Esophageal Disorders Flashcards
Hiatal Hernia
Diaphragmatic hernia, esophageal hernia
Herniation of portion of stomach into esophagus through an opening in diaphragm
Most common abnormality found on upper GI x-ray
Sliding Hiatal Hernia
Stomach slides through opening with pt is supine, goes back into abdominal cavity when pt is standing upright
Most common type
Paraesophageal Hiatal Hernia
Esophogastric junction remains in place but fundus and greater curvature of stomach roll up through diaphragm
Acute parasophageal hernia is a medical emergency
Causes of hiatal hernia
Many factors
Structural changes, weaken diaphragm muscles
Increased intraabdominal pressure (obesity, pregnancy, heavy lifting)
Hiatal hernia clinical manifestations
May be asymptomatic
Heartburn
Dysphagia
Hiatal hernia complications
GERD Esophagitis Hemorrhage from erosion Stenosis Ulcerations of herniated portion Strangulation of hernia Regurgitation with tracheal aspiration Increased risk of respriatory problems
Hiatal hernia lifestyle modifications
Eliminate alcohol Elevate HOB Stop smoking Avoid lifting/straining Reduce weight, if appropriate Use antisecretory agents and antacids
Hiatal Hernia Surgical Therapy
Reduction of herniated stomach
Herniotomy (excision of hernia sac)
Herniorrhaphy (closure of hiatal defect)
Gastropexy (antireflux procedure)
*Laparoscopically: Nissen or Toupet techniques used
*Thoracic or open abdominal used depending on individual pt
Gastropexy
Attachment of the stomach supdiaphragmatically to prevent reherniation
Nissen Fundoplication
Fundus of stomach is wrapped around distal esophagus, fundus is then stuffed into itself
Esophageal Cancer
Malignant neoplasm of esophagus
Comes from structural changes
\
Squamous Cell
Changes due to damage that leads to cancer
Adenocarcinomas
Arise from glands lining esophagus
Resemble cancers of stomach and small intestine
Risk factors for esophageal cancer
Smoking Excessive alcohol intake Barrett's metaplasia Central obesity History of achalasia
Barrett’s metaplasia
Seen in long term bulimics and long term GERD
Etiology and Patho
Esophageal Cancer
Majority of tumors located in middle/lower portions of esophagus
Malignant tumors
Malignant tumors
Usually appear as ulcerated lesion
May penetrate muscular layer and outside wall of esophagus
Obstruction in later stages
Esophageal Cancer Clinical Manifestations
Symptom onset is late
Progressive dysphagia is most common (initially w/ meat then w/ soft foods and liquids)
Pain develops late (substernal, epigastric, or back area)
Weight loss
Regurgitation of blood-flecked esophageal contents
If the tumor is in the upper third of the esophagus…
Sore throat
Choking
Hoarseness
Esophageal Cancer Complications
Hemorrhage (if it erodes into aorta)
Esophageal perforation w/ fistula formation
Esophageal obstruction
Metastasis via lymph system (liver and lung metastases most common)
Esophageal Cancer Diagnostic Studies
Endoscopy w/ biopsy (necessary for definitive diagnosis) Endoscopic ultrasonography (EUS) *Important tool to stage Esophagogram (barium swallow)
Esophageal Cancer Collaborative Care
Treatment depends on location and spread
Poor prognosis (usually not diagnosed until advanced)
*Get best results with combination therapy
Surgical Procedures for Esophageal Cancer
Esophagectomy
-removal of part or all of esophagus
-Use Dacron graft to replace resected part
Esophagogastrostomy
-Resection of portion of esophagus and anastomosis of remaining portion to stomach
Concurrent radiation and chemotherapy (esophageal cancer)
Slows progression
Sometimes started before surgery
No standard single or combination drug therapy
Palliative Care (esophageal cancer)
Restoration of swallowing function (dilation, stent placement)
Maintenance of nutrition and hydration
Nutritional Therapy (esophageal cancer)
After surgery, parenteral fluids given
Jejunostomy feeding tube may be used
Swallowing study may be done before patient can have oral fluids
Preoperative Care (esophageal cancer, acute interventions)
Explain surgical procedure High-calorie, high-protein diet I/O record for patient/family Teach patient/family how to assess for fluid and electrolyte disturbances Oral care
What to teach the patient and caregiver about with preoperative care (esophageal cancer)
Chest tubes (if open thoracic approach used) IV lines NG Tubes Pain management Gastrostomy feeding (if appropriate) Turning, coughing, deep breathing
Postoperative care (esophageal cancer, acute intervention)
NG tube w/ bloody drainage for 8-12 hrs
Changes gradually to greenish/yellow
NG tube should not be repositioned or reinserted w/o surgeon’s approval!!!
Turning and deep breathing q 2 hrs
Incentive spirometer use
Position in semi-Fowler’s or Fowler’s (should be maintained at least 2 hrs after eating)
Monitor for complications
