7/22/2013

7/22/2013

Answers:

What two muscles make up the upper esophageal sphincter?
A) Cricothyroid and Inf. Constrictor 
B) Cricothyroid and Sup. Constrictor 
C) Cricopharyngeus and Inf. Constrictor 
D) Cricopharyngeus and Sup. Constrictor 
E) Cricopharyngeus and Esophageal Crus

UES = cricopharyngeus and inf constrictor

The superior third of the esophagus is composed of --- muscle whereas the inferior two thirds of the esophagus is composed of --- muscle.

Skeletal; smooth.

MC Question:

An esophageal diverticulum that forms as an outpouching through Killians triangle is called?
A) Traction Diverticulum 
B) Epiphrenic 
C) Pharyngoesophageal Diverticulum 
D) Howard's Diverticulum

Free Response Questions:
The classic appearance of the esophageal mucosa in Barrett esophagus on endoscopy is...

Quick Facts:
Esophageal Cancer
-10K deaths/yr
-Until 1970s mostly SCC in thoracic esophagus of black men.
-Now, in US, adenocarcinoma of distal esophagus make up 50% of cases
-SCC still the most common type worldwide.
-Mostly 60-70s, M>W.
Pathogenesis
-For SCC tobacco and Etoh major factors as well as ingestion of hot liquids and poor hygiene.
-Achalasia, caustic injuries and plummer vinson syndrome associated.
-GERD is most common predisposing factor for adenocarcinoma.
Signs/Symptoms
-Dysphagia, at first just solids, but progresses to liquids.
-Weight loss
-Odynophagia, hoarseness, regurg and aspiration.
Treatment:
-Candidates for esophageal resection if:
-no evidence of tumor spread to other structured.
-no evidence of distant mets
-pt is fit from cardiac/respiratory point of view.
-Two approaches: transhiatal and transthoracic.
-After esophagectomy, continuity is restored using stomach or colon.
-Neoadjuvant therapy has largely failed.
Prognosis
-Stage is most important indicator.
-Overall 5 yr survival is 25-30%, but better if no lymph node mets.