THE OESOPHAGUS

1. 1

2. 2 SURGICAL ANATOMY

3. 3 PHYSIOLOGY

4. 4 PHYSIOLOGY

5. SYMPTOMS

6. SYMPTOMS

7. REGURGITATION AND REFLUX REGURITATION : RETURN OF CONTENTS FORM OESOPHAGUS REFLUX : PASSIVE RETURN OF GASTRODUODENAL CONTENTS TO MOUTH

8. REGURGITATION AND REFLUX CHEST PAIN : GASTRO-OESOPHAGEAL REFLUX , MOTALITY DISDRERS

9. INVESTIGATIONS RADIOGRAPHY - CONTRAST RADIOGRAPHY : NARROWING , SPACE-OCCUPYING LESIONS , ANATOMICAL DISTORTION , ABNORMAL MOTALITY PLAIN RADIOGRAPH : OPAQUE FOREIGN BODIES CT SCAN : ASSESSMENT

10. ENDOSCOPY NECESSARY FOR INVESTIGATION TO VIEW INSIDE OESOPHAGAS AND OESOPHAGEGASTRIC JUNCTION , BIOPSY OR CYTOLOGY , REMOVE F.B. DILATE STRICTURE

11. RIGID OESOPHAGOSCOPY

12. VIDEO ENDOSCOPY

13. VIDEO ENDOSCOPY

14. 14 THERAPEUTIC PROCEDURES DILATATION OF STRICTURES - GUIDEWIRE – DIRECTED DILATATION : CELESTIN DILATORS - BALLOONS : LESS EFFECTIVE

15. 15 THERAPEUTIC PROCEDURES

16. 16 THERAPEUTIC PROCEDURES

17. 17 CONGENITAL ABNORMALITIES ATRESIA AND TRACHEO- OESOPHAGEAL FISTULA :- 85% LOWER SEGMENT COMMUNICATES WITH TRACHEA

18. 18 CONGENITAL ABNORMALITIES CLINICAL FEATURES * REGURGITATE ; FIRST FEED * SALIVA POURS * COUGHING AND CYANOSIS OCCUR ON FEEDING * HYDRAMNIOS : 50% OF CASE OF ATRESIA * VACTER

19. 19 CONGENITAL ABNORMALITIES - CLINICAL CONFIRMATION OF THE DIAGNOSIS : NG TUBE - RADIOLOGICAL CONFIRMATION

20. 20 CONGENITAL ABNORMALITIES RADIOLOGICAL CONFIRMATION :- LATERAL CHEST RADIOGRAPH ; LUCENT PROXIMAL POUCH , BOWEL GAS TREATMENT : SURGERY

21. 21 CONGENITAL ABNORMALITIES OPERATION :- THORACOTOMY (RIGHT), FIFTH INTERCOSTAL SPACE - DIVIDE AND CLOSE FISTULA - END TO END ANASTOMOSIS

22. FOREIGN BODIESIN THE OESOPHAGUS

23. PERFORATION

24. PERFORATION

25. PERFORATION

26. PERFORATION

27. PERFORATION

28. 28

29. 29 NON-OPERATIVE MANAGEMENT OF PERFORATED OESOPHAGUS

30. OPERATIVE MANAGEMANT

31. 31 MALLORY-WEISS SYNDROME FORCEFUL VONITING 90% MUCOSAL TEAR AT CARDIA, 10% OESOPHAGUS HAEMATEMESIS TREATMENT : SUPPORTIVE , ENDOSCOPIC INJECTION TRERAPY

32. 32 CORROSIVE INJURY SODIUM HYDROXIDE (LYE) ,SULPHURIC ACID TREATMENT : EARLY ENDOSCOPY - MINIMAL INJURY ; RESOLVE RAPIDLY - SEVERE INJURY : STEROID 3 WEEK , REGULAR DILATION - FULL-THICKNESS NECROSIS : RESECTION - LATE CASE : STRICTUR ; RESECTION , BY PASS

33. 33 DRUG-INDUCED INJURY ANTIBIOTICS , POTASSIUM DYSPHAGIA , ODYNOPHAGIA NO SPECIFIC TREATMENT

34. GASTRO-OESOPHAGEAL REFLUX DISEASE

35. 35 AETIOLOGY LOSS OF COMPETENCE OF LOS TRANSIENT LOWER OESOPHAGEAL SPHINCTER RELAXATIONS (TLOSRS) SEVERE GORD : LOST LOS BASAL TONE AND SHORTER LENGTH EXPOSED TO INTRA-ABDOMINAL PRESSURE

36. 36 CLINICAL FEATURES MOST COMMON SYMPTOMS : RETROSTERNAL BURNING PAIN (HEARTBURN) , EPIGASTRIC PAIN - FATTY DYSPEPSIA - UNPLEASANT TASTE - ODYNOPHAGIA : HOT BEVERAGES, CITRUS DRINKS , ALCOHOL - DYSPHAGIA : STRICTURE

37. 37 DIAGNOSIS ENDOSCOPY : EXELUDE MORE SERIOUS PATHOLOGY 24 HOUR OESOPHAGEAL pH RECORD MANOMETRY : ECLUDE ACHALASIA BARIUM SWALLOW : PLANNING AN OPERATION

39. 39 MEDICAL MANAGEMENT SELF-MEDICATE : ANTACID, ANTACID – ALGINATE PREPARATIONS, H2 RECEPTER ANTAGONISTS MOST EFFECTIVE DRUG : PPIs, OMEPRAZOLE , PANTOPRAZOLE, LANSOPRAZONE 1-2 DILATATIONS ADVICE : WEIGHT LOSS , SMOKING , ALCOHOL , TEA , COFFEE ,HEAD-UP TILT OF BED

40. 40 SURGERY ANTIREFLUX OPERATION 1. ALLISON REPAIR OF HIATUS HERNIA 2. NISSEN TOTAL FUNDOPLICATION 3. HILL PROCEDURE : FIXED CARDIA TO PREAORTIC FASCIA

41. 41 SURGERY 4. BALSEY MARK IV OPERATION * THORACIC PROCEDURE * SUTURE OESOPHAGUS TO DIAPHRAGM AND FUNDUS COMPLICATED : PARTIAL GASTRECTOMY WITH ROUX-EN-Y RECONSTRUCTION

42. 42 COMPLICATION OF GORD * STRICTURE - LATE MIDDLE-AGED , ELDERLY - DILATATION , PPI * OESOPHAGEAL SHORTENING - LONGSTANDING REFLUX OESOPHAGITIS - COLLIS GASTROPLASTY , COLLIS- NISSEN OPERATION

43. 43 COMPLICATION OF GORD * BARRETT’S OESOPHAGUS (COLUMNAR- LINED LOWER OESOPHAGUS) - METAPLASTIC CHANGE - INCREASE RISK OF CANCER - TREATMENT : LASER , PHOTDYNAMIC THERAPY , ARGON-BEAM PLASMA COAGULATION - BARRETT’S ULCER : PRONE TO BLEEDING

44. 44 PARAOESOPHAGEAL (ROLLING) HIATUS HERNIA * TRUE HERNIA - MOST COMMON IN ELDERLY - SYMPTOMS :- DYSPHAGIA - CHEST PAIN - DIAGNOSIS :- PLAIN RADIOGRAPH - BARIUM MEAL - TREATMENT :- NG TUBE - SURGERY

45. NEOPLASMS OF THE OESOPHAGUS

46. CARCINOMA OF THE OESOPHAGUS

48. 48 SQUAMOUS CELL CANCER ENDEMIC AREA :- TRANSKEI REGION OF SOUTH AFRICA , MIDDLE OF ASIA INCIDENCE - LINXIAN IN HENAN PROVINCE IN CHAINA 100 : 100,000 - U.S.A < 5 : 100,000 - FRANCE 26.5 : 100,000 ADENOCARCINOMA - WESTERMISED CONTRIES

49. 49 CLINICAL FEATURES DYSPHAGIA WEIGHT LOSS HOARSENESS PALPABLE LYMPHADENOPHATHY

50. 50 STAGINE AND GENERAL ASSESSMENT ULTRASONOGRAPHY OF LIVER CT SCANNING OF CHEST AND ABDOMEN ENDOSCOPIC ULTRASONOGRAPHY BRONCHOSCOPY RESPIRATORY AND CARDIOVASCULAR FUNCTION NUTRITPONAL ASSESSMENT

51. 51 TREATMENT OF MALIGNANT TUMOURS PRINCIPLES :- RELIEF OF DYSPHAGIA AND PAIN SURGERY : CURATIVE SURGERY ; RESECTION OF OESOPHAGUS , STOMACH , LYMPH NODE

52. 52 SUBTOTAL OESOPHAGECTOMY MCKEOWN OPERATION - INCISION : ABDOMEN , THORACIC , NECK 2. IVOR - LEWIS (LEWIS-TANNER) - INCISION : ABDOMEN , THORACIC

53. 53 TRANSHIATAL OESOPHAGECTOMY (WITHOUT THORACOTOMY) ORRINGER (USA) , PINOTTI (BRALIL) INCISION : ABDOMEN , NECK LESIONS OF LOWER OESOPHAGUS

54. 54 THORACOSCOPIC OESOPHAGECTOMY VIDEO-ASSITED THORACIC SURGERY (VATS) TAKES LONGER THAN OPEN SURGERY POSTOPERATIVE MORBIDITY

55. RADIOTHERAY :- EFFECTIVE FOR SQUAMOUS CELL CANCER , ADENOCACINOMA

56. PALLIATIVE TREATMENT 1. INTUBATION :- EXPANDING METAL STENT 2. ENDOSCOPIC LASER - CORE A CHANNEL THROUGH THE TUMOUR - REPEATED EVERY FEW WEEKS - UNBLOCK A STENT 3. BRACHYTHRAPY :- INTRALUMINAL RADIATION

57. OESOPHAGEAL MOTALITY DISORDERS :- DYSPHAGIA IN ABSENCE OF STRICTURE :- OESOPHAGEAL MANOMETRY : ABNORMAL CONTRACTIONS :- DISPROPORTIONATELY SEVERE SYMPTOMS

59. 59 PATHOLOGY AND AETIOLOGY LOSS OF GANGION CELLS IN AUERBACH’SPLEXUS CUASE : VARICELLA ZOSTER PHYSIOLOGICAL ABNORMALITIES : INCOMPLETE OF ABSENT RELAXATION OF LOS , ABSENT PERISTALSIS IN BODY OF OESOPHAGUS INCREASE INCIDENCE OF CARCINOMA PSEUDOACHALASIA : ACHALASIA-LIKE DISORDER PRODUCE BY ADENOCARCINOMA OF CARDIA

60. 60 CLINICAL FEATURES MOST COMMON IN MIDDLE LIFE DYSPHAGIA EARLY STAGE : RETROSTERNAL DISCOMFORT REGURGITATION

61. 61 DIAGNOSIS ENDOSCOPY : TIGHT CARDIA , FOOD RESIDUAL BARUN RADIOLOGY : “BIRD’S BEAK” OESOPHAGEAL MANOMETRY LOS : HYPERTENSINE , NOT RELAY OESOPHAGEAL BODY : APERISTALSIS , RISED RESTING PRESSURE

62. 62 TREATMENT ? FORCEFUL DILATATION - BALLOON : STRETCH CARDIA TO DISRUPT MUSCLE - COMPLICATION : PERFORATION - CURE RATE 75-85% - BEST RESULT : AGE > 45 YEARS

63. 63 TREATMENT CUTTING MUSCLE OF LOWER OESOPHAGUS AND CARDIA COMPLICATION : GASTRO-OESOPHAGEAL REFLUX SUCCESSFUL : 90% AFTER FAILED DILATATION

65. 65

66. 66

67. 67

68. OEOSINHILIC OESOPHAGITIS PATHOLOGIC DIAGNOSIS TREATMENT : ANTIHISTAMINE , SODIUM CHROMOGCYCATE , STEROIDS

69. 69 OESOPHAGEAL DIVERTICULAR PULSION DIVERTICULAR : DEVELOP AT WEAKNESS SITE TRACTION DIVERTICULAR : CONSEQUENCE OF CHRONIC GRANULOMATOUS DISEASE

70. 70 ZENKER’S DIVERTICULUM (PHARYNGEAL POUCH) - ABOVE CRICOPHARYNGEAL SPHINCTER - DIVERTICULO-OESOPHAGOSTOMY

71. 71 EPIPRENIC DIVERTICULA ? ABOVE DIAPHRAGM ? LARGE , FEW SYMPTOMS ? TREATMENT : EXCISION , MYOTOMY

72. 72 OTHER NON-NEOPLASTIC CONDITIONS ? SCHATZKI’S RING - CIRCULAR RING AT SQUAMOCOLUMNAR JUNCTION - TREATMENT : SINGLE DILATATION

73. 73 OTHER NON-NEOPLASTIC CONDITIONS ? MONILIAL OESOPHAGITIS - CANDIDA ALBICANS - ENDOSCOPY : PLAQUES CANNOT BE MOVED - TREATMENT : NYSTATIN LOZENGES, ANIFUNGAL

74. 74 OTHER NON-NEOPLASTIC CONDITIONS ? AIDS AND THE OESOPHAGUS - DYSPHAGIA , ODYNOPHAGIA - CANDIDA,HSV, CYTOMEGALOUIRUS

75. 75 OTHER NON-NEOPLASTIC CONDITIONS ? CROHN’S DISEASE - SYMPTOMS : SEVERE RETROSTERNAL PAIN , DYSPHAGIA - DIAGNOSIS : BIOPSY - TREATMENT : SURGERY

76. 76 OTHER NON-NEOPLASTIC CONDITIONS ? PLAMMER-VINSON SYNDROME - YOUNG WOMAN WITH IRON DEFICIENCY ANEMIA AND DYSPHAGIA - DYSPHAGIA : SPASM OR WEB IN POST-CRICOID AREA - COMPLICATION : STRICTRUR , ULCERATION , ADENOCACINOMA