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Esofag Flashcards

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1
Q

Dimensiuni esofag si segmente:

A

Lungime 25 cm, largime 1-1.5 cm
Vertebre C6 -T10-11
Portiuni: - cervicala: 6-8 cm
- toracica: 16-18 cm
- diafragmatica: 1-1,5cm
- abdominala: 2-3 cm

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2
Q

Esofag Cervical: limite, localizare, traiect

A

Limite: C6-T2
Limita sup: m. cricofaringian=m. constrictor inferior al
farigelui = sf. esofagian superior.
Localizare: posterior de trahee si anterior de fascia prevertebrala.
Lat:pachete vasculonervoase gât, n.laringeu rec.stg., lob tiroidian
stg, canal toracic
Traiect: usor oblic spre stg

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3
Q

Esofagul Toracic: localizare, traiect

A

Localizare: mediastinul posterior
- ant: trahee
- post: vertebre
- stg: posterior de arcul aortic si bronhia stg
- dreapta: vena azygos,trunchi brahiocefalic, n.vag drept
- ulterior: trece anterior de aorta si posterior de pericard (sp.Truesdale)
- lateral: raporturi cu pleura, plexuri vagale -vag dr,stg

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4
Q

Esofag toracic (Segment epifrenic)

A
  • Segment epifrenic: ultimii 6 cm între strâmtorile funcționale
    Von Hacker(sup) și Mouton(inf) - Ampula epifrenică
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5
Q

Spatiul Truesdale

A

Delimitat anterior de pericard, posterior de aorta
Portiunea toracala a esofagului

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6
Q

Esofagul diafragmatic:

A

Localizare: T11
Invelit de: Membrana Leimer-Bertelli

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7
Q

Esofagul Abdominal: limite, particularitate

A

Limite: de la hiatus la cardia
Particularitate: acoperit ant. de
peritoneu

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8
Q

Esofag stramtori naturale:

A
  • cricofaringiana
  • bronhoaortica
  • diafragmatica
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9
Q

Vascularizatie esofag:

A

Particularitate: slaba,intre cele 2 st. musculare
• Artere:
- cervical: a. tiroidiana inf, a. subclavie, carotidă com.
- toracic: 4-6 aa. esofagiene lungi (din aorta), aa.intercostale, aa. esofagiene scurte,aa.bronsice
- abdominal: a. gastrica stg ,a.frenica inf. stg.

• Vene:plexuri:
- 2/3 sup: submucos periesof. → sist. azigos
- 1/3 inf. -> sist port

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10
Q

Limfatice esofag:

A

plex submucos, plex muscular →gg.cervicali,traheo-bronsici, mediastinali dorsali, celiaci.

Esofag deasupra bifurație
trahee: duct toracic
Esofag sub bifurcație trahee: cisterna chyli

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11
Q

Inervatie esofag:

A

Inerv. Extrinsecă:
Vegetatvă: vag(parasimpatic), nn splahnici (simpatic)
Somatică: nn laringei recurenți
- reg.cervicala:laringeu sup.(vag),laringeu recurent(vag.)
- reg. toracica:vag(inerv. motorie),n.toracic sup.(simpatic)
- reg.abdominala: ultimii 5 cm plex vagal esofagian din care se
individualizeaza: vag dr.(post), vag stg.(ant.)

Inerv. Intrinsecă:
plex vegetativ periesofagian cu fibre spre:
- Meisner(submucos): peristaltică muscularis mucosae+activitate secretorie
- Auerbach(mienteric): persistaltica tunică musculară

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12
Q

SES: lungime, presiuni, timp relaxare

A
  • lungime: 3cm
  • p de repaus: 20-60 mmHg
  • durata relaxare la deglutitie: 0,5-1 sec.
  • p contractie: 100 mmHg, 2-4 sec postdeglutitie
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13
Q

SEI: lungime, presiuni

A
  • 3-5cm
  • situat in abdomen=zona de presiune pozitiva
  • rol antireflux
  • p repaus: 10-20mmHg
  • se relaxeaza aprox 5 sec
    apoi se contracta (p=35mmHg) 10 sec si revine la p
    de repaus.
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14
Q

Scorul DeMeester

A

In urma ph-metriei esofagiene 24 de ore

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15
Q

Testul de evacuare a acidului din esofag:

A

Cate înghițituri sunt necesare pentru a aduce pH din esofagul distal la >5(după instilare HCL)
Asoc. cu pH metrie.
Normal15 înghițituri

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16
Q

Control neuroendocrin esofag deglutitie

A

Nervi: facial, glosofaringian, accesor, hipoglos
Hormoni:
Scad pres ses: cck, vip, gip, glucagon, progesteron, estrogeni, prostaglandine
Cresc pres ses: gastrina, pentagastrina, polipeptid pancreatic

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17
Q

Cauze globus histericus (sei)

A

neurologice, miastenia gravis, brge, esofagita, corpi straini, cancer incipient, parkinson, polimiozita
Frecvent pur psihice

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18
Q

Cauze disfunctie de motilitate corp esofagian: in general

A

Diabet, alcoolism (neuropatii)
Sclerodermie, dermatomiozita (colagen)
Scleroza laterala amiotrofica (neuro)
Miastenia gravis

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19
Q

Forme de disfunctii motilitate corp esofaguan

A

Spasm, atonia esof, achalazia, hipertonia sei, disfagia postvagotomie, hipertrofia sei, tulb nespecif de motil

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20
Q

Etiologie achalazie

Study These Flashcards
A

NECLARA:
declansator: stress emotional sau fizic
Boala Chagas, disfunctie neuroni inhibitori nonadrenergici, noncolinergici, carenta vit B1

21
Q

Cilinica achalazie

Study These Flashcards
A

Triada: disfagie, regurgitatie, scadere ponderala
+ tuse, sughit, palpitatii dspnee

22
Q

Diagnostic diferential achalazie-sclerodermie

Study These Flashcards
A

Testul cu betanecol: in achalazie apare peristaltica

23
Q

Chrurgical achalazie

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A

Esocardiomiotomia extramucoasa(heller) + refacere unghi hiss + piloroplastie

24
Q

Tratament endoscopic achalazie

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A

POEM: miotomia endoscopica perorala

25
Dosfagia lusoria
Paraclinic: arteriografie selectiva Rx + endo nu dau informatii Tratament: rezectie+ reimplantare
26
Fiziopatologie Boerhave
In timpul varsaturii diametrul sei creste de 5 ori, iar daca presiunea depaseste 150 mm hg si sei rodicat in torace => ruptura Cu mediastinita si hidropneumotorax (daca perf pleura)
27
Semn patognomonic boerhave
Emfizem subcutanat (crepitatii) *semn hamman: zg hidroaerice ritmate de bataile inimii
28
Etape Johnson: evolutie arsuri chimice esofagiene
1. Acuta: 1-4 zile, necroza, inflamatie, tromboza vase mici 2. Ulceratie: ziua 5-6 eliminare necroze, perete subtire, rosc maxim perf 3. Granulare: din z 10 4. Cicatrizare: din z 10, stenoze
29
Forme clinice arsuri esofagiene:
1. Esofagita edematoasa/eritematoasa 2.Esofagita cu ulceratii superficiale 3. Esofagita necrotica necomplicata 4.Esofagita necrotica complicata
30
Cauze de esofagite
Alimente fierbinti, reci, alcool, vapori, gaze, acizi, baze Sclerodermie, Anemie Biermer Sd. Plummer-Vinson Carente A, B6, B12, C infectioase
31
Patogeneza brge, multifactoriala
1. Afectarea mec antireflux 2. Golirea dificila esofag 3. Golire gastrica intarziata 4. Tipul refluxului 5. Scaderea cant de mucus/pg
32
Semnul siretului
Pirozis accentuat la aplecare inainte
33
Simptomele tipice pt brge
Pirozis/durere postprandial Regurgitatii acide
34
Testul perfuziei acide Bernstein
Perfuzie intraesof hcl 0.1 =>pirozis Sensib 80%
35
Clasificarea Los Angeles
A. Eroziuni<5mm B. Eroziuni>5 mm neconfluente C. Eroziuni confluente necircuferentiale D. Eroziuni circumferentiale
36
Clasificarea savary miller raportat la LA
Grad1: A+B Grad 2: C Grad 3: D Grad 4: complicatii
37
Complicatii brge
Stenoze, inel schatzki Barret Ulcer Perforatie Hds Malignizare Brosiectazii, pneumonii Fringolaringita de reflux
38
Tratament brge:
Alimentatie Pozittie Medic: antiacide, ipp, antih2, protectoare, prokinetice (meto, dom, cisaprida, eritro, azitro Chirurgical: Nissen, toupet, dor, belsey-mark
39
Clasificare Allison ulcer esofagian (stadii)
1. Inflamatie (premergator) 2. Exulceratii+ edem+ false mb 3. Ulceratii superf. circumf. 4. Ulceratii ce trec de mucoasa 5. Ulcer+ fibr. submuc.+ stenoza 6. Ulcer+ stenoza stransa+ dilatatie supraiacenta ! Primele 3 reversibile
40
Clinica clasica esofag barret
Asimptomatic Pirozis, disfagie
41
Diverticuli epibronsici
Div adevarati in urma unor procese infl mediastinale (tbc, histoplasmoza) asimptomatici, mici, triunghiulari, necesita trat chir doar in complicatii
42
Clasificare Ackerlund
Tip I: prin brahisofag Tip II: alunecare (axiale) Tip III: rostogolire (paraesof)
43
Diagnostic diferential hh de alunecare cu hh prin brahiesofag:
Rx cu bariu in strt subtire: evid pliurilor gastrice in torace
44
Triada Brochard- Lenormant
In volvulus gastric: Durere epigastrica+ efort varsaturi inef + nu trece sng
45
Tumori benigne esofagiene in ordinea incidentei
Leiomiom Polipi Hemangiom Mioblastom(abrikosoff) Polip fibrovascular Papiloame Adenoame T.carcinoide
46
Cancer esofagian in ordinea incidentei:
Cancer scuamos Adenocarcinom Cancer cu celule mici Carcinom adenochistic Melanom malign Carcinosarcom
47
Clasificare TNM cancer esofagian:
T1: <5cm, fara obstr. T2: >5cm T3: extensie extraesof N1: unilateral, mobili N2: bilateral, mobili N3: regionali, ficsi M0 fara M1 cu
48
Stadializare cancer esofagian
Stadiu1: T1,N1-2,M0 Stadiu2: cervical: T2,N1-2, M0 Toracic: T2,N0,M0 Stadiu3: cervical: orice t3/n3 Toracic: n1 Stadiu4: M1
49
Factori genetici carcinom scuamos esofagian
Sd neppk- autozomal dom Tylosis palmaris

Chirurgie (16 decks)

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