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Pulmonology and Thoracic surgery > Pulmonary Insuffienciency, Spontaneous Pneumothorax, Esophagus > Flashcards

Pulmonary Insuffienciency, Spontaneous Pneumothorax, Esophagus Flashcards

1
Q

COPD

-3 main interconnected processes

A
  • chronic thickening and narrowing
  • chronic mucus hypersecretion
  • emphysema
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2
Q

Lung transplantation

-2 options

A
  • heart and lung complex

- only lung

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3
Q

Lung transplantation

-contraindications

A

Absolute

  • recent maligancy
  • smoking
  • severe psychiatric illness
  • non-compliance to treatment
  • infection

Relative

  • > 65 y.o
  • obesity
  • past thoracic procedures
  • comorbidities
  • mechanical vent.
  • extrapulmonary organ dysfunction
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4
Q

Bronchiolitis obliterans syndrome (BOS)

  • definition
  • symptoms
A
  • fibrosis of terminal bronchioles –> obstruction and proximal bronchiectasis
  • DRY cough, shortness of breath, subfebrile fever
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5
Q

Spontaneous Pneumothorax

-classification

A
  • spontaneous is NEVER open

- primary and secondary

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6
Q

Primary spontaneous pneumothorax

  • characteristics
  • symptoms
  • diagnostics
  • histology
A
  • the reason is unknown
  • usually is more common in men, tall, slim, healthy, <30 y.o
  • sudden sharp chest pain, dyspnea
  • anteroposterior x-ray!
  • bullae
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7
Q

Secondary spontaneous pneumothorax

  • etiology
  • symptoms
  • more often in…
  • histology
A
  • lung and airways diseases (COPD, asthma, cystic fibrosis, sarcoidosis) and infectious diseases (TB, bacteria, fungal…)
  • more dyspnea than pain
  • men, >45 y.o
  • diffuse lung disease
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8
Q

Catamenial spontaneous pneumothorax (4)

A
  • women
  • occurs around 72 hours from the beginning of menstruation
  • more often on the right
  • may repeat several times before diagnosis
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9
Q

Spontaneous pneumothorax

-treatment

A
  • chest tube for the 1st episode

- VATS/surgery for recurrence

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10
Q

Esophageal diseases

-anatomy

A

cervical
thoracic - upper (until azygous vein), middle (until pulmonary vein), lower
abdominal part

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11
Q

Esophageal cancer

-location

A
  • upper and middle third –> squamous CC

- lower third –> adenocarcinoma

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12
Q

Esophageal cancer

-TNM classification

A

T1 - mucosa and submucosa
T2 - muscles
T3 - fat
T4a - mediastinal structures - pleura, pericardium
T4b - mediastinal structures - aorta, vertebra, vena cava, trachea, main bronchi

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13
Q

Esophageal cancer

-correlation between the damage of esophagus wall and dysphagia

A
  • more than 50% damage = transitory dysphagia
  • less than 10mm damage = stable dysphagia - hard to swallow solid
  • less than 5mm damage = stable dysphagia - hard to swallow liquids
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14
Q

Esophageal cancer

-diagnosis

A

1 - endoscopy + biopsy
2 - CT
3 - EUS +/- biopsy (for TNM)
4 - PET

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15
Q

Esophageal cancer

-most common surgical procedures (4)

A
  • Ivor-Lewis - intrathoracic anastomosis –> if the tumor is at the level of the azygous vein
  • Mckeown - anastomosis in the neck –> if the tumor is above the level of the azygous vein
  • Orringer - trans-Hiatal approach –> only incision in the neck, NOT RECOMMENDED if spread to the lymph nodes
  • Esophagectomy through left thoracophrenolaparatomy –> not recommended, trauma is too big
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16
Q

Best organ to replace the esophagus

A

stomach
small intestine
colon

17
Q

Esophageal cancer

-palliative care (3)

A
  • ablation - electrocoagulation, laser
  • dilatation - stenting
  • non-endoscopic procedures - surgery, chemo, radiotherapy
18
Q

Benign tumors of the esophagus

  • Leiomyoma (3)
  • GIST (3)
  • Lipoma (4)
A
  • most common, lower part, usually causes no symptoms
  • biopsy is recommended, wider resection, biological therapy: tyrosine kinase inhibitors
  • rare, upper part, increases with peristalsis (overtime), recommended to be removed because aspiration risk is high if patient is vomiting
19
Q

Benign tumors of the esophagus

  • Schwannoma (2)
  • Hemangioma (3)
  • Squamous cell papilloma (3)
A
  • in all layers of the wall, resection if patient has symptoms
  • blue color during endoscopy, can cause bleeding if traumatized, resection or sclerotherapy
  • small, all parts, can be resected (need to evaluate morphology first)
20
Q

Chemical burns of the esophagus

-degrees

A

I - mucosa - edema, erythema
IIa - mucosa and submucosa - hemorrhage, erosions, blisters, ulcers
IIb - mucosa + submucosa - circumferential lesions
IIIa - + muscle - ulcers
IIIb - all layers - ulcers
IV - all layers - perforation

21
Q

Esophageal strictures

  • where does it occur more often?
  • etiology
  • diagnostics
A
  • most often occurs in the sites of anatomical and physiological narrowing
  • esophagitis, caustic strictures, iatrogenic, Schatzik ring
  • x-ray with barium sulfate, endoscopy, evaluate the cause - pH metry, CT, manometry
22
Q

Esophageal strictures

-treatment (3)

A
  • esophageal dilation
  • surgery - new esophagus
  • stenting
23
Q

Esophageal strictures

-treatment –> esophageal dilation - indications (2) and disadvantages (3)

A

indications: stable dysphagia, gastroscope doesn’t fit in the esophagus
disadvantages: long treatment (procedure needs to be done many times), frequent complications, discomfort

24
Q

Esophageal strictures

-treatment - -> stenting - complications (5)

A 
pain 
bleeding 
movement of the stent 
tumor grows in the stent
GERD and hearburn
25
Q

Esophageal perforation

-symptoms

A 
pain swallowing 
dysphagia 
swelling of the neck
abdominal pain 
subcutaneous emphysema

Manifestation of Boerhaave syndrome - Mackler’s triad: vomiting, chest pain that radiates to the back, subcutaneous emphysema

26
Q

Esophageal perforation

  • etiology
  • diagnosis
A

-iatrogenic, spontaneous, trauma

  • x-ray with barium sulfate –> nacler sign
  • CT
  • endoscopy
27
Q

Esophageal perforation

-treatment (5)

A

start from 0 diet, gastric relief, infusion therapy + antibiotics, nutrition, drainage

28
Q

Esophageal diverticulum

  • classification (3)
  • symptoms (2)
A

abnormal pouches that arise from the wall of the esophagus

  • Pharyngoesophageal (Zenker’s), middle esophageal, Epiphrenic (rare, grow a lot, rarely cause symptoms)
  • dysphagia, halitosis
29
Q

Esophageal diverticulum

  • location
  • diagnosis
  • treatment
A
  • between inferior constrictor and cricopharyngeus
  • barium swallow, endoscopy, esophageal manometry
  • PPI, surgery
30
Q

Esophageal achalasia

  • etiology
  • pathogenesis
A
  • unknown
  • increased basal LES pressure, incomplete relaxation of LES upon swallowing, aperistalsis
  • lack of noradrenergic, non-cholinergic, inhibitory ganglion cells –>imbalance in excitatory and inhibitor neurotransmission
  • cardiospasms
31
Q

Esophageal achalasia

  • symptoms (4)
  • diagnosis (3)
  • treatment
A
  • dysphagia, weight loss, chest pain, regurgitation
  • esophageal manometry, endoscopy, x-ray with barium sulfate
  • calcium channel blockers, long-acting nitrates, botulinum toxin
  • Heller myotomy, Dor or Toupet fundoplication esophagectomy

Pulmonology and Thoracic surgery (8 decks)

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