diverticuli esofagieni si achalazia
TRANSCRIPT
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DIVERTICULII ESOFAGIENI
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Diverticolul esofagianDiverticolul esofagian - dilatatie - dilatatie excentrica si circumscrisa a excentrica si circumscrisa a lumenului esofagian. Are o cavitate lumenului esofagian. Are o cavitate proprie care comunica cu lumenul proprie care comunica cu lumenul esofagian printr-un orificiu de esofagian printr-un orificiu de dimensiuni variabile.dimensiuni variabile.
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Clasificare Dupa modul de producere:Dupa modul de producere: de pulsiune de pulsiune – protruzia mucoasei si – protruzia mucoasei si
submucoasei printr-o fereastra musculara, submucoasei printr-o fereastra musculara, datorita presiunii intraluminaledatorita presiunii intraluminale
de tractiunede tractiune – prin tractiunea peretelui – prin tractiunea peretelui esofagian spre mediastin (aderenta esofagian spre mediastin (aderenta periesofagiene) periesofagiene)
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Clasificare
Dupa localizare: faringoesofagieni sau cervicali (Zenker) toracici
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I. Diverticuli
faringoesofagieni (ZENKER)
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Tablou clinic
A.Semne si simptomeA.Semne si simptome- disfagie- disfagie- regurgitatii de alimente nedigerate - regurgitatii de alimente nedigerate - masajul regiunii cervicale pt. golirea - masajul regiunii cervicale pt. golirea diverticululuidiverticulului- sunete de clapotaj la nivelul gatului- sunete de clapotaj la nivelul gatului- halena, gust metalic- halena, gust metalic
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Tablou clinic
B. Investigatii paracliniceB. Investigatii paraclinice
- tranzit baritat- tranzit baritat
- endoscopie- endoscopie
- studii de manometrie si pH-metrie- studii de manometrie si pH-metrie
- tomografie computerizata- tomografie computerizata
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Tranzit baritat
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Endoscopie
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Tomografie computerizata
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Manometrie
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Esential in diagnostic
Disfagie, simptome de compresiune si Disfagie, simptome de compresiune si sunete de clapotaj la nivelul gatului;sunete de clapotaj la nivelul gatului;
Regurgitare de alimente nedigerate, Regurgitare de alimente nedigerate, halena;halena;
Golirea manuala a diverticulului de Golirea manuala a diverticulului de catre pacient.catre pacient.
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Diagnostic diferential
Leziuni maligneLeziuni maligne Achalazia musculaturii cricofaringieneAchalazia musculaturii cricofaringiene Malformatii ale esofagului cervicalMalformatii ale esofagului cervical
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Complicatii
Aspiratia – iritatii traheobronsice si Aspiratia – iritatii traheobronsice si pneumoniipneumonii
Perforatia – mediastinita, abces Perforatia – mediastinita, abces periesofagian periesofagian
HemoragiaHemoragia
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Tratament
Tratamentul de electie este cel Tratamentul de electie este cel chirurgicalchirurgical::
miotomie cricofaringeanamiotomie cricofaringeana
diverticulectomiediverticulectomie
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Rezultate
Complicatii postoperatorii:Complicatii postoperatorii:
- sunt rare - sunt rare leziune de nerv recurent leziune de nerv recurent
fistula esofago-cutanatafistula esofago-cutanata Inceperea alimentarii la o zi postoperatorInceperea alimentarii la o zi postoperator
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II.
Diverticulul toracic
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Clasificare
traheo-bronsici (epibronsici) traheo-bronsici (epibronsici) - situati - situati in treimea medie a esofaguluiin treimea medie a esofagului
supradiafragmatici (epifrenici)supradiafragmatici (epifrenici)
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Tablou clinic
A. SimptomatologieA. Simptomatologie
-disfagie-disfagie
-regurgitatii-regurgitatii
-aspiratia-aspiratia
-simptome pulmonare-simptome pulmonare
B. InvestigatiiB. Investigatii
-radiologice-radiologice
-manometrice-manometrice
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Diverticul epifrenic
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Diverticul epibronsic
Diverticul epifrenic
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Esential in diagnostic
Disfagia si senzatia de compresiune la Disfagia si senzatia de compresiune la nivelul esofagului inferior dupa nivelul esofagului inferior dupa alimentarealimentare
Regurgitatii, dureri retrosternaleRegurgitatii, dureri retrosternale Investigatiile imagisticeInvestigatiile imagistice Motilitate modificata a esofagului Motilitate modificata a esofagului
inferiorinferior Ocazional asocierea herniei hiataleOcazional asocierea herniei hiatale
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Diagnostic diferential
AchalaziaAchalazia Hernia hiatalaHernia hiatala Stenoze benigne sau maligneStenoze benigne sau maligne
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Complicatii
EsofagitaEsofagita
PeriesofagitaPeriesofagita
HemoragiaHemoragia
Perforatia - rarPerforatia - rar
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Tratament chirurgical
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Prognostic
Tratamentul chirurgical are succes in 80 – Tratamentul chirurgical are succes in 80 – 90 % din cazuri.90 % din cazuri.
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Diverticulul de tractiune
Apare consecutiv Apare consecutiv unei afectiuni unei afectiuni inflamatorii inflamatorii specificespecifice
Simptomatologie Simptomatologie ocazionalaocazionala
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A C H A L A Z I A
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Consideratii generale
Dilatare esofagiana consecutiv unei Dilatare esofagiana consecutiv unei tulburari neuromusculare, fara stenoza tulburari neuromusculare, fara stenoza organica.organica.
““Cardiospasm” Cardiospasm” Sir Cooper Perry, Thomas WillisSir Cooper Perry, Thomas Willis
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Tablou clinic
DisfagiaDisfagia Retentia alimentelor ingerateRetentia alimentelor ingerate Dureri retrosternaleDureri retrosternale RegurgitatiiRegurgitatii AspiratiaAspiratia
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Investigatii paraclinice
RadiologiceRadiologice EndoscopiceEndoscopice ManometriceManometrice
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Manometrie
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Endoscopie
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Esential in diagnostic
DisfagiaDisfagia Rtentia alimentelor ingerateRtentia alimentelor ingerate Radiologie - absenta miscarilor peristalticeRadiologie - absenta miscarilor peristaltice
- lumenul esofagian dilatat- lumenul esofagian dilatat
- jonctiune cardioesofagiana de - jonctiune cardioesofagiana de forma conica forma conica
Manometrie – absenta peristaltismuluiManometrie – absenta peristaltismului
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Diagnostic diferential
Sticturi benigne Sticturi benigne Carcinom al jonctiunii cardioesofagieneCarcinom al jonctiunii cardioesofagiene Diverticulul epifrenicDiverticulul epifrenic
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Complicatii
Ulceratii ale mucoaseiUlceratii ale mucoasei HemoragiaHemoragia AspiratiaAspiratia - pneumonii, - pneumonii,
- traheobronsite - traheobronsite Malnutritie usoara pana la moderataMalnutritie usoara pana la moderata Degenerare maligne – 3-5%Degenerare maligne – 3-5%
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Tratament
ChirurgicalChirurgical miotomia miotomia
laparatomia sau laparatomia sau toracotomia deschisa toracotomia deschisa
laparoscopialaparoscopia DilatatiiDilatatii Medical – blocanti ai canalelor de CaMedical – blocanti ai canalelor de Ca
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Metoda laparoscopica
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Prognostic
In 85-90% din cazuri In 85-90% din cazuri rezultatele sunt bune.rezultatele sunt bune.