ESOFAG

Question 1

Avantaje stomac- grefon

Answer 1

• vascularizatie bogata
  
  • mob chir facila prin pedicul vascularizat
  • necesar ⬇️ anastomose gastro-intestinale

Question 2

Dezav stomac ca grefon

Answer 2

• ischemie fornix

- simpt BRGE postop- anastomoza intratoracica > cervicala

Question 3

Tehnica grefon gastric

Answer 3

sectionare a. gastrica stg + gastrice scurte
ascensionare fornix in torace/cervical
vasc pt stomac : gastrica dreapta + GD
n VAG e sectionat => piloromiotomie pt a facilita evacuarea gastrica

Question 4

Avantaje colon stg ca grefon

Answer 4

• ascensionare facila pana la esofagul cervical

- rezistent la reflux acid

Question 5

Dezavantaje colon stg ca grefon

Answer 5

• 2 anastomoze suplimentare

- experienta tehnica ⬆️

Question 6

Moduri de interpunere a grefonui colonic stg

Answer 6

1. PREFERATA: prin spatiul esofagului rezecat in mediastin POST.
   Daca esofagul NU poate fi rezecat in siguranta, sunt ADERENTE, EXTINDERE af
   2. Calea RETROSTERNALA- NU e optima, are traiect sinuos si ⤴️ OBSTRUCTIE - apertura toracica SUP

Question 7

Grefon jejunal

Answer 7

• rar
  
  • ocazional: ca grefa LIBERA( segm scurt cervical rez) - de interpunere intre segm esofagiene
  • grefa PEDICULATA- dificil pt ca are anatomie vasculara NEFAV
  • reconstructie jejunala prin conex Roux en Y= gastrectomie totala + esofagectomie distala

Question 8

Tehnica cu triplu abord

Answer 8

McKeown- toracotomie dr, laparatomie + cervicala

Question 9

Avantaje tehnica McKeown

Answer 9

• margini chir de sig mai largi( rez proximala mai ext)

- anastomoza cervicala pt care consecintele unui fistule anostomotice mai putin severe decat ale uneia intra-toracice

Question 10

Mc Keown se foloseste pt cancer esofagian?

Answer 10

Proximal si Mediotoracic

Question 11

Incizia toraco-abdominala stanga se foloseste pt??

Answer 11

Cancer distal extins in stomac cu boala avansata local

Question 12

Cel mai comun abord al Toracotomiei

Answer 12

Abord Ivor-Lewis

Question 13

cele 3 aborduri chir Toracotomie

Answer 13

1. Ivor Lewis
   
   2. McKeown
   3. Incizia toraco-abdominala stg

Question 14

Se recomanda pt cancer esofagian distal :

Answer 14

abord transhiatal

abord toraco-abd stg

Question 15

Tehnica de esofagectomie : anastomoza intratoracica

Answer 15

abord Lewis

Question 16

Risc de perforatie esofagiana

Answer 16

Dilatatia endoscopica
Stenturi metalice expandabile
Ablatia cu laser

Question 17

Factori limitanti RT-CHM in tumori esofagiene

Answer 17

1. rasp terapeutic la cateva saptamani( vs interv endoscopice-imediat)
2. EA sistemice CHM

Question 18

Risc imediat in perforatia cervicala

Answer 18

Sepsis

Question 19

Sdr Boerhaave

Answer 19

perforatia spontana a esofagului distal prin varsaturi violente

🆘 TC Dramatic si prognostic mai PROST prin contaminare ridicata cu cont esofago-gastric

Question 20

TX perforatia cervicala

Answer 20

ATB IV + debridare + drenaj
incizie cervicala pe partea leziunii
gastrostoma de alimentatie 
sutura primara nu e obligatorie 
\+ Lez traheale- lambou musc pediculat pt a preveni fistule eso-traheale

Question 21

Sdr Mallory Weiss

Answer 21

perforatia mucoasei G-E prin varsaturi violente

NU transmurale, HDS

Question 22

Excludere chirurgicala in perforatia de esofag toracic

Answer 22

Indicatii- lez eso semnif la TARATI care nu pot tolera int chir
- IZOLARE segm lezat prin SUTURI/CAPSE prox + distal, esofagostomie cervicala, jejunostomie de alimentatie. drenaj+ debridare
Dupa recuperare: RECANALIZARE spontana/ RECONSTR cu substitut esofagian

Question 23

Standard de aur hernii hiatale

Answer 23

Tranzit digestiv sup cu subst ct

Question 24

Tratamentul actual achalazie

Answer 24

dilatare SEI cu balon endoscopic

miotomie chirurgicala

Question 25

Tx initial in achalazie

Answer 25

Medical: nitriti oral/sbg + blocante ale canalelelor de Ca- relaxeaza SEI inainte de mese, dar NU ofera ameliorare de durata

Question 26

Semnul de cioc de pasare este vizibil pe :

Answer 26

TRANZIT BARITAT cand subst contrast intalneste o obstructie cronica la niv SEI

Question 27

Cea mai eficienta intv nechirurgicala in Achalazie

Answer 27

Dilatare endoscopica pneumatica cu balon

Question 28

ce e POEM?

Answer 28

Miotomie endoscopica per orala- se creeaza un tunel submucos esofagian endoscopic + miotomie a SEI ⛔️ Reflux ( nu asociaza fundoplicatura)

Question 29

Anomalia primara in Achalazie

Answer 29

Boala degenerativa a plexului MIENTERIC( Auerbach) din MUSCULARA

Question 30

Inv paraclinice in achalazie

Answer 30

TB- diagnostic Manometrie Endoscopie- pt excludere alte cauze obst distala( cancer esofagian)

Question 31

Ce e miotomia Heller?

Answer 31

sectionarea SEI pana la MUCOASA( conservata) + fundoplicatura conc

Question 32

Ce se CI in ingestia de corpi straini?

Answer 32

Tranzit baritat - ⤴️ risc aspiratie si subst cu ct nu ajuta

Question 33

Prim test pt a evalua cauza disfagiei in cancer esofagian

Answer 33

Tranzit baritat- defect de umplere neregulat= confirma stenoza

Question 34

pt confimare histologica in cancer esofagian :

Answer 34

EDS

Question 35

Meta la distanta in cancer esofagian

Answer 35

PET-CT

Question 36

Situsuri frecv de meta in cancer esofagian

Answer 36

ggl periesofagieni | ficat , plaman