Thoracic Surgery Flashcards
most common entry for esophageal surgery
right thoracotomy
regions of the esophagus
cervical; proximal; middle; distal
when to use left thoracotomy
distal esophageal surgery
most common time to experience GERD symptoms
post heavy, greasy meal
most common GERD surgery
laparoscopic nissen fundoplication
most common type of esophageal cancer
adenocarcinoma
most common segment of GI tract used to reconstruct alimentary canal
stomach
dysphagia
difficulty ingesting food from mouth to stomach
most common surgical procedure for esophageal cancer
Ivor-Lewis (right thorax + abdominal incision)
most common lung neoplasm
metastatic lesion from another primary malignancy
causes of odynophagia
esophagitis (candida, CMV, HSV)
heartburn (pyrosis/water brash) can indicate:
strictures or achalasia
singultus (hiccups)
result of diaphragmatic irritation; could indicate hernia, acute gastric dilation, or subendocardial MI
causes of recurrent bronchitis/pna:
recurrent aspiration d/t: esophageal obstruction, congenital malformation, diverticula, or other dysmotility d/o
differences between esophageal d/o and angina pectoris:
- chest pain relieved when bending over
- relieved by belching
- pain may be relieved by nitroglycerin (if esophageal spasm)
first study obtained in w/u of dysphagia, regurg or heart burn:
barium esophagography (barium swallow)
purpose of esophageal manometry:
- assess fxn of UES and LES
- ID contraction abnormalities
demeester score
- score indicating which patients may benefit from anti-reflux surgery
- higher score indicates more acidic environment
diagnostic eval MANDATORY for w/u of esophageal dz:
upper endoscopy (direct visualization)
endoscopic exam findings in GERD
- extent of mucosal injury
- presence of atypical histologic changes (in Barrett’s)
endoscopic ultrasound evaluates:
- esophageal wall
- adjacent lymph nodes
diagnostic tool used to guide FNA for esophageal cancer:
endoscopic ultrasound
most common cause of GERD:
incompetent LES
causes of incompetent LES:
- hiatal hernia (most common)
- gastric outlet obstruction
- food/drug induced LES relaxation
- abdominal esophageal peristaltic activity
symptoms of GERD:
- heavy pressure-like discomfort in epigastrium
complications of GERD:
- narrowing distal esophagus (Schatzkis ring)
- hyperplasia of distal esophageal mucosa (Barrett’s esophagus* malignant!)
follow up with Barrett’s esophagus:
- routine f/u endoscopy every 6-12 mo w/biopsies
work-up for esophageal sxs:
- barium swallow
- esophageal manometry
- pH study
- upper endoscopy
medical treatment of GERD:
- behavior modifications
- PPIs
- H2 blockers
- antacids
common indication for GERD surgery in pediatric population:
aspiration pneumonitis
indications for GERD surgery:
- fail medical management
- cannot continue PPIs
- complication from GERD
nerve of concern in laparoscopic nissen fundoplication:
vagus nerve
esophageal adenocarcinoma presentation:
- healthier
- less advanced disease
esophageal SCC presentation:
- advanced disease
- greater weight loss
- hx smoking and EtOH abuse
diagnostic tool for identifying esophageal mets:
-PET scan
common location for distant esophageal mets:
- liver
- lungs
TNM
tumor depth
nodes
mets
early esophageal cancer disease is stage:
= stage IIa (limited local tumor invasion, no lymph node involvement, no mets)
McKeown approach for esophageal cancer:
- cervical + right thorax + abdominal incision
palliative measures for esophageal cancer:
- esophageal dilation
- stents
- laser & photodynamic therapy
- radiation & chemoradiation
indications for laryngoscopy:
carcinoma of lung is suspected
when is a lung carcinoma inoperable?
tumor involvement of recurrent laryngeal nerve
types of bronchoscopy
1- rigid bronchoscopy
2- flexible bronchoscopy (during intubation)
mediastinoscopy use:
- sampling mediastinal lymph nodes for staging cancer
positive cytologic findings in thoracentesis indicate:
inoperable tumor
leading cause of cancer death in the US:
bronchogenic carcinoma
most common lung carcinoma:
adenocarcinoma
second most common lung carcinoma:
SCC
treatment for non- small cell lung carcinoma:
surgery
treatment for small cell lung carcinoma:
radiation and chemo (surgery if early on)
most common symptom of bronchogenic carcinoma
unrelenting coughing
metastatic bronchogenic carcinoma SXS:
weight loss, malaise, HA, n/v, bone pain
non-metastatic bronchogenic carcinoma SXS:
Cushing syndrome, hypercalcemia, myasthenic neuropahties, hypertrophic osteoarthropathies, gynecomastia
Pancoast tumors can cause:
Horner syndrome (ptosis, miosis, anhidrosis)
most common dx tool to find bronchogenic carcnioma:
CXR (nodule, infiltrate, atelectasis)
contraindications for thoracotomy: SSSTOP IT
- SVC syndrome
- supraclavicular node mets
- scalene node mets
- tracheal carina involvement
- oat cell ca
- PFTs show FEV < 0.8L
- infarction (Myocardial)
- tumor elsewhere (mets)
pulmonary nodules are more (benign/malignant)
benign (60/40)
carcinoid tumor (carcinoid adenoma, bronchial gland tumor) characteristics:
- well differentiated neuroendocrine tumor
- younger than 60
- more commonly in GI tract
carcinoid tumor clinical features:
- mostly asymptomatic
- can be hemoptysis, cough, focal wheezing, recurrent pna
- carcinoid syndrome (flushing, diarrhea, wheezing, hypotension)
carcinoid tumor diagnostic studies:
- pink or purple central lesion on bronchoscopy
- CT to determine extent and growth
carcinoid tumor treatment:
- surgical excision
- NOT radiation or chemo
double lumen ETTs used for:
isolated lung (cardiothoracic surgery)
most common open approach for lung procedures
posterolateral thoracotomy
