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Flashcards in Esophageal Disorders Deck (29)
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1

Hiatal Hernia

Diaphragmatic hernia, esophageal hernia
Herniation of portion of stomach into esophagus through an opening in diaphragm
Most common abnormality found on upper GI x-ray

2

Sliding Hiatal Hernia

Stomach slides through opening with pt is supine, goes back into abdominal cavity when pt is standing upright
Most common type

3

Paraesophageal Hiatal Hernia

Esophogastric junction remains in place but fundus and greater curvature of stomach roll up through diaphragm
Acute parasophageal hernia is a medical emergency

4

Causes of hiatal hernia

Many factors
Structural changes, weaken diaphragm muscles
Increased intraabdominal pressure (obesity, pregnancy, heavy lifting)

5

Hiatal hernia clinical manifestations

May be asymptomatic
Heartburn
Dysphagia

6

Hiatal hernia complications

GERD
Esophagitis
Hemorrhage from erosion
Stenosis
Ulcerations of herniated portion
Strangulation of hernia
Regurgitation with tracheal aspiration
Increased risk of respriatory problems

7

Hiatal hernia lifestyle modifications

Eliminate alcohol
Elevate HOB
Stop smoking
Avoid lifting/straining
Reduce weight, if appropriate
Use antisecretory agents and antacids

8

Hiatal Hernia Surgical Therapy

Reduction of herniated stomach
Herniotomy (excision of hernia sac)
Herniorrhaphy (closure of hiatal defect)
Gastropexy (antireflux procedure)
*Laparoscopically: Nissen or Toupet techniques used
*Thoracic or open abdominal used depending on individual pt

9

Gastropexy

Attachment of the stomach supdiaphragmatically to prevent reherniation

10

Nissen Fundoplication

Fundus of stomach is wrapped around distal esophagus, fundus is then stuffed into itself

11

Esophageal Cancer

Malignant neoplasm of esophagus
Comes from structural changes
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12

Squamous Cell

Changes due to damage that leads to cancer

13

Adenocarcinomas

Arise from glands lining esophagus
Resemble cancers of stomach and small intestine

14

Risk factors for esophageal cancer

Smoking
Excessive alcohol intake
Barrett's metaplasia
Central obesity
History of achalasia

15

Barrett's metaplasia

Seen in long term bulimics and long term GERD

16

Etiology and Patho
Esophageal Cancer

Majority of tumors located in middle/lower portions of esophagus
Malignant tumors

17

Malignant tumors

Usually appear as ulcerated lesion
May penetrate muscular layer and outside wall of esophagus
Obstruction in later stages

18

Esophageal Cancer Clinical Manifestations

Symptom onset is late
Progressive dysphagia is most common (initially w/ meat then w/ soft foods and liquids)
Pain develops late (substernal, epigastric, or back area)
Weight loss
Regurgitation of blood-flecked esophageal contents

19

If the tumor is in the upper third of the esophagus...

Sore throat
Choking
Hoarseness

20

Esophageal Cancer Complications

Hemorrhage (if it erodes into aorta)
Esophageal perforation w/ fistula formation
Esophageal obstruction
Metastasis via lymph system (liver and lung metastases most common)

21

Esophageal Cancer Diagnostic Studies

Endoscopy w/ biopsy (necessary for definitive diagnosis)
Endoscopic ultrasonography (EUS) *Important tool to stage
Esophagogram (barium swallow)

22

Esophageal Cancer Collaborative Care

Treatment depends on location and spread
Poor prognosis (usually not diagnosed until advanced)
*Get best results with combination therapy

23

Surgical Procedures for Esophageal Cancer

Esophagectomy
-removal of part or all of esophagus
-Use Dacron graft to replace resected part
Esophagogastrostomy
-Resection of portion of esophagus and anastomosis of remaining portion to stomach

24

Concurrent radiation and chemotherapy (esophageal cancer)

Slows progression
Sometimes started before surgery
No standard single or combination drug therapy

25

Palliative Care (esophageal cancer)

Restoration of swallowing function (dilation, stent placement)
Maintenance of nutrition and hydration

26

Nutritional Therapy (esophageal cancer)

After surgery, parenteral fluids given
Jejunostomy feeding tube may be used
Swallowing study may be done before patient can have oral fluids

27

Preoperative Care (esophageal cancer, acute interventions)

Explain surgical procedure
High-calorie, high-protein diet
I/O record for patient/family
Teach patient/family how to assess for fluid and electrolyte disturbances
Oral care

28

What to teach the patient and caregiver about with preoperative care (esophageal cancer)

Chest tubes (if open thoracic approach used)
IV lines
NG Tubes
Pain management
Gastrostomy feeding (if appropriate)
Turning, coughing, deep breathing

29

Postoperative care (esophageal cancer, acute intervention)

NG tube w/ bloody drainage for 8-12 hrs
Changes gradually to greenish/yellow
NG tube should not be repositioned or reinserted w/o surgeon's approval!!!
Turning and deep breathing q 2 hrs
Incentive spirometer use
Position in semi-Fowler's or Fowler's (should be maintained at least 2 hrs after eating)
Monitor for complications