Q) Elderly healthy male with impacted denture. Removed endoscopically. Pt developed fever, dyspnoea and respiratory distress over 24 hrs. X-ray revealed Lt hydrothorax and mediastinal emphysema.
a) ICD and NG feeds
b) ICD and TPN
c) Cervical esophagectomy, FJ, debridement, ICD
d) Debridement, primary repair with buttress and ICD
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Q. 40 yr old lady with symptoms of GERD. Endoscopy shows hiatus hernia. Symptoms controlled with PPI. Next step
a) Leave alone
b) Manometry with Ph study
c) Ba swallow with Manometry
d) Ba swallow with Ph study
Answer
Q ) Modified Nissen's Fundoplication is
a) 2700 anterior wrap around esophagus
b) 2400 wrap
c) 3600 wrap over > 52 Fr for 1 – 2 cm
d) 600 wrap over 42 Fr for 4 cm
Answer
c
Nissen fundoplication is complete 360 degree but has high incidence of gas bloat. To counter, this modification done to wrap over 52 F tube for 1-2 cm
Belsey - Left thoracotomy, mobilization of distal esophagus and stomach, hiatus opened from above, fundus is brought 270 degrees around distal esophagus. Then the whole assembly is brought down and crura is repaired.
Hill procedure - No fundoplication is done
Toupet is anterior fundoplication either 240 degree or 270 degree.
Q. Early adenocarcinoma of Esophagus
a) Around one third have lymph node mets
b) EMR curative in approx 90%
c) EMR can remove all dysplastic epithelium
d) In high grade dysplasia esophagectomy reveals around 50% invasive malignancy
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This question in another format was also discussed at www.mcqsurgery.com/esophagus4
Q. Blood supply of esophagus are all except (SS 2012)
a) Inferior thyroid A
b) Middle thyroid A
c) Tracheobronchial A
d) Bronchoesophageal A
Q) True about Vagal sparing Esophagectomy
a) Same lymphadenectomy as THE
b) Comparable morbidity to THE
c) Usually done for T3 tumors
d)None
Q) True about foreign body in esophagus
a) Sharp objects should be operated and not retrieved
b) Lead batteries should be removed
c) Most common impacted foreign bodies are dentures
d) Contrast examination of esophagus should be done before endoscopy
Sharp objects can be removed over overtubes and not always require surgery. Lead batteries can corrode and decay in the stomach or intestine and should always be removed. Most common impacted foreign bodies are food boluses above a pathological narrowing and require endoscopic break up
Contrast examination is not always required and might complicate things
Bailey page 991
Q) Which is not included in two field esophagectomy in carcinoma esophagus
a) Supra carinal and cervical
b) Infra carinal and celiac
c) Superior mediastinal
d) d) Posterior mediastinal
Discusss the lymph node stations
Japanese and european classifications of esophageal spread
Two field esophagectomy
