kpripper
Основатель
Специальность : Хирург
Одобрения от коллег : 241
 |  Тема: Dr House ward rounds: 2 - 30.07.2009 Чт 17 Дек 2009 - 15:59 | |
| Minherz пишет: - Цитата :
Полномасштабную эндоскопию верхних отделов пищеварительного тракта (upper GI [gastro-intestinal] endoscopy) стал делать только в ЮАР: за 12 лет я сделал где-то... ээээ... минимум 5 в неделю х на 40 недель = где-то 200 исследований в год... х 12 лет = что-то 2 000 - 2 500... ну, пусть будет 2 000...
На это количество исследований встретил только один раз Schatzki ring - кольцевидные образования слизистой пищевода... Как назло, ни засписывающее устройство в эндоскопической системе нен работало, ни у меня с собой не было камеры... Честно говоря, я даже не сообразил, с чем имю дело... Звоню своему молодому талантливому украинскому африканскому хирургу Мацевичу:
- Олег, вот такая вот хреновина... Шо це такэ..?
Вот этот Олег, который сейчас усиленно сдаёт очередные ЮАРовские медицинские экзамены, и просветил меня...
Побежал я в Интернет - нашёл там и статью про эти кольца и вот такой снимок...
У меня, правда, кольцо было более выражденное...
Обратился за помощью в международное сообщество хирургов - мне подсказали интернетовскийц адрес, откуда я и и сдаунлодил чудесный снимок...
A Schatzki ring or Schatzki-Gary ring is a narrowing of the lower part of the esophagus that can cause difficulty swallowing. The narrowing is caused by a ring of mucosal tissue (which lines the esophagus) or muscular tissue.[1] Patients with Schatzki rings can develop intermittent dysphagia (difficulty swallowing), or, more seriously, a completely blocked esophagus. The ring is named after the American physician Richard Schatzki.
A Schatzki ring is a specific type of "esophageal ring" termed a "B ring".[2] An "A ring" refers to a ring at the esophagus/stomach junction.[3]
Clinical presentation
Not all patients with Schatzki rings have symptoms; barium swallow tests of the esophagus sometimes show Schatzki rings in patients with no swallowing difficulties. When Schatzki rings cause symptoms, they usually result in episodic dysphagia with solid foods, or a sensation that the food "sticks" while swallowing, especially if the food is not chewed thoroughly. Patients usually are able to regurgitate or force through the food material and resume eating. However, complete obstruction of the esophagus by a bolus of food (often called steakhouse syndrome) can occur. This can cause crushing chest pain and may need immediate treatment with endoscopy, which is the use of a specialized fibre-optic camera in order to remove the lodged food.[4] After the obstruction is located, snares or forceps are inserted to pull the food out of the esophagus or to push it into the stomach. The latter is done with caution, usually when the anatomy of the structures around the obstruction is already known.
Diagnosis
A Schatzki ring is typically diagnosed by esophagogastroduodenoscopy or barium swallow. Endoscopy usually shows a ring within the lumen of the esophagus which can be of variable size (see picture). The ring is usually located a few centimetres above the gastro-esophageal junction, where the esophagus joins the stomach. Schatzki rings can often resemble a related entity called an esophageal web. Esophageal webs are also contain extra mucosal tissue, but do not completely encircle the esophagus.
Endoscopies and barium swallows done for other reasons often reveal unsuspected Schatzki rings,[5] meaning that many Schatzki rings are asymptomatic.
Two varieties of Schatzki rings have been described. The original description by Schatzki and Gary was of a ring of fibrous tissue seen on autopsy; this is the less common type of Schatzki ring.[1] More commonly, the ring consists of the same mucosal tissue that lines the entire esophagus. Although many hypotheses have offered, the cause of Schatzki rings remains uncertain; both congenital and acquired factors may be involved.
Treatment
Asymptomatic Schatzki rings seldom worsen over time, and need no treatment.
Symptomatic Schatzki rings may be treated with esophageal dilatation, using bougie or balloon dilators. These have been found to be equally effective.[6] Bougie dilatation involves passage of long dilating tubes of increasing size down the esophagus to stretch the area of narrowing, either over a guidewire passed into the stomach by endoscopy (the Savary-Gillard system) or using mercury-weighted dilators (the Maloney system). This is usually done with intravenous sedation to reduce discomfort. Dilatation can produce some temporary irritation. A short course of proton pump inhibitor therapy may decrease aggravation by stomach acid reflux into the esophagus. The duration of the benefit of dilation varies, but may be from months to years. Dilation may be repeated if narrowing recurs.
Other associations
Schatzki rings can be associated with swallowing syncope, a rare variety of syncope.[7]
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