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PATOLOGIE

ESOFAGIAN

Prof. Dr. Brtucu E.

Curs 1

G.E.R.D

Hernia Hiatal

Achalazia cardiei

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Anatomia diafragmului

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G.E.R.D.

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Etiologia G.E.R.D.

CAUZE:

Incompetena mecanic a L.E.S.

Clearence esofagian insuficient

Modificarea presiunii intragastrice

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L.E.S. incompetent

Presiunea L.E.S. < 6mmHg (n = 10-26mmHg)

Lungimea L.E.S. < 2cm (n = 5-8cm)

Lungimea esof. abdominal < 1cm

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CLEARENCE-ul ESOFAGIAN insuficient

gravitaia

activitatea motorie a esofagului

salivaia

sistemul hiatal esofagian

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PRESIUNEA INTRAGASTRIC

Insuf. evacuatorie gastric

aerofagie

hipersecreie gastric

diskinezie duodenal

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SIMPTOMATOLOGIE - 1% n 1980

arsuri retrosternale

regurgitaii acide

balonari postprandiale tuse cronic - manif. bronho-pulmonare

durere toracic

odinofagie sialoree

sngerri oculte

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EXPLORARE

Are reflux?prnz baritat +/- scintigrafie

pH-metrie / 24h -> pH < 4; durata i frecvena

manometrie standard +\- 24h

Simptomele se datoreaz refluxului?testul Bernstein ?!

Rsunetul refluxului?endoscopia

biopsia

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ENDOSCOPIA

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Clasificarea Savary / Miller

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Esofagita de reflux - aspect endoscopic

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Esofagita de reflux - aspect endoscopic

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DIAGNOSTIC DIFERENIAL

esofagita micotic

esofagita herpetic

esofagita medicamentoas

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CHIRURGIE ANTIREFLUX

Simptome persistente, recurente saucomplicaii dup 8-12 spt. de blocani anti H2 esofagit std. III i IV

pH-metrie alterat manometrie alterat

hernie hiatal asociat

esofag Barrett - 10%

motilitate normal a esofagului

evaluare endoscopic -> persistena esofagitei

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PRINCIPII CHIRURGICALE

Restabilirea competenei L.E.S.

dublul presiunii gastrice = 6mmHglungime L.E.S. > 3cm

Esofag intraabdominal = 2cm

Nissen - Fundoplicatur

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Fudoplicatura

Nissen -aspect final

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HERNIA HIATAL

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Tipuri de hernie

hiatal

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Simptomatologia

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ACHALAZIA

1929 - Hurst

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CAUZE

Degenerare plexuri mienterice

inflamaie cronic

infecii virale neurotrope

boala Chagas - Tripanosoma

teren stress

uneori degenerescen vagal

hipersensibilitatea L.E.S. la gastrin

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SIMPTOME

arsuri

regurgitaii acide vrsturi esofagiene

dureri retrosternale disfagie paradoxal sau total

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DIAGNOSTIC

Rgr. toracic simpl -> lrgirea mediastinului

Prnz baritat:

tranzit esofagian ncetinit

unde antiperistaltice - brasaj

megaesofag asistolic

proba la nitroglicerina

Endoscopia

Manometria

absena peristalticii esofagului inferior

creterea presiunii L.E.S .> 50mmHg

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TRATAMENT

Conservator

nitrai

blocani de Cadilatri pneumatice - 300mmHg

ChirurgicalOp. Heller

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