MCQs on Esophagus Questions 1-5

Surgery Questions on esophagus.

Questions 6-10

Questions 11-15         

Q 16-20          

Q21-25           

26-30

31-40

Questions 41-50      

GIST MCQs                  

 Q1. The usual incision given for surgery of  Zenker's diverticulum of esophagus is
a) Left Cervical incision
b) Right Cervical
c) Suprahyoid
d) Midline
1. a
 Zenker's diverticulum is a pulsion (false) diverticulum between the cricopharungeal muscle and inferior constrictor muscle in an area  Killian's dehiscence.
There may be other areas of weakness as well such as Killian Jamieson area between the oblique and transverse fibres of cricopharyngeal muscle and Laimer's triangle formed between the cricopharyngeal muscle and most superior esophageal wall circular muscles.
 
 (Zenker’s diverticulum)  -most common esophageal diverticulum.
Occurs due to 
1. Increased upper esophageal sphincter (UES) pressure
2. Failure of UES to relax
3.Incordination between hypophraynx and sphincter to relax
 
 
Treatment can be done endoscopically or surgically.
Surgery  Esophagomyotomy and resection of the diverticulum-  through an oblique left cervical incision
 Complications of Surgery for Zenker's divertculum
Salivary fistula 4-24%

Recurrence of Zenker's diverticulum  2.5-20%

 
 Q2. In Transhiatal  Vs Trans thoracic esophagectomy most common complication associated  with THE (Trans Hiatal esophagectomy) is
 
a) Pulmonary complications
b) Anastomotic leak
c) Bleeding
d) Injury to recurrent laryngeal nerve

 2. d
The transhiatal cervical anastomosis   New leak rates   (7.6% for transhiatal vs. 9.4% for transthoracic)
 
Transthoracic resections, have a higher incidence of pulmonary complications compared to THE
Operative blood loss is  less during transhiatal esophagectomy compared with transthoracic esophagectomy
 
Now Orringer - stapled side to side esophagogastric anastomoses in THE has reduced the anatomotic leak rate to 3%
Postoperative complications, n (%)              THE                             TTE
Superficial wound infection                        173 (10.2)                     110 (4.7) < 0.0001
Deep wound infection                                  53 (3.1)                          30 (1.3) < 0.0001
Anastomosis leaka                                        128 (7.6)                       189 (9.4) 0.35
Pneumonia                                                    234 (13.8)                      396 (16.8) 0.01
PE/DVT                                                          74 (4.4)                          121 (5.1) 0.28
Cardiac complications                                46 (2.7)                           56 (2.4) 0.48
Bleeding requiring transfusion                   196 (11.6)                      363 (15.4) 0.0006Mortality                                                          39 (2.3)                         60 (2.5) 0.63
Transhiatal vs. Transthoracic Esophagectomy: A NSQIP Analysis of Postoperative Outcomes and Risk Factors for Morbidity.

 Q3.Which  is the most disabling complication after three field esophagectomy?
a) Bronchorrhoea
b) Recurrent  laryngeal nerve palsy
c) Tracheal stenosis
d)

3. a
Three field esophagectomy involves lymph node dissection in the cervical, mediastinal and abdominal
region.
In contrast to the standard two field esophagectomy, japanese surgeons argue that three field esophagectomy leads to better prognostication and survival benefits without significantly increasing the morbidity and mortality.
Cervical lymphadenectomy included the paratracheal lymph nodes (deep internal nodes). The nodes lateral from the sternocleidomastoid muscle, ie, lateral to the internal jugular vein and supraclavicular nodes
 Q4. What is the most common complication after  esophagectomy
a) Arrhythmia
b) Pulmonary Collapse  and Consolidation
c) Recurrent laryngeal nerve injury

d) Massive bleeding

 4.b

Pulmonary complications occurred in 32.8%, cardiac dysrhythmias in 10.9%, and persistent recurrent nerve problems in 2.6%.

Q 5.Most important  investigation for preoperative evaluation of extensive corrosive stricture is
 a) Endoscopic ultrasound
b) Barium study
c) CT Thorax
d) Pharyngoscopy

 

 5.a

The management of corrosive esophageal stricture depends on the timing :

Emergency (Immediate management), Intermediate management and chronic long term management.

In the early phase - Investigations ordered are X ray chest,

X ray abdomen for perforation

Patients with fever, tachycardia, leukocytosis, metabolic acidosis need ICU care  and resuscitated urgently, and have the endoscopic assessment performed under general anesthesia in the operating room. 

Then after stabilization all symptomatic patients should undergo endoscopy. Endoscope should not be passed across the 1st sign of injury.

Endoscopic Grading of Caustic Injury
Grade 1Mucosal edema or hyperemia

Grade 2

A: Friability, erosions, exudates

B: As above, plus deep or circumferential ulceration

Grade 3

A: Scattered areas of necrosis with black or grey discoloration

B: Extensive areas of necrosis

Barium and other imaging studies are of no immediate value.

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  1. Esophagus MCQs 16-20
  2. Esophagus 11-15