Transcript Esophageal stricture

ESOPHAGEAL DISORDERS
A. VAYDA
department of surgery with anesthesiology
Esophageal diverticula
The esophageal diverticula are the sacciform
outpouchings of the esophageal wall, which filled with
mucus and undigested food.
Etiology and pathogenesis
Pulsion diverticula - increase of intraesophageal pressure
proximal to muscle sphincters.
Traction diverticula - paraesophageal inflammatory and
sclerotic processes.
Classification
1.According to the origin:
a)congenital;
b)acquired.
2. According to the histological structure:
a)true (have all layers of esophageal wall);
b)false (absent muscular layer of esophageal wall).
3. According to the localization:
a)pharyngoesophageal (Zenker's);
b)bifurcational;
c)epiphrenic.
4. According to the clinical course:
a)complicated;
b)uncomplicated.
Signs and clinical course
salivation,
cervical dysphagia,
difficult swallowing and cough.
Complications
diverticulitis.
perforation of diverticulum
bleeding
malignancy
The diagnostic program
1. Anamnesis and objective
examination.
2. General blood and urine analyses.
3. Coagulogram.
4. Chest X-radiography.
5. Contrast roentgenoscopy of
esophagus and gastrointestinal tract.
6. Fibrogastroduodenoscopy.
X-ray examination
Zenker’s Diverticulum
Midesophageal
Diverticulum
Epiphrenic
Diverticulum
Fibrogastroduodenoscopy examination
Differential diagnostics
Stenocardia.
Achalasia
Tactics and choice of treatment
Achalasia of the cardia
Achalasia of the cardia is the disease, which is
characterized by failure of the lower esophageal
sphincter to relax with swallowing.
Etiology
The cause of this disease is still unknown.
Among the underlying mechanisms are:
•psycho-emotional trauma,
•disturbance of parasympathetic and sympathetic
innervation
•influence of vegetotrophic substances on muscular fibers.
Symptomatology and clinical course
Dysphagia.
Dysphagia.
Esophageal vomiting (regurgitation).
Splashing sounds and gurgling behind breastbone.
The sign of nocturnal cough.
Pain.
Loss of weight.
Classification
1)functional spasm without esophageal dilation;
2)constant spasm with a moderate esophageal dilation and maintained
peristalsis;
3)cicatricial changes of the wall with expressed esophageal dilation,
the peristalsis is absent;
4)considerable esophageal dilation with S-shaped elongation and the
presence of erosive changes of esophageal mucosa.
The diagnostic program
1.Anamnesis and physical findings.
2.General blood and urine analyses.
3.Chest X-radiography.
4.Esophagogastroscopy.
5.Contrast roentgenoscopy (barium swallow).
Differential diagnostics
•Cancer of the lower part of esophagus and cardial part of
stomach.
Tactics and choice of treatment
•Diet.
•The conservative
treatment.
•Cardiodilatation.
Tactics and choice of treatment
Cardiodilatation.
Surgical treatment.
Heller's method
(esophagomyotomy).
Esophageal stricture
The cicatrical esophageal stenosis can arise owing
chemical, thermal and radial burns, and as a result
esophagitis or peptic ulcers. The most frequent cause
cicatrical strictures is considered to be chemical burns
esophagus, which are usually the result of accidentally
purposely (suicide) drink of acids or alkalis.
to
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CLASSIFICATION
According to clinical course:
I. The period of acute manifestation.
ІІ. The latent period (false improvement).
ІІІ. The period of cicatrization.
Tactics of treatment of esophageal
burn
neutralizing solutions
the treatment of shock and hypovolemia
antibacterial therapy is nominated for prevention of
infection complications.
parenteral feeding
prophylaxis of cicatrical stenosis of esophagus
elastic thermoslabile bougies.
esophagoplasty by stomach, small and large
intestine.
Treatment of esophageal stricture
elastic thermoslabile bougies.
Treatment of esophageal stricture
Dilatation of the stricture.
Treatment of esophageal stricture
esophagoplasty by stomach, small and large intestine.
Diaphragmatic hernia
Diaphragmatic hernia represents herniation of abdominal
organs through natural openings of diaphragm, its weak
places or ruptures.
Etiology and pathogenesis
diaphragmatic anomaly
age-dependent involution of the diaphragm
visceral ptosis
increase of intraperitoneal pressure
obesity
overfeeding
constipation
pregnancy.
The cause of sliding hernias can be draw of esophagus
upward in reflux esophagitis owing to intensive contraction
of its longitudinal musculature.
Classification
Clinical manifestation
pain behind breastbone.
heartburn.
belching.
Regurgitation, the sign of
"lacing shoes".
nausea and vomiting.
dysphagia.
roentgenological signs: 1) the
sign of "bell"; 2) blunt His
angle; 3) lack of air bubble of
the stomach.
Differential diagnostics
Stenocardia.
Peptic ulcer.
Lung atelectasis, pleurisy, pneumonia.
Tactics and choice of treatment
Conservative therapy:
1)the diet the same, as in peptic ulcer;
2) elevated upside position of the patient;
3)suppression of gastric secretion by administering of
Н2-blockers;
4)neutralization of gastric acid;
5)intensifying of evacuation of the food from stomach;
6)avoid of constipation;
7) sedative agents.
Surgical treatment.
Stages of the operation:
1.Drawing of the stomach into abdominal cavity.
2.The plastics of esophageal hiatus of the diaphragm
(cruroplasty).
3. Nissen fundoplication.
4.Gastropexia – fixation of gastric wall to parietal
peritoneum.