Diseases and Injuries of the Oesophagus

Question 1

How many stages of achalasia of the oesophagus (cardiospasm) are there and what are they called?

Answer 1

There are four stages:

Stage 1 (inconstant spasm of cardia);

Stage 2 (stable spasm of cardia);

Stage 3 (scar changes in cardia and dilation of oesophagus);

Stage 4 (severe scar changes of cardia with excessive dilation and deviation of the oesophagus).

Question 2

What are the characteristics of stage 1 achalasia of the oesophagus?

Answer 2

Short timing dysphagia (ill-times opening of the cardia); anatomy of the oesophagus and gastric section are normal; active peristalsis up to the cardia; oesophageal evacuation in good time.

Question 3

What are the characteristics of stage 2 achalasia of the oesophagus?

Answer 3

Expressed dysphagia with slowed emptying of the oesophagus; even distal dilation of the oesophagus (conical narrowing); peristalsis is faster.

Question 4

What are the characteristics of stage 3 achalasia of the oesophagus?

Answer 4

Fibrosis of the oesophagus leading to scarring; sharp dysphagia; retrosternal pain; regurgitation; conical distal oesophagus; incomplete opening of the cardia; disorderly peristalsis and sharp weak spasms.

Question 5

What are the characteristics of stage 4 achalasia of the oesophagus?

Answer 5

Intense scarring of the of the cardia leading to narrowing; dilation, curving and lengthening of the oesophagus; atonic wall; delayed emptying of the oesophagus (large volume of liquid in the oesophagus.

Question 6

What are the primary symptoms of achalasia of the oesophagus?

Answer 6

Dysphagia; regurgitation; retrosternal pain; abundant mucus and hyper-salivaiton.

Question 7

What are the secondary symptoms of achalasia of the oesophagus?

Answer 7

Aerophagia (swallowing of air); hydrophagia; decrease in body mass; loss of ability to work.

Question 8

What is the difference between oesophageal vomiting and gastric vomiting?

Answer 8

Oesophageal vomiting: no foul smell; no sour taste; no violation of appetite.

Question 9

What are the causes of vomiting in the initial and late stages of achalasia of the oesophagus?

Answer 9

In the initial stage vomiting is due to spasm of the oesophageal wall. In the late stage it is due to overfilling and vomiting often occurs at night during the horizontal position.

Question 10

Why do patients with achalasia of the oesophagus experience aerophagia and hydrophagia?

Answer 10

Improves passage of food through the cardia by increasing pressure.

Question 11

What factors should be assessed during anamnesis morbi of a patient with achalasia of the oesophagus?

Answer 11

When the disease first started; what foods cause a reaction; characteristics of dysphagia; when oesophageal vomiting began; development of pain.

Question 12

What additional examinations can be conducted to confirm the diagnosis of achalasia of the oesophagus?

Answer 12

Roentgenoscopy (w/ contrast to examine the oesophagus); oesophagoscopy; oesophageal manometry and PH-metry.

Question 13

What features of achalasia of the oesophagus can be seen on an ordinary roentgenograph of a patient with achalasia of the oesophagus?

Answer 13

Contours of the oesophagus; horizontal level of liquid; absent gas bubble of stomach.

Question 14

What features of achalasia of the oesophagus can be seen on a roentgenograph with barium contrast?

Answer 14

Form, position and contours of the oesophagus, wall tone; relief of mucus membrane and motor function.

Question 15

What features of achalasia of the oesophagus can be seen during oesophagoscopy?

Answer 15

Extended oesophagus; hyperaemic membrane; closed cardiac channel and allows you to differentiate between achalasia and cancer.

Question 16

What are the differential diagnosis of achalasia of the oesophagus?

Answer 16

Benign and malignant tumours of the oesophagus; diverticulas; strictures. These all have the general symptoms of dysphagia; pain and regurgitation.

Question 17

How to differentiate between benign / malignant cancer and achalasia of the oesophagus?

Answer 17

Benign tumours are rarer than cardiospasm and dysphagia is a rare symptom. Upon further investigation there will be a defect of filling with smooth contours of the oesophagus. Malignant tumours are more common than cardiospasm. Dysphagia develops quicker with worsening of condition. During cancer there is marked defect of filling with deformed contours of the oesophagus.

Question 18

What other conditions commonly lead to oesophageal scarring?

Answer 18

Reflux-oesophagitis and chemical burns of the oesophagus.

Question 19

In what stages of achalasia of the oesophagus can cardiodilation be used?

Answer 19

I - III stage.

Question 20

What are the indications fro operative treatment of achalasia of the oesophagus?

Answer 20

IV stage of disease (however, contraindicated is there is conomitant pathologies); III stage is 3/4 unsuccessful attempts of cardiodilation have been made or cardiodilator cannot be passed through cardia; if the patient is a child; relapse of the disease.

Question 21

What conservative therapy can be used in achalasia of the oesophagus?

Answer 21

Conservative therapy is not affective unless used as a precursor for patients undergoing cardiodilation. The conservative treatment in this case is: diet; spasmolitics; sedative drugs and physiotherapy. N.B Botulinum toxin can be used in the early stages of the disease.

Calcium channel blocker- Nifedipine
Long acting nitrates

Question 22

What are the three main types of cardyodilators used in the treatment of achalasia of the oesophagus?

Answer 22

Stark, pneumatic cardiodilators and Wilson-Cook dilator.

Question 23

How do you carry out cardiodilation for patients suffering from achalasia of the oesophagus?

Answer 23

Carried out on an empty stomach. Premedication and anaesthesia of pharynx with 1% dicaine. Performed under X-ray. Balloon inserted up to gastro-oesophageal sphincter and inflated (3 - 4 times over period of 3 - 4 days). Manometry used to assess pressure (11 - 22 mmHg).

Question 24

What are the complications of cardiodilation for the treatment of achalasia of the oesophagus?

Answer 24

Rupture; incompetence of sphincter leading to reflux - oesophagitis.

Question 25

How is the operation of Heller performed to treat achalasia of the oesophagus?

Answer 25

Longitudinal oesophagocardiomyotomy. Anterior incision through longitudinal and circular muscle layers. Mucosa separated 2/3 rds of the diameter. Mucosa herniates.

Question 26

How is the operation of Petrovsky performed to treat achalasia of the oesophagus and what are the complications?

Answer 26

Longitudinal oesophagocardiomyotomy (Heller) with a graft of diaphragm on the crus. A common complication is relapse due to scar regeneration of the graft.

Question 27

How is the operation of Kolesov performed to treat achalasia of the oesophagus and what are the complications?

Answer 27

Longitudinal oesophagocardiomyotomy (Heller) with omentoplasty. A common complicarion of relapse due to scar regeneration of the graft.

Question 28

How is the operation of Gotschtein - Shalimov performed to treat achalasia of the oesophagus and what are the complications?

Answer 28

Longitudinal oesophagocardiomyotomy. Graft created using cardia muscles and fundophrenopexy. The complications of this procedure are insufficiency of the cardia and development of reflux - oesophagitis.

Question 29

How is the operation of Gotshteyna - Shalymova performed to treat achalasia of the oesophagus?

Answer 29

Longitudinal oesophagocardiomyotomy. Graft created using cardia muscles with the addition of Nissen fundoplication. This has the added benefit of preventing reflux - oesophagitis.

Question 30

What are the complications of a laparoscopic longitudinal cardiomyotomy performed to treat achalasia of the oesophagus?

Answer 30

Relapse; reflux-oesophagitis; empyema and peritonitis.

Question 31

What are the complications associated with the operation of Heller?

Answer 31

Relapse; reflux-oesophagitis; empyema; peritonitis.

Question 32

How long does the transnasal probe need to be left in and what purpose does it serve?

Answer 32

Must be left in for six days to evacuate gastric content and perform feeding from third day.

Question 33

What are the tasks of the postoperative period after surgery for achalasia of the oesophagus?

Answer 33

Restoration of water - electrolyte imbalance; antibiotic therapy; prophylaxis of cardio - respiratory complications and symptomatic therapy.

Question 34

What urgent condition can develop after surgery for achalasia of the oesophagus?

Answer 34

Rupture of the oesophagus leading to bleeding.

Question 35

What complication can develop as a result of achalasia of the cardia?

Answer 35

Oesophagitis; spontaneous rupture of the oesophagus; cancer; bleeding; aspirated pneumonia; chronic bronchitis; atelectasis; bronchiectatic disease; bronchial asthma and abscesses of lungs.

Question 36

What are the classification systems of diverticulosis of the oeasophagus according to Shalimov?

Answer 36

There are four types of classification: localisation; mechanism; clinical course and complications.

Question 37

What are the localisation of diverticulosis of the oesophagus?

Answer 37

Neck; thoracal segment (bifurcation and supradiaphragmal diverticulas); abdominal part and multiple diverticulas.

i.e.
Pharnygoesophageal
Mid- esophageal
Epiphrenic

Question 38

What are the mechanisms fo diverticulosis of the oesophagus?

Answer 38

Pulsing; traction; combined and functional (relaxation).

Question 39

What is the classification of diverticulosis of the oesophagus by clinical course?

Answer 39

Compensated; decompensated (predominant: oesophageal / gastric symptoms or combined).

Question 40

What is the classification of diverticulosis of the oesophagus based on complications?

Answer 40

Inflammatory processes;

Acute, chronic and recurrent, peridiverticulitis, tracheitis, bronchitis, oesophagitis, mediastinitis;

Perforation of the diverticula;

Cervical phlegmon, mediastinits, tracheo-oesophageal fistula, empyema of pleura, abscess of lungs, perforation of diverticula in the pleural cavity, cavity of the pericardium and peritoneal cavity, bleeding from diverticula, stenosis of the oesophagus;

Tumours of diverticula (benign and malignant).

Question 41

What symptoms appear in the early stages of diverticulosis of the cervical part of the oesophagus?

Answer 41

Irritation of throat - burning, dryness; cough; feel a foreign body in the throat; disorder fo swallowing; salivation; halitosis; nausea.

Question 42

Explain the mechanism of development of diverticulosis of the cervical part of oesophagus?

Answer 42

Known as pharyngeal pounch or Zenker’s diverticulum. Dorsal penetration of the circular and oblique parts of the triangle of Lane - Hakerman.

Question 43

What are the general symptoms of diverticulosis of the cervical part of the oesophagus?

Answer 43

If the size of the diverticulum in