Diverticul Zenker

diverticul de pulsiune cervical;

Clinic:
disfagie, regurgitaii cu alimente
nedigerate, halen fetid;
Explorri:
tranzit baritat, endoscopie (risc de
perforaie!), manometrie;
Complicaii:
diverticulit, perforaie, hemoragie, infecii
respiratorii recurente (aspiraie),
malignizare;
Tratament:
diverticulectomie (stapler) + miotomie
crico-faringian.
Diverticul esofagian epifrenic
diverticul de pulsiune;
Clinic:
disfagie pentru solide, durere toracic,
regurgitaii;
Explorri:
tranzit baritat, endoscopie, manometrie;
Complicaii:
diverticulit, perforaie, hemoragie, infecii
respiratorii recurente (aspiraie),
malignizare;
Tratament:
diverticulectomie (stapler) + miotomie
esofagian.

Achalazia cardiei
tulburare motorie primar a sfincterului
esofagian inferior;
Clinic:
disfagie paradoxal, regurgitaii;
Explorri:
manometrie esofagian, tranzit baritat,
endoscopie;
Complicaii:
infecii respiratorii recurente (aspiraie),
esofagite acute, malignizare;
Tratament:
operaia Heller (cardio-miotomie)
laparoscopic hemifundoplicatur.
Neoplasm esofagian
a 8-a neoplazie ca frecven i a 6-a cauz
de deces; prognostic nefavorabil;
Clinic:
disfagie progresiv, scdere ponderal;
Explorri:
endoscopie,
eco-endoscopie,
tranzit
baritat, CT, PET, bronhoscopie;
Complicaii:
invazia organelor, stenoz complet,
caexie;
Tratament:
radical RDT + CHT + esofagectomie +
esofagoplastie;
paleativ endoprotezare;

Stenoz esofagian postcaustic

ultima faz evolutiv a esofagitei acute
postcaustice;
Clinic:
disfagie progresiv, antecedente de
ingestie de caustic;
Explorri:
tranzit baritat, endoscopie;
Complicaii:
infecii respiratorii recurente (aspiraie),
malignizare, caexie;
Tratament:
esofagoplastie dup eecul dilataiei
pneumatice.

Neoplasm gastric antral

neoplazie cu pronostic rezervat, mai
frecvent la brbatul vrstnic;
Clinic:
inapeten, vrsturi, dureri epigastrice,
scdere ponderal;
Explorri:
tranzit
baritat,
endoscopie,
ecoendoscopie, CT;
Complicaii:
stenoz, hemoragie digestiv, perforaie;
Tratament:
gastrectomie subtotal R0 +
limfadenectomie D2 + tratament adjuvant
(CHT).

Tumor gastric stromal

tumori gastrice cu origine din celulele
Cajal;
Clinic:
melen, hemoragii oculte;
Explorri:
tranzit
baritat,
endoscopie,
ecoendoscopie, CT, imunohistochimie
CD117 (c-kit);
Complicaii:
hemoragie, perforaie;
Tratament:
rezecie chirurgical R0 + tratament cu
inhibitori de tirozinkinaz (Glivec).
Neoplasm gastric corporeal cu invazie
hepatic
cancer localizat pe corpul gastric T4;
Clinic:
dureri epigastrice, melen, scdere
ponderal;
Explorri:
tranzit
baritat,
endoscopie,
ecoendoscopie, CT;
Complicaii:
hemoragie digestiv superioar, perforaie;
Tratament:
gastrectomie total R0+ ablaie mare
epiploon + limfadenectomie D2 + rezecie
hepatic atipic + CHT.

Ulcer duodenal perforat

complicaie acut a ulcerului peptic;
Clinic:
durere abdominal lancinant, contractur
abdominal, antecedente ulceroase (triada
Mondor);
Explorri:
Pneumoperitoneu (radiografie simpl);
Complicaii:
peritonit generalizat, sepsis;
Tratament:
sutura perforaiei (clasic sau laparoscopic)
+ tratament medical (anti-H. pylori) sau
ulcero-piloroplastie + vagotomie
troncular.
Metastaz intestinal de melanom
malign cutanat
cauz rar de ocluzie intestinal;
Clinic:
sindrom ocluziv (durere, vrsturi, oprirea
tranzitului intestinal, meteorism);
Explorri:
radiografie abdominal simpl (nivele
hidro-aerice), CT, RMN;
Complicaii:
ocluzie
prin
invaginaie,
perforaie
digestiv;
Tratament:
enterectomie segmentar +
limfadenectomie

Tuberculoz digestiv
form rar de tuberculoz cu localizare
intestinal sau/i peritoneal;
Clinic:
iniial hemoragie digestiv superioar i
apoi sindrom peritonitic;
Explorri:
radiografia abdominal simpl
pneumoperitoneu; ecografie, CT, RMN;
Complicaii:
peritonit generalizat, sepsis;
Tratament:
sutura perforaiilor, enterectomie +
anastomoz ileo-transvers +
tuberculostatice.
Diverticulit sigmoidian cu fistul
sigmoido-vezical
complicaie a diverticulozei colice;
Clinic:
dureri abdominale n fosa iliac stng,
febr, fecalurie;
Explorri:
colonoscopie, clism baritat, cistoscopie;
Complicaii:
perforaie cu peritonit localizat sau
generalizat, sepsis;
Tratament:
colectomie segmentar + sutura breei
vezicale + antibioterapie.

Diverticuloz colic
diverticuli fali, de pulsiune, cu localizare
sigmoidian (95%);
Clinic:
dureri abdominale n fosa iliac stng,
tulburri de tranzit intestinal;
Explorri:
colonoscopie, clism baritat;
Complicaii:
perforaie cu peritonit localizat sau
generalizat, sepsis, hemoragie digestiv
inferioar, fistule;
Tratament:
colectomie segmentar laparoscopic.

Apendicit acut
cea mai frecvent cauz de abdomen acut
chirurgical;
Clinic:
febr, durere, aprare muscular n fosa
iliac dreapt (triada Dieulafoy);
Explorri:
leucocitoz, ecografie;
Complicaii:
perforaie cu peritonit generalizat sau
localizat, abces, pileflebit;
Tratament:
apendicectomie clasic sau laparoscopic
+ antibioterapie.

Neoplasm de colon drept cu metastaz

hepatic sincron
neoplasmul colic 1.000.000 de cazuri noi
i peste 500.000 decese anual;
Clinic:
dureri n hemiabdomenul drept, tulburri
de tranzit, hemoragii oculte;
Explorri:
ecografie, colonoscopie, clism baritat,
CT, ecografie peroperatorie;
Complicaii:
hemoragie, ocluzie, perforaie;
Tratament:
hemicolectomie dreapt + rezecie
hepatic atipic.

Neoplasm de rect
cancer cu inciden crescut, tuabil, cu
metastazare frecvent hepatic;
Clinic:
rectoragii, tenesme rectale, tulburri de
tranzit, formaiune deseori accesibil
tueului rectal;
Explorri:
recto-colonoscopie, ecografie endorectal,
CT, RMN;
Complicaii:
ocluzie, hemoragie, abces perirectal;
Tratament:
rezecie total de rect abdomino-perineal
(amputaie) + trat. adjuvant.

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