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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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