1. ESOPHAGEAL DISORDERS A. VAYDA department of surgery with urology and 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

8. 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.

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

12. Fibrogastroduodenoscopy examination

13. Differential diagnostics Stenocardia.

14. Tactics and choice of treatment

16. 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.

17. 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.

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

19. 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.

20. 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).

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

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

24. Helerovsky's method. Surgical treatment. Heller's method (esophagomyotomy).

25. 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.

26. CLASSIFICATION According to clinical course: I. The period of acute manifestation. ІІ. The latent period (false improvement). ІІІ. The period of cicatrization. According to the depth of lesion: I degree – superficial burn with the damage of epithelial layer of esophagus; ІІ degree – the burn with the damage of entire mucosa of esophagus; ІІІ degree – the burn damage of all layers of esophagus; ІV degree – the spread of postburn necrosis on paraesophageal tissue and adjacent organs.

27. Tactics and choice of treatment  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.

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

29. 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.

30. Diaphragmatic hernia.  Sliding (axial) diaphragmatic hernia: Diaphragmatic hernia of paraesophageal type Classification

31.  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. Clinical manifestation

32. Differential diagnostics  Stenocardia.  Peptic ulcer.  Lung atelectasis, pleurisy, pneumonia.

33. 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 Н 2 -blockers; 4)neutralization of gastric acid; 5)intensifying of evacuation of the food from stomach; 6)avoid of constipation; 7) sedative agents.

34. 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.