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Chirurgie > Esofag > Flashcards

Esofag Flashcards

1
Q

Dimensiuni esofag si segmente:

A

Lungime 25 cm, largime 1-1.5 cm
Vertebre C6 -T10-11
Portiuni: - cervicala: 6-8 cm
- toracica: 16-18 cm
- diafragmatica: 1-1,5cm
- abdominala: 2-3 cm

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2
Q

Esofag Cervical: limite, localizare, traiect

A

Limite: C6-T2
Limita sup: m. cricofaringian=m. constrictor inferior al
farigelui = sf. esofagian superior.
Localizare: posterior de trahee si anterior de fascia prevertebrala.
Lat:pachete vasculonervoase gât, n.laringeu rec.stg., lob tiroidian
stg, canal toracic
Traiect: usor oblic spre stg

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3
Q

Esofagul Toracic: localizare, traiect

A

Localizare: mediastinul posterior
- ant: trahee
- post: vertebre
- stg: posterior de arcul aortic si bronhia stg
- dreapta: vena azygos,trunchi brahiocefalic, n.vag drept
- ulterior: trece anterior de aorta si posterior de pericard (sp.Truesdale)
- lateral: raporturi cu pleura, plexuri vagale -vag dr,stg

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4
Q

Esofag toracic (Segment epifrenic)

A
  • Segment epifrenic: ultimii 6 cm între strâmtorile funcționale
    Von Hacker(sup) și Mouton(inf) - Ampula epifrenică
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5
Q

Spatiul Truesdale

A

Delimitat anterior de pericard, posterior de aorta
Portiunea toracala a esofagului

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6
Q

Esofagul diafragmatic:

A

Localizare: T11
Invelit de: Membrana Leimer-Bertelli

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7
Q

Esofagul Abdominal: limite, particularitate

A

Limite: de la hiatus la cardia
Particularitate: acoperit ant. de
peritoneu

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8
Q

Esofag stramtori naturale:

A
  • cricofaringiana
  • bronhoaortica
  • diafragmatica
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9
Q

Vascularizatie esofag:

A

Particularitate: slaba,intre cele 2 st. musculare
• Artere:
- cervical: a. tiroidiana inf, a. subclavie, carotidă com.
- toracic: 4-6 aa. esofagiene lungi (din aorta), aa.intercostale, aa. esofagiene scurte,aa.bronsice
- abdominal: a. gastrica stg ,a.frenica inf. stg.

• Vene:plexuri:
- 2/3 sup: submucos periesof. → sist. azigos
- 1/3 inf. -> sist port

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10
Q

Limfatice esofag:

A

plex submucos, plex muscular →gg.cervicali,traheo-bronsici, mediastinali dorsali, celiaci.

Esofag deasupra bifurație
trahee: duct toracic
Esofag sub bifurcație trahee: cisterna chyli

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11
Q

Inervatie esofag:

A

Inerv. Extrinsecă:
Vegetatvă: vag(parasimpatic), nn splahnici (simpatic)
Somatică: nn laringei recurenți
- reg.cervicala:laringeu sup.(vag),laringeu recurent(vag.)
- reg. toracica:vag(inerv. motorie),n.toracic sup.(simpatic)
- reg.abdominala: ultimii 5 cm plex vagal esofagian din care se
individualizeaza: vag dr.(post), vag stg.(ant.)

Inerv. Intrinsecă:
plex vegetativ periesofagian cu fibre spre:
- Meisner(submucos): peristaltică muscularis mucosae+activitate secretorie
- Auerbach(mienteric): persistaltica tunică musculară

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12
Q

SES: lungime, presiuni, timp relaxare

A
  • lungime: 3cm
  • p de repaus: 20-60 mmHg
  • durata relaxare la deglutitie: 0,5-1 sec.
  • p contractie: 100 mmHg, 2-4 sec postdeglutitie
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13
Q

SEI: lungime, presiuni

A
  • 3-5cm
  • situat in abdomen=zona de presiune pozitiva
  • rol antireflux
  • p repaus: 10-20mmHg
  • se relaxeaza aprox 5 sec
    apoi se contracta (p=35mmHg) 10 sec si revine la p
    de repaus.
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14
Q

Scorul DeMeester

A

In urma ph-metriei esofagiene 24 de ore

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15
Q

Testul de evacuare a acidului din esofag:

A

Cate înghițituri sunt necesare pentru a aduce pH din esofagul distal la >5(după instilare HCL)
Asoc. cu pH metrie.
Normal15 înghițituri

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16
Q

Control neuroendocrin esofag deglutitie

A

Nervi: facial, glosofaringian, accesor, hipoglos
Hormoni:
Scad pres ses: cck, vip, gip, glucagon, progesteron, estrogeni, prostaglandine
Cresc pres ses: gastrina, pentagastrina, polipeptid pancreatic

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17
Q

Cauze globus histericus (sei)

A

neurologice, miastenia gravis, brge, esofagita, corpi straini, cancer incipient, parkinson, polimiozita
Frecvent pur psihice

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18
Q

Cauze disfunctie de motilitate corp esofagian: in general

A

Diabet, alcoolism (neuropatii)
Sclerodermie, dermatomiozita (colagen)
Scleroza laterala amiotrofica (neuro)
Miastenia gravis

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19
Q

Forme de disfunctii motilitate corp esofaguan

A

Spasm, atonia esof, achalazia, hipertonia sei, disfagia postvagotomie, hipertrofia sei, tulb nespecif de motil

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20
Q

Etiologie achalazie

A

NECLARA:
declansator: stress emotional sau fizic
Boala Chagas, disfunctie neuroni inhibitori nonadrenergici, noncolinergici, carenta vit B1

21
Q

Cilinica achalazie

A

Triada: disfagie, regurgitatie, scadere ponderala
+ tuse, sughit, palpitatii dspnee

22
Q

Diagnostic diferential achalazie-sclerodermie

A

Testul cu betanecol: in achalazie apare peristaltica

23
Q

Chrurgical achalazie

A

Esocardiomiotomia extramucoasa(heller) + refacere unghi hiss + piloroplastie

24
Q

Tratament endoscopic achalazie

A

POEM: miotomia endoscopica perorala

25
Q

Dosfagia lusoria

A

Paraclinic: arteriografie selectiva
Rx + endo nu dau informatii
Tratament: rezectie+ reimplantare

26
Q

Fiziopatologie Boerhave

A

In timpul varsaturii diametrul sei creste de 5 ori, iar daca presiunea depaseste 150 mm hg si sei rodicat in torace => ruptura

Cu mediastinita si hidropneumotorax (daca perf pleura)

27
Q

Semn patognomonic boerhave

A

Emfizem subcutanat (crepitatii)

*semn hamman: zg hidroaerice ritmate de bataile inimii

28
Q

Etape Johnson: evolutie arsuri chimice esofagiene

A
  1. Acuta: 1-4 zile, necroza, inflamatie, tromboza vase mici
  2. Ulceratie: ziua 5-6 eliminare necroze, perete subtire, rosc maxim perf
  3. Granulare: din z 10
  4. Cicatrizare: din z 10, stenoze
29
Q

Forme clinice arsuri esofagiene:

A
  1. Esofagita edematoasa/eritematoasa
    2.Esofagita cu ulceratii superficiale
  2. Esofagita necrotica necomplicata
    4.Esofagita necrotica complicata
30
Q

Cauze de esofagite

A

Alimente fierbinti, reci, alcool, vapori, gaze, acizi, baze
Sclerodermie,
Anemie Biermer
Sd. Plummer-Vinson
Carente A, B6, B12, C
infectioase

31
Q

Patogeneza brge, multifactoriala

A
  1. Afectarea mec antireflux
  2. Golirea dificila esofag
  3. Golire gastrica intarziata
  4. Tipul refluxului
  5. Scaderea cant de mucus/pg
32
Q

Semnul siretului

A

Pirozis accentuat la aplecare inainte

33
Q

Simptomele tipice pt brge

A

Pirozis/durere postprandial
Regurgitatii acide

34
Q

Testul perfuziei acide Bernstein

A

Perfuzie intraesof hcl 0.1 =>pirozis
Sensib 80%

35
Q

Clasificarea Los Angeles

A

A. Eroziuni<5mm
B. Eroziuni>5 mm neconfluente
C. Eroziuni confluente necircuferentiale
D. Eroziuni circumferentiale

36
Q

Clasificarea savary miller raportat la LA

A

Grad1: A+B
Grad 2: C
Grad 3: D
Grad 4: complicatii

37
Q

Complicatii brge

A

Stenoze, inel schatzki
Barret
Ulcer
Perforatie
Hds
Malignizare
Brosiectazii, pneumonii
Fringolaringita de reflux

38
Q

Tratament brge:

A

Alimentatie
Pozittie
Medic: antiacide, ipp, antih2, protectoare, prokinetice (meto, dom, cisaprida, eritro, azitro

Chirurgical:
Nissen, toupet, dor, belsey-mark

39
Q

Clasificare Allison ulcer esofagian (stadii)

A
  1. Inflamatie (premergator)
  2. Exulceratii+ edem+ false mb
  3. Ulceratii superf. circumf.
  4. Ulceratii ce trec de mucoasa
  5. Ulcer+ fibr. submuc.+ stenoza
  6. Ulcer+ stenoza stransa+ dilatatie supraiacenta !

Primele 3 reversibile

40
Q

Clinica clasica esofag barret

A

Asimptomatic
Pirozis, disfagie

41
Q

Diverticuli epibronsici

A

Div adevarati in urma unor procese infl mediastinale (tbc, histoplasmoza) asimptomatici, mici, triunghiulari, necesita trat chir doar in complicatii

42
Q

Clasificare Ackerlund

A

Tip I: prin brahisofag
Tip II: alunecare (axiale)
Tip III: rostogolire (paraesof)

43
Q

Diagnostic diferential hh de alunecare cu hh prin brahiesofag:

A

Rx cu bariu in strt subtire: evid pliurilor gastrice in torace

44
Q

Triada Brochard- Lenormant

A

In volvulus gastric:
Durere epigastrica+ efort varsaturi inef + nu trece sng

45
Q

Tumori benigne esofagiene in ordinea incidentei

A

Leiomiom
Polipi
Hemangiom
Mioblastom(abrikosoff)
Polip fibrovascular
Papiloame
Adenoame
T.carcinoide

46
Q

Cancer esofagian in ordinea incidentei:

A

Cancer scuamos
Adenocarcinom
Cancer cu celule mici
Carcinom adenochistic
Melanom malign
Carcinosarcom

47
Q

Clasificare TNM cancer esofagian:

A

T1: <5cm, fara obstr.
T2: >5cm
T3: extensie extraesof

N1: unilateral, mobili
N2: bilateral, mobili
N3: regionali, ficsi

M0 fara
M1 cu

48
Q

Stadializare cancer esofagian

A

Stadiu1: T1,N1-2,M0
Stadiu2: cervical: T2,N1-2, M0
Toracic: T2,N0,M0
Stadiu3: cervical: orice t3/n3
Toracic: n1
Stadiu4: M1

49
Q

Factori genetici carcinom scuamos esofagian

A

Sd neppk- autozomal dom
Tylosis palmaris

Chirurgie (16 decks)

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