Category: Esophagus

Management DES

Management DES

Q) DES esophagus False in the management of this patient

a) Treatment is primarily medical management

b) Long myotomy necessary if surgery indicated

c) Dor's Fundoplication is recommended to prevent reflux

d) Endoscopic dilatation.

Answer  Q 30

 

Esophagus Perforation

Esophagus Perforation

Q )  Esophageal perforation true is

a) Contrast esophagogram in upright position is better

b) Massive hematemesis

c) Mid esophageal perforation causes right pneumothorax

d) More than 80% crepitus seen


Answer 

 

Association of Carcinoma Esophagus

Association of Carcinoma Esophagus

Q) Adenocarcinoma of esophagus is associated with which of the following? (DNB 2018)

a) Achalasia cardia

b) Barrett's disease

c) Human Papilloma virus (HPV)

d) Alcohol use


Answer - b

Association of carcinoma esophagus is with a number of risk factors. Both squamous cell carcinoma and adenocarcinoma of esophagus have different etiologies

Risk factors for Adenocarcinoma are                                                        Risk factor for Squamous cell carcinoma are

  1. Tobacco                                                                                                   1. Alcohol
  2. GERD                                                                                                       2. tobacco 
  3. Obesity                                                                                                     3. Achalasia
  4. Barrett                                                                                                      4. Caustic injury of esophagus
  5. H/o previous radiation for breast cancer                                         5. Previous radiation of CA breast                

                                                                                                                             6. H/o head and neck cancer

                                                                                                                             7. Plummer vinson and tylosisassociation-of-carcinoma-esophagus-1-300x239 Association of Carcinoma Esophagus

 

Esophagus Length DNB 2018

Esophagus Length DNB 2018

Q) Length of Esophagus

 A. 20cm
B. 25cm
C. 30-35cm
D. 40cm


Answer

29) b

The esophageal length is anatomically defined as the distance between the cricoid cartilage and the gastric
orifice. It ranges in adults from 22 to 28 cm (24
± 5 SD), 3 to 6 cm of which are located in the abdomen.

The shortest distance between the cricoid cartilage and the celiac axis is the orthotopic route in the posterior mediastinum, being 30 cm. The retrosternal (32 cm) and the subcutaneous route (34 cm) proved to be
longer

Ref Shackelford page 10

anatomy of esophagus

anatomy of esophagus

Q Which of the following is true about anatomy of esophagus?
A. Oesophageal hiatus is superior to aortic hiatus
B. Thoracic duct crosses esophagus at T3-T4level at the level of azygos vein arch
C. Laimer triangle is superior to the Killians triangle

D. In the mediastinum right vagus runs anteriorly and left vagus runs posteriorly

Answer

Post op chyle leak

Post op chyle leak

Q 27 Postoperative chyle leak following esophagectomy which is true?
A. Intraoperative prophylactic ligation of thoracic duct reduce leak risks
B. Conservative management - almost all heal by 3 weeks
C. Transthoracic ligation only
D. Conservative treatment includes antibiotics, enteral nutrition only

Answer 

 

Oropharyngeal dysphagia

Oropharyngeal dysphagia

 Oropharyngeal dysphagia false is
A. Nasal twang in voice, ptosis
B. Treatment is most often not satisfactory if conservative
C. Associated with myesthenia gravis and Parkinsonism
D. Water brasch and regurgitation presentation

Answer 

Chyle leak after esophagectomy

Chyle leak after esophagectomy

Q After  esophagectomy ICD draining 800 – 1000ml chyle 5-7 days post operatively. Next management

a) NPO, TPN

b) Enteral feeding with medium chain

c) Re explore and suture the defect

Answer free 

c

Once the diagnosis is made, one should ensure the pleural space is completely evacuated; if needed, drainage is done by a chest tube or a radiologically directed catheter placement.

Feedings are stopped and total parenteral nutrition (TPN) is started. The amount of chest tube output is then monitored for several days in order to make a decision about the possible need for reoperation. Small leaks can seal with nonoperative therapy. Large initial daily outputs (typically greater than 1 L/day) often fail nonoperative therapy and require reoperation. An absolute amount of drainage for prediction of failure is unknown and one should consider also if there is a gradual reduction in daily output to continue with conservative therapy.

If the drainage is less than 500 mL per day and slowly decreasing, continued conservative therapy is frequently successful. Continued volumes more than 1 L after 2 days of TPN is a good indication of the need for reoperation. In general, it is better to be more rather than less aggressive in returning to the operation theater with a chylothorax. It was more common after THE and was associated with longer intensive care unit (ICU) and hospital stays. There was no difference in mortality between those with and without a chylothorax.

Patients with initial drainage exceeding 2 L within 2 days of starting conservative treatment all required reoperation.

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