Pulmonary Insuffienciency, Spontaneous Pneumothorax, Esophagus Flashcards
COPD
-3 main interconnected processes
- chronic thickening and narrowing
- chronic mucus hypersecretion
- emphysema
Lung transplantation
-2 options
- heart and lung complex
- only lung
Lung transplantation
-contraindications
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
Bronchiolitis obliterans syndrome (BOS)
- definition
- symptoms
- fibrosis of terminal bronchioles –> obstruction and proximal bronchiectasis
- DRY cough, shortness of breath, subfebrile fever
Spontaneous Pneumothorax
-classification
- spontaneous is NEVER open
- primary and secondary
Primary spontaneous pneumothorax
- characteristics
- symptoms
- diagnostics
- histology
- 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
Secondary spontaneous pneumothorax
- etiology
- symptoms
- more often in…
- histology
- 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
Catamenial spontaneous pneumothorax (4)
- women
- occurs around 72 hours from the beginning of menstruation
- more often on the right
- may repeat several times before diagnosis
Spontaneous pneumothorax
-treatment
- chest tube for the 1st episode
- VATS/surgery for recurrence
Esophageal diseases
-anatomy
cervical
thoracic - upper (until azygous vein), middle (until pulmonary vein), lower
abdominal part
Esophageal cancer
-location
- upper and middle third –> squamous CC
- lower third –> adenocarcinoma
Esophageal cancer
-TNM classification
T1 - mucosa and submucosa
T2 - muscles
T3 - fat
T4a - mediastinal structures - pleura, pericardium
T4b - mediastinal structures - aorta, vertebra, vena cava, trachea, main bronchi
Esophageal cancer
-correlation between the damage of esophagus wall and dysphagia
- 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
Esophageal cancer
-diagnosis
1 - endoscopy + biopsy
2 - CT
3 - EUS +/- biopsy (for TNM)
4 - PET
Esophageal cancer
-most common surgical procedures (4)
- 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
Best organ to replace the esophagus
stomach
small intestine
colon
Esophageal cancer
-palliative care (3)
- ablation - electrocoagulation, laser
- dilatation - stenting
- non-endoscopic procedures - surgery, chemo, radiotherapy
Benign tumors of the esophagus
- Leiomyoma (3)
- GIST (3)
- Lipoma (4)
- 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
Benign tumors of the esophagus
- Schwannoma (2)
- Hemangioma (3)
- Squamous cell papilloma (3)
- 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)
Chemical burns of the esophagus
-degrees
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
Esophageal strictures
- where does it occur more often?
- etiology
- diagnostics
- 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
Esophageal strictures
-treatment (3)
- esophageal dilation
- surgery - new esophagus
- stenting
Esophageal strictures
-treatment –> esophageal dilation - indications (2) and disadvantages (3)
indications: stable dysphagia, gastroscope doesn’t fit in the esophagus
disadvantages: long treatment (procedure needs to be done many times), frequent complications, discomfort
Esophageal strictures
-treatment - -> stenting - complications (5)
pain bleeding movement of the stent tumor grows in the stent GERD and hearburn
Esophageal perforation
-symptoms
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
Esophageal perforation
- etiology
- diagnosis
-iatrogenic, spontaneous, trauma
- x-ray with barium sulfate –> nacler sign
- CT
- endoscopy
Esophageal perforation
-treatment (5)
start from 0 diet, gastric relief, infusion therapy + antibiotics, nutrition, drainage
Esophageal diverticulum
- classification (3)
- symptoms (2)
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
Esophageal diverticulum
- location
- diagnosis
- treatment
- between inferior constrictor and cricopharyngeus
- barium swallow, endoscopy, esophageal manometry
- PPI, surgery
Esophageal achalasia
- etiology
- pathogenesis
- 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
Esophageal achalasia
- symptoms (4)
- diagnosis (3)
- treatment
- 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
