Professional Documents
Culture Documents
A. VAYDA
department of surgery with urology and anesthesiology
Esophageal diverticula
The esophageal diverticula are the sacciform outpouchings of the esophageal wall, which filled with mucus and undigested food.
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.
Complications
diverticulitis. perforation of diverticulum bleeding malignancy
X-ray examination
Zenkers Diverticulum
Midesophageal Diverticulum
Epiphrenic Diverticulum
Fibrogastroduodenoscopy examination
Differential diagnostics
Stenocardia.
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.
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.
Differential diagnostics
Cancer of the lower part of esophagus and cardial part of stomach. Pneumothorax.
Cardiodilatation.
Surgical treatment.
Helerovsky's method.
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 of of of or
CLASSIFICATION
According to clinical course: I. The period of acute manifestation. . The latent period (false improvement). . The period of cicatrization.
According to the depth of lesion: I degree superficial burn with the damage of epithelial layer of esophagus; degree the burn with the damage of entire mucosa of esophagus; degree the burn damage of all layers of esophagus; V degree the spread of postburn necrosis on paraesophageal tissue and adjacent organs.
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.
Diaphragmatic hernia
Diaphragmatic hernia represents herniation of abdominal organs through natural openings of diaphragm, its weak places or ruptures.
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
Diaphragmatic hernia. Sliding (axial) diaphragmatic hernia: Diaphragmatic hernia of paraesophageal type
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.
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.