50 Most frequently occurring
value... Mode Slide 51 Middle value of set of data (50 th %ile)
Median Slide 52 2 types of qualitative variables... Nominal Named
(color) Ordinal On a scale (pain from 1-10) Slide 53 Prevalence #
of people having disease in population Slide 54 Incidence # of
newly diagnosed cases in a population over period of time (usually
a year) Slide 55 Whats power? Probability of making the correct
conclusion. 1 probability of Type II error Larger sample size
increases power of test. Slide 56 Whats relative risk? Incidence in
exposed/incidence in unexposed. Slide 57 Whats sensitivity? Ability
to detect disease. TP/(TP+FN) Positive test Negative test Has
disease TPFN No disease FPTN Slide 58 Positive test Negative test
Has disease TPFN No disease FPTN Ability to state that no disease
was present TN/(TN+FP) Whats specificity? Slide 59 Whats PPV?
Positive testNegative test Has diseaseTPFN No diseaseFPTN
Likelihood that with a positive result, the patient actually has
the disease. TP/(TP+FP) Slide 60 Whats NPV? Likelihood that with a
negative result the patient really doesnt have disease. TN/(TN+FN)
Positive test Negative test Has disease TPFN No disease FPTN Slide
61 Whats accuracy? (TP+TN)/(TP+TN+FP+FN) Positive test Negative
test Has disease TPFN No disease FPTN Slide 62 Esoph cancer with
palpable supraclavicular node. Whats the treatment? M1 disease
unresectable Chemoradiation. Slide 63 Clinical signs of
unresectability for esoph cancer? Hoarseness, Horners syn, phrenic
nerve involvement, malignant pleural effusion, malignant fistula,
airway invasion, vertebral invasion.
