METHODICAL INSTRUCTIONS FOR 5th YEAR STUDENTS

METHODICAL INSTRUCTIONS FOR 5th YEAR STUDENTS

METHODOLOGICAL INSTRUCTION FOR LESSON №3

“DISEASES OF THE ESOPHAGUS.”

 

The aim. To master clinics, diagnostics, and differential diagnostics of diseases of the esophagus: achalasia, burns, and diverticula. To learn the treatment tactics, indications and contraindications for conservative and operative treatment, operative intervention type, principles of the pre- and postoperative periods, expertise of the working ability after operations on the esophagus.

 

Professional orientation of students. Diseases of the esophagus come across comparatively rare (0,5-1,5%) but traumas of the esophagus, namely burns, are more common and their complications in 10-30% of the cases lead to essential disablement and high lethality.

 

Methodology of Practical Class 9.00-12.00.

 

Algorithm of communicative skills:

1. To greet and name itself.

2. Friendly behavour.

3. To explain to the patient a purpose of the visit, duration of conversation and to get his agreement.

4. Correct and quiet conversation with a patient.

5. To get the agreement of patient for the performance of the examination.To take complaints. Correct and quiet conversation with a patient. A patient is in vertical position persons to the doctor, neck and shoulders of patient is maximally weakened.

 

Student’s independent work program:

1.      Anatomic and physiologic data about the esophagus.

2.      Topography of the mediastinum.

3.      Semiotics of the esophagus diseases.

4.      Achalasia of the esophagus. Concept definition. Classification.

5.      Clinical characteristics of the achalasia depending on its stage.

6.      Differential diagnosis of the achalasia.

7.      Verification methods of achalasia diagnosis.

8.      Curing tactics and choice of treatment method of achalasia of the esophagus depending on the clinical stage.

9.      Cardiodilatation – indications, methodics, results, eventual complications.

10.  Indications and operative treatment methods of achalasia of the esophagus.

11.  Peculiarities of the preoperative preparation and the postoperative period course in patients with the achalasia.

12.   Diagnosis verification methods (esophagoscopy, roentgenography, biopsy).

13.  Curing tactics and principles of conservative and operative treatment of patients with esophageal diverticula.

14.  Disablement expertise after treatment of esophageal diverticula.

 

Break 12.00-12.30

 

Seminar discussion of theoretical issues 12.30-14.00.

1.  Anatomic and physiologic features of the esophagus.

2. Classification, semiotics of esophagus diseases.

3. Semiotics of esophagus diseases. 

4. Achalasia of the esophagus. Concept definition, classification.

5. Clinical characteristics, diagnostics and differential diagnostics of achalasia of the esophagus depending on the clinical stage and complications.

6. Curing methods choice esophagus diseases.

7. Choice of treatment methods of achalasia of the esophagus depending on the clinical stage and complications.

8. Methods of conservative and operative treatment of achalasia of the esophagus.

9. Cardiodilatation – indications, results, eventual complications.

10. Methods of operations at achalasia of the esophagus.

11. Esophageal burns. Classification.

12. Clinical characteristics of chemical burns of the esophagus depending on the substance origin (acids, alkaline).

13. First aid at chemical burns of the esophagus depending on the substance origin. 

14. Curing tactics at chemical burns of the esophagus depending on the stage of the wound process.

15. Esophageal diverticula. Concept definition, classification.

16. Clinical characteristics, diagnosis, differential diagnosis and diagnosis verification methods of esophageal diverticula.

17. Diverticula complications. 

18. Methods of conservative and operative treatment of esophageal diverticula.

 

 

Test evaluation and situational tasks 14.00-15.00.

Initial level of knowledge and skills are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions.

(the instructor has tests & situational tasks)

 

The tests for self-checking of knowledge, skills.

 

1. What sign is not typical for Zenker’s diverticula?

1. Salivation

2. Cervical dysphagia

3. Difficult swallowing

4. Cough

5. Dyspnea

 

2. Zenker’s diverticulum is:

1. Pharyngoesophageal diverticulum

2. Bifurcational diverticulum

3. Epiphrenic diverticulum

4. Paraaortal diverticulum

5. Multiple diverticula

 

3. What is the main objective manifestation of epiphrenal diverticula?

1. Signs of achalasia

2. Cyanosis of the upper part of body

3. Compressible mass on the left side of the neck

4. Esophago-bronchial fistula with aspiration pneumonia

5. Lung atelectasis

 

4. What is the roentgenological sign of achalasia?

1. Filling defects

2. “Rat tail” sign

3. “Niche” sign

4. “Bell” sign

5. Blunt His angle

 

5. What is the main treatment of the III stage of achalasia?

1. Diet, conservative treatment

2. Cardiodilatation

3. Esophagomyotomy (Heller’s operation)

4. Esophagogastroanastomosis (Helerovsky’s operation)

5. Esophageal plastics by intestine

 

6. What solution is used for washing out of acid esophageal burn?

1. Antiseptic solution

2. Antibiotic solution

3. Glucose solution

4. Sodium hydrocarbonatis solution

5. Vinegar solution

 

7. What is the main prophylaxis of esophageal stricture after the chemical burn?

1. Spasmolytics

2. Parenteral feeding

3. Esophageal bougienage

4. Pneumocompression

5. Gastrostomy

 

8. The woman, 48 years old, complains of salivation, cervical dysphagia, difficult swallowing and cough. Has been ill for 10 years. On X-ray examination with barium the outpouching of mucosa in the pharyngoesophageal junction. What is the optimal treatment for this patient?

1. Resection of the diverticulum

2. Heller’s operation

3. Esdophagogastric anastomosis

4. Esophageal plastics by small intestine

5. Esophageal plastics by large intestine

 

9. The woman, 44 years old, complains of salivation, cervical dysphagia, difficult swallowing and cough. Has been ill for 10 years. On X-ray examination with barium the outpouching of mucosa in the pharyngoesophageal junction. What is the diagnosis of this patient?

1. Bifurcational diverticulum

2. Zenker’s diverticulum

3. Esophageal achalasia

4. Esophageal cancer

5. Diaphragmatic hernia

 

10. The man, 44 years old, who has been ill for 10 years by esopageal diverticulum, marked the severe pain in chest, salivation, belching, and difficult swallowing. X-ray examination with barium showed the Zenker’s diverticulum . What complication of the disease can be suspected?

1. The perforation of diverticulum

2. Bleeding

3. Malignancy

4. Diverticulitis

5. Esophagotracheal fistula

 

 

The student must know:

1. Anatomic and physiologic features of the esophagus.

2. Classification, semiotics of esophagus diseases.

3. Semiotics of esophagus diseases. 

4. Achalasia of the esophagus. Concept definition, classification.

5. Clinical characteristics, diagnostics and differential diagnostics of achalasia of the esophagus depending on the clinical stage and complications.

6. Curing methods choice esophagus diseases.

7. Choice of treatment methods of achalasia of the esophagus depending on the clinical stage and complications.

8. Methods of conservative and operative treatment of achalasia of the esophagus.

9. Cardiodilatation – indications, results, eventual complications.

10. Methods of operations at achalasia of the esophagus.

11. Esophageal burns. Classification.

12. Clinical characteristics of chemical burns of the esophagus depending on the substance origin (acids, alkaline).

13. First aid at chemical burns of the esophagus depending on the substance origin. 

14. Curing tactics at chemical burns of the esophagus depending on the stage of the wound process.

15. Esophageal diverticula. Concept definition, classification.

16. Clinical characteristics, diagnosis, differential diagnosis and diagnosis verification methods of esophageal diverticula.

17. Diverticula complications. 

18. Methods of conservative and operative treatment of esophageal diverticula.

 

The student has to be able to:

1. To take the history of the patient with the esophagus diseases.

2. To perform esophageal intubation.

3. To make a plan of patient’s examination and to explain the examination results (roentgenologic examination (esophagoscopy, esophagography), ultrasonic examination).

4. To define curing tactics, indications and contraindications for an operative intervention to choose properly the preoperative preparation, anesthesia type, operative access and type of intervention according to the clinical form

 

The answers for the self-checking tests.

1 – E.

2 – A.

3 – A.

4 – B.

5 – C.

6 – D.

7 – C.

8 – A.

9 – B.

10 – D.

 

References:

Main

• Herbella FA, Patti MG. Modern pathophysiology and treatment of esophageal diverticula. Langenbecks Arch Surg. Jan 2012;397(1):29-35. 

• D’Journo XB, Ferraro P, Martin J, Chen LQ, Duranceau A. Lower oesophageal sphincter dysfunction is part of the functional abnormality in epiphrenic diverticulum. Br J Surg. Aug 2009;96(8):892-900. 

• Christiaens P, De Roock W, Van Olmen A, et al. Treatment of Zenker’s diverticulum through a flexible endoscope with a transparent oblique-end hood attached to the tip and a monopolar forceps. Endoscopy. Feb 2007;39(2):137-40.

• Kos MP, David EF, Mahieu HF. Endoscopic carbon dioxide laser Zenker’s diverticulotomy revisited. Ann Otol Rhinol Laryngol. Jul 2009;118(7):512-8.

• Helmstaedter V, Engel A, Huttenbrink KB, Guntinas-Lichius O. Carbon dioxide laser endoscopic diverticulotomy for Zenker’s diverticulum: results and complications in a consecutive series of 40 patients. ORL J Otorhinolaryngol Relat Spec. 2009;71(1):40-4.

• “Facultative Surgery” under the edition of V.O.Shidlovsky – Ternopil: Ukrmedknyga, 2002, section “Diseases of the esophagus”,compact disc “Facultative surgery, file “Diseases of the esophagus”.

• Website of the Ternopil University

 

 

Additional

• L.Ya.Kovalchuck, Yu.P.Spizhenko, V.F.Sayenko and others. “Hospital surgery”. Ternopil: Ukrmendknyga, 1999- 590C.

• M.I.Kuzin “Surgical diseases” – M.:-Medicina,1986.-611C.

 

 

Обговорено на засіданні кафедри 

“03” червня 2014 р. протокол №2