Esoph. cancer and perforation, hiatal hernia

Question 1

Cancer. subtypes?

Answer 1

Adenocarcinoma
Squamous cell carcinoma

Question 2

Cancer. Adenocarcinoma location? risk factors?

Answer 2

Distal esophagus (lower 1/3), arises from BARRETT ESOPHAGUS

Advanced GERD (more than 20 years). nu sitas bareta ir sukelia
Obesity

Question 3

Cancer. Squamous location? risk factors?

Answer 3

Anywhere in the esophagus - šiaip labiau būna upper 2/3 of esophagus.
Risk: smoking, alcohol, caustic injury.

Question 4

Cancer. CP?

Answer 4

Chest pain
weight loss
Dysphagia (solids)

in adeno - GERD

Question 5

Cancer. Diagnosis?

Answer 5

Endoscopy with biopsy

CT (PET/CT) for staging

Jeigu padarytume barium - asymetry

Question 6

Cancer. treatment?

Answer 6

▪ Chemoradiation.
▪ Surgery.

Question 7

Eso perforation. etiology?

Answer 7

Instrumentation (eg endoscopy), trauma
Effort rupture (boerhaave syndrome)
Esophagitis (infectious/pills/caustic)

MCC - is endoscopy

Question 8

Eso perforation. CP?

Answer 8

Chest/back and epigastric pain, systemic (eg fever)
Crepitus, Hamman sign (crunching sound on auscultation)
Pleural effusion with atypical (eg green) fliud

Question 9

Eso perforation. What is Hamman sign?

Answer 9

crunching sound on auscultation

Question 10

Eso perforation. pleural effusion analysis?

Answer 10

Atypical green fluid on pleural effusion.

On analysis: low pH and high salivary amylase and may show food particles.

Question 11

Eso perforation. diagnosis? methods

Answer 11

X-ray or CT scan
Esophagography with water-souble contrast –> if non diagnostic, do barium study.

Question 12

Eso perforation. what seen on xray/CT?

Answer 12

on both: widened mediastinum, pneumonediastinum, pneumothorax, pleural effusion

CT scan: esophageal wall thickening, mediastinal fluid collection

Question 13

Eso perforation. what seen on esophagography?

Answer 13

leak from perforation

Question 14

Eso perforation. what diagnostic is gold standard?

Answer 14

Stable and gold standard –> contrast esophagography.

Question 15

Eso perforation. what diagnostic for nonstable?

Answer 15

CT scan with contrast.

Question 16

Eso perforation. complications?

Answer 16

mediastinitis

Question 17

Eso perforation. management?

Answer 17

URGENT SURGICAL CONSULT
NPO, IV abs broad spectrum, PPI

surgery - primary closure of esophagus and drainage of mediastinum.

Question 18

Hiatal hernia. types?

Answer 18

Hiatal hernia: Protrusion of the stomach above the diaphragm.
Type 1: sliding hernia.
Type 2: paraesophageal hernia.

Question 19

Hiatal hernia. CP?

Answer 19

C/P: GERD. Bleeding, ulcerations, and strictures in severe cases.

Question 20

Hiatal hernia. diagnosis?2

Answer 20

Diagnosis:
Barium swallow: gastric folds above the diaphragm.
Retrocardiac air-fluid level –> paraesophageal.

Question 21

Hiatal hernia. treatment? 2

Answer 21

Treatment:
Lifestyle modification and medical management.
Laparoscopic Nissen fundoplication with hiatoplasty.