6. esofagus
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Dr.H.Arsil Syam,Sp THT-KL
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Anatomi :1.Esofagus Servikal : 5 – 6 cm (C VI – C VII)2.Esofagus Torakal : 16 – 18 cm (T1 – T10)3.Esofagus Abdominal : 3 – 4,5 cm - Pars Diafragmatika : 1 - 1,5 cm- Pars Abdominal : 2 - 3 cm
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Terdapat 4 Penyempitan :1. Di bawah Introitus (Sfincter Superior) 23 mm 17 mm2. Setinggi Penyilangan Arkus Aorta Kiri 23 mm 19 mm3. Setinggi Penyilangan Bronkus Kiri Kiri depan 23 mm 17 mm4. Di atas Sfincter Inferior 23 mm 23 mm
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Gambar :
C VI
C X
1
2
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1. Fase Oral secara sadar2. Fase Faringeal secara refleksi3. Fase Esofagal peristaltik Rangsangan Bolus Relaksasi M.Krikofaring Introitus Esofagus Terbuka Bolus Lewat Kontraksi M.Krikofaring Peristaltik Sfingter Distal Terbuka
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patologi 1. Fungsional Hipomotilitas ( Orang Manula )2. Akalasia Neuromuskuler3. Hiatus Hernia4. Cincin Kontraksi “Schatski”5. Divertikuli6. Penyakit Sistemik7. Esofagitis8. Neoplasma9. Kongenital10.Benda Asing
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Definisi :Lokalisasi : 75% ProksimalPredisposisi :1. Personal2. Dental3. Kurang hati – hati4. Bentuk & ukuran benda asingKlinis :1. Disfagi / Odinofagi2. Regurgitasi / MuntahRadiologi :Terapi :- Ekstraksi (Dengan Bantuan Esofagoskopi)- Esofagotomi
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Definisi : Zat Kimia Korosif 1. Asam Kuat : - Asam Sulfat - Asam Citrat 2. Basa Kuat : Natrium Hidroksida 3. Zat Organik : - Lisol - Karbol Patologi Derjat Kerusakan : Basa kuat > Asam Kuat > Organik Basa Kuat : Nekrosis mencair Mukosa + Otot Asam Kuat : Nekrosis menggumpal Mukosa + Otot Organik : Edema Mukosa & Sub Mukosa
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Faktor-faktor yang mempengaruhi1. Jenis zat korosif2.Konsentrasi Korosif3.Dosis Korosif4.Lama Kontak - Padat / Cair - Sengaja / Tidak - Muntah / Tidak
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I. Fase Akut (1-3 hari) - Tanda luka bakar (Edema & Laserasi) pada mulut,bibir & faring kadang-kadang perdarahan
- Disfagi & Odinofagi hebat - Suhu tubuhII. Fase Laten (>2-6 minggu dari kejadian)
– Pembentukan jaringan parutIII. Fase Kronis Disfagia kembali (>1-3 th)
Komplikasi - Syok,koma,edema laring- Aspirasi Pnemoni- Perforasi Esofagus - Mediastinitis
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1. Perbaiki K.U - Aminofuchsin 2 botol - Glukosa 10% 2 botol - NaCl 0,9% + KCl 5 meq /L 1 botol
2. Netralisasi ( <6 jam)3. A.B 2-3 minggu4. Kortikosteroid
D 80mg hari I, 60 mg hari II, 40 mg hari III, & 20mg sampai sembuh (Prednison) A 1 mg/kg BB/hari 2minggutapering off
5. Analgesik6. Makan NGT7. Dilatasi pada fase laten & kronis
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Macam Esofagoskop : I. Kaku II. Fleksibel Indikasi Diagnostik 1. Evaluasi Keluhan 2. Evaluasi Penyakit 3. Evaluasi kel. Radiologik 4. Evaluasi Pasca Operasi Esofagus Terapi 1. Dilatasi 2. Ekstraksi CA 3. Skeloterapi Varises 4. Coagulasi Diatermi 5. Miotomi
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