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Z - SURGERY

Esophagus

QuestionAnswer
Boerhaave Syndrome Spontaneous esophageal rupture
Is esophageal perforation a surgical emergency? Yes
Spontaneous esophageal performation comprises what percentage of all causes of esophageal perforation? 15%; most of the time, esophageal perforations are iatrogenic from a procedure
Acute onset of CP after vomitting typical of Boerhaave Syndrome
Sx's of Boerhaave Syndrome (5) 1. Acute onset of CP after vomiting, 2. shoulder pain, 3. dyspnea, 4. midepigastric pain; 5. pleural effusion (75%)
Signs of systemic infection (3) tachycardia, fever, leukocytosis
Most spontaneous esophageal ruptures occur in the distal third of esophagus about GR jxn. What side pleural effusion more common? L
In esophageal perforation - what is the timeline of CP? immediate and persistent; most common presenting sx
In esophageal perforation - what is the timing of subQ emphysema? 1h after perforation - may not be present wth lower esophageal perforation
In esophageal perforation - what is the timing of pleural effusion? Can be immediate or after 6h; happens in 75% of cases; mostly on L
In esophageal perforation - when would you see fever and leukocytosis? What would it be from? >4h from sepsis from mediastinitis
In esophageal perforation - what is the chance of death? If dx <24h, 15%; if dx > 24h, >40%
In esophageal perforation - what is the best initial diagnostic test? Water soluble contrast esophagogram - ID in 90% of cases
In esophageal perforation - What position should pt be in when getting esophagogram? R lateral decubitus
What is the most common presenting sx of esophageal rupture? CP
subcutaneous emphysema air is present in the subcutaneous layer of the skin; characteristic crackling feel to the touch, like Rice Krispies;[2] crepitus.
Initial tx of esophageal perforation (4) ABC's, IVF, abx, chest tube
Tx principles for spontaneous esophageal perforation (4) 1. surgical drainage, 2. debridement, 3. repair, 4. diversion
What kind of surgery is done for spontaneous esophageal perforation? chest thoracotomy (R posterolateral) --> exposure of tear, debridement, primary suture repair, reinforcement (with flap), drainage
What is the follow up for spontaneous esophageal perforation? restudy with esophagogram in 1 week for presence of leak
achalasia esophageal motility disorder: smooth muscle layer of esophagus loses normal peristalsis, & LES fails to relax properly in response to swallowing. Characterized by difficulty swallowing, regurgitation, and sometimes chest pain
pt w CP after vomiting, subQ emphysema on exam, and Lsided pleural effusion spontaneous esophageal perforation
Where do most spontaneous esophageal ruptures occur? Distal third of esophagus
Created by: christinapham