Thoracic Medicine 🩻✅ Flashcards
First line test for suspected oesophageal cancer
Upper GI endoscopy
Investigations needed to stage oesophageal cancer
CT first, to check mets. But local stage often done with eNdoscopic US. Laparoscopy done to check peritoneal disease (PET CT done is non conclusive)
Management for esophagus cancer (generally speaking)
Surgery (Iver Lewis), especially if patient has LN involvement. Other less invasive methods if no LN involvement, Such as sub/mucosal resection with endoscopy. Adjunct chemo too
Main issues with Iver Lewis Sx
Anastomotic leak causing mediastinitis
Main invx for suspected traumatic pneumothorax/hemothorax
Chest X-ray (maybe stabilise patient first if needed)
Traumatic Pneumothorax management ?
Chest drain. Aspiration is too risky in trauma, and can become a tension
Main case of cause of Hemothorax
Laceration of intercostal or internal mammary artery after rib fracture
Hemothorax management. And when to do thoracotomy?
Wide bore 36F chest drain . Do thoracotomy when >1.5 L of blood losses or >200ml per hour for >2 hours
BIG contraindication for traumatic pneumothorax patients
Never mechanically ventilate until a chest drain inserted
Invx for hiatal hernia?
CXR with contrast is best, upper GI series to rule out complications
Uncomplicated sliding hiatal hernias Tx?
PPIs usually. Unless patient really wants Sx
Complicated hiatal hernia Tx
Indicated for surgery
Most common treatment for pectus excavatam and carinatum
Regular monitoring by paeds surgeon.
Surgery for pectus excavatum
Expand chest
Treatment for pectus carinatum
Bracing
