1. department of surgery with anesthesiology
ESOPHAGEAL DISORDERS
A. VAYDA
department of surgery with anesthesiology

3. Esophageal diverticula
The esophageal diverticula are the sacciform outpouchings of the esophageal wall, which filled with mucus and undigested food.

4. Etiology and pathogenesis
Pulsion diverticula - increase of intraesophageal pressure proximal to muscle sphincters.
Traction diverticula - paraesophageal inflammatory and sclerotic processes.

5. Classification 1.According to the origin: a)congenital; b)acquired.
2. According to the histological structure:
a)true (have all layers of esophageal wall);
b)false (absent muscular layer of esophageal wall).
3. According to the localization:
a)pharyngoesophageal (Zenker's);
b)bifurcational;
c)epiphrenic.
4. According to the clinical course:
a)complicated;
b)uncomplicated.

6. Signs and clinical course
salivation,
cervical dysphagia,
difficult swallowing and cough.
Complications
diverticulitis.
perforation of diverticulum
bleeding
malignancy

7. The diagnostic program
1. Anamnesis and objective examination.
2. General blood and urine analyses.
3. Coagulogram.
4. Chest X-radiography.
5. Contrast roentgenoscopy of esophagus and gastrointestinal tract.
6. Fibrogastroduodenoscopy.

8. X-ray examination Zenker’s Diverticulum Midesophageal Diverticulum
Epiphrenic Diverticulum

10. Fibrogastroduodenoscopy examination

12. Differential diagnostics
Stenocardia.
Achalasia

13. Tactics and choice of treatment

18. Achalasia of the cardia
Achalasia of the cardia is the disease, which is characterized by failure of the lower esophageal sphincter to relax with swallowing.

19. Etiology The cause of this disease is still unknown.
Among the underlying mechanisms are:
psycho-emotional trauma,
disturbance of parasympathetic and sympathetic innervation
influence of vegetotrophic substances on muscular fibers.

20. Symptomatology and clinical course
Dysphagia.
Esophageal vomiting (regurgitation).
Splashing sounds and gurgling behind breastbone.
The sign of nocturnal cough.
Pain.
Loss of weight.

21. Classification 1)functional spasm without esophageal dilation;
2)constant spasm with a moderate esophageal dilation and maintained peristalsis;
3)cicatricial changes of the wall with expressed esophageal dilation, the peristalsis is absent;
4)considerable esophageal dilation with S-shaped elongation and the presence of erosive changes of esophageal mucosa.

23. The diagnostic program
1.Anamnesis and physical findings.
2.General blood and urine analyses.
3.Chest X-radiography.
4.Esophagogastroscopy.
5.Contrast roentgenoscopy (barium swallow).

25. Differential diagnostics
Cancer of the lower part of esophagus and cardial part of stomach.

26. Tactics and choice of treatment
Diet.
The conservative treatment.
Cardiodilatation.

27. Tactics and choice of treatment
Cardiodilatation.

28. Heller's method (esophagomyotomy).
Surgical treatment.
Heller's method (esophagomyotomy).

29. Esophageal stricture
The cicatrical esophageal stenosis can arise owing to chemical, thermal and radial burns, and as a result of esophagitis or peptic ulcers. The most frequent cause of cicatrical strictures is considered to be chemical burns of esophagus, which are usually the result of accidentally or purposely (suicide) drink of acids or alkalis.

30. CLASSIFICATION According to clinical course:
I. The period of acute manifestation.
ІІ. The latent period (false improvement).
ІІІ. The period of cicatrization.

33. Tactics of treatment of esophageal burn
neutralizing solutions
the treatment of shock and hypovolemia
antibacterial therapy is nominated for prevention of infection complications.
parenteral feeding
prophylaxis of cicatrical stenosis of esophagus
elastic thermoslabile bougies.
esophagoplasty by stomach, small and large intestine.

34. Treatment of esophageal stricture
elastic thermoslabile bougies.

35. Treatment of esophageal stricture
Dilatation of the stricture.

36. Treatment of esophageal stricture
esophagoplasty by stomach, small and large intestine.

37. Diaphragmatic hernia
Diaphragmatic hernia represents herniation of abdominal organs through natural openings of diaphragm, its weak places or ruptures.

38. Etiology and pathogenesis
diaphragmatic anomaly
age-dependent involution of the diaphragm
visceral ptosis
increase of intraperitoneal pressure
obesity
overfeeding
constipation
pregnancy.
The cause of sliding hernias can be draw of esophagus upward in reflux esophagitis owing to intensive contraction of its longitudinal musculature.

39. Classification

40. Clinical manifestation
pain behind breastbone.
heartburn.
belching.
Regurgitation, the sign of "lacing shoes".
nausea and vomiting.
dysphagia.
roentgenological signs: 1) the sign of "bell"; 2) blunt His angle; 3) lack of air bubble of the stomach.

42. Differential diagnostics
Stenocardia.
Peptic ulcer.
Lung atelectasis, pleurisy, pneumonia.

43. Tactics and choice of treatment
Conservative therapy:
1)the diet the same, as in peptic ulcer;
2) elevated upside position of the patient;
3)suppression of gastric secretion by administering of Н2-blockers;
4)neutralization of gastric acid;
5)intensifying of evacuation of the food from stomach;
6)avoid of constipation;
7) sedative agents.

44. Surgical treatment. Stages of the operation:
1.Drawing of the stomach into abdominal cavity.
2.The plastics of esophageal hiatus of the diaphragm (cruroplasty).
3. Nissen fundoplication.
4.Gastropexia – fixation of gastric wall to parietal peritoneum.