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Rezi > ESOFAG > Flashcards

ESOFAG Flashcards

1
Q

Avantaje stomac- grefon

A
  • vascularizatie bogata
    • mob chir facila prin pedicul vascularizat
    • necesar ⬇️ anastomose gastro-intestinale
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2
Q

Dezav stomac ca grefon

A
  • ischemie fornix

- simpt BRGE postop- anastomoza intratoracica > cervicala

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3
Q

Tehnica grefon gastric

A

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

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4
Q

Avantaje colon stg ca grefon

A
  • ascensionare facila pana la esofagul cervical

- rezistent la reflux acid

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5
Q

Dezavantaje colon stg ca grefon

A
  • 2 anastomoze suplimentare

- experienta tehnica ⬆️

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6
Q

Moduri de interpunere a grefonui colonic stg

A
  1. PREFERATA: prin spatiul esofagului rezecat in mediastin POST.
    Daca esofagul NU poate fi rezecat in siguranta, sunt ADERENTE, EXTINDERE af
    1. Calea RETROSTERNALA- NU e optima, are traiect sinuos si ⤴️ OBSTRUCTIE - apertura toracica SUP
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7
Q

Grefon jejunal

A
  • 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
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8
Q

Tehnica cu triplu abord

A

McKeown- toracotomie dr, laparatomie + cervicala

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9
Q

Avantaje tehnica McKeown

A
  • 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

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10
Q

Mc Keown se foloseste pt cancer esofagian?

A

Proximal si Mediotoracic

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11
Q

Incizia toraco-abdominala stanga se foloseste pt??

A

Cancer distal extins in stomac cu boala avansata local

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12
Q

Cel mai comun abord al Toracotomiei

A

Abord Ivor-Lewis

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13
Q

cele 3 aborduri chir Toracotomie

A
  1. Ivor Lewis
    1. McKeown
    2. Incizia toraco-abdominala stg
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14
Q

Se recomanda pt cancer esofagian distal :

A

abord transhiatal

abord toraco-abd stg

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15
Q

Tehnica de esofagectomie : anastomoza intratoracica

A

abord Lewis

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16
Q

Risc de perforatie esofagiana

A

Dilatatia endoscopica
Stenturi metalice expandabile
Ablatia cu laser

17
Q

Factori limitanti RT-CHM in tumori esofagiene

A
  1. rasp terapeutic la cateva saptamani( vs interv endoscopice-imediat)
  2. EA sistemice CHM
18
Q

Risc imediat in perforatia cervicala

A

Sepsis

19
Q

Sdr Boerhaave

A

perforatia spontana a esofagului distal prin varsaturi violente

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

20
Q

TX perforatia cervicala

A 
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
21
Q

Sdr Mallory Weiss

A

perforatia mucoasei G-E prin varsaturi violente

NU transmurale, HDS

22
Q

Excludere chirurgicala in perforatia de esofag toracic

A

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

23
Q

Standard de aur hernii hiatale

A

Tranzit digestiv sup cu subst ct

24
Q

Tratamentul actual achalazie

A

dilatare SEI cu balon endoscopic

miotomie chirurgicala

25
Q

Tx initial in achalazie

A

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

26
Q

Semnul de cioc de pasare este vizibil pe :

A

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

27
Q

Cea mai eficienta intv nechirurgicala in Achalazie

A

Dilatare endoscopica pneumatica cu balon

28
Q

ce e POEM?

A

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

29
Q

Anomalia primara in Achalazie

A

Boala degenerativa a plexului MIENTERIC( Auerbach) din MUSCULARA

30
Q

Inv paraclinice in achalazie

A

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

31
Q

Ce e miotomia Heller?

A

sectionarea SEI pana la MUCOASA( conservata) + fundoplicatura conc

32
Q

Ce se CI in ingestia de corpi straini?

A

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

33
Q

Prim test pt a evalua cauza disfagiei in cancer esofagian

A

Tranzit baritat- defect de umplere neregulat= confirma stenoza

34
Q

pt confimare histologica in cancer esofagian :

A

EDS

35
Q

Meta la distanta in cancer esofagian

A

PET-CT

36
Q

Situsuri frecv de meta in cancer esofagian

A

ggl periesofagieni

ficat , plaman

Rezi (11 decks)

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