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Diseases of the esophagus. Congenital: Atresia Traumatic: FB Caustic ingestion Perforation Neoplastic : Benign (rare) Malignant Functional : GERD Neuro-muscular : Achalasia. The most common; Atresia with Tracheo-esophageal fistula

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Presentation Transcript
slide2
Congenital:

Atresia

Traumatic:

FB

Caustic ingestion

Perforation

Neoplastic:

Benign (rare)

Malignant

Functional:

GERD

Neuro-muscular:

Achalasia

congenital anomalies
The most common; Atresia with Tracheo-esophageal fistula

Regurgitation of food  aspiration, chocking and cyanosis

A catheter fail to enter the stomach

Congenital Anomalies
slide4
طفل مولود كل مايرضع اللبن يرجع ويحصل له كحة شديدة واختناق وزرقان في اللون
  • نحاول نعدي قسطرة ماتعديش
  • (ممكن القسطرة تعدي tracheo-esophageal fistula only))
  • Lipoidol swallow
atresia with tracheo esophageal fistula
The commonest

congenital anomaly of the

Esophagus

The upper segment ends

as a blind pouch

The lower segment is

connected to the trachea

Atresia with Tracheo-esophageal fistula
slide6

Clinical Picture

Immediately after birth:

Marked regurgitation and

Drolling

Oral Catheter fails to enter the stomach

Investigations;

Lipidol swallow

Treatment:

Immediate surgical repair

slide7

Traumatic conditions

1- Foreign body

2- Caustic ingestion

  • Corrosive esophagitis
  • Stricture of the esophagus

3-Esophageal perforation

slide8
Children : the commonest .

It is accidental

عندما يلعب الطفل بوضع الأشياء في فمه

Adult : suicidal

Type of patient

Type of foreign body

Foreign Body in

the esophagus

In children: the commonest is coin & disc battery

In adult: fish & meat bone

In elderly : dentures and meat limp

In suicisal cases: razor or pins

slide9
At the upper end:

below the cricopharyngeal

sphincter. The commonest site

At normal constrictions

Anywhere with sharp FB

Type of patient

Type of foreign body

Site of impaction

Sequlae:

Mechanical obstruction dysphagia

& regurgitation

Disc batteries  liquifactive necrosis

and even perforation

Sharp FB  mucosal tears

&even perforation

slide10

Type of patient

  • Type of foreign body
  • Site of impaction
  • Sequlae:
  • Symptoms
  • Signs
  • Investigations
  • Complications: perforation
  • Treatment :

Removal by esophagoscope

History

Dysphagia

It may be severe with drolling of saliva

Regurgitation of undigested food

slide11
1- Foreign body

2- Caustic ingestion

  • Corrosive esophagitis
  • Stricture of the esophagus

3-Esophageal perforation

slide12

Corrosive esophagitis

Etiology

  • Strong Alkalies(common) liquid cleaners &disc batteries progessive liquifactive necrosis and even perforation
  • Strong Acids: (rare) self limited coagulative necrosis act as a barrier  protect the mucosa

Symptoms:

History:

Severe mouth and throat pain

Dysphagia: so severe , the patient cann’t swallow his saliva  drolling

Stridor and hoarsness: due to laryngeal edema

ماب بطاريات

slide13
في الاسعافات الأولية يجب استخدام اشياء متوفرة حولنا

Fist Aid :

Combat shock ; IV fluids and analgesics

Buffering solution:

-Vinegar or diluted lemon to neutralize alkalies

- Anti-acid for strong acids

Emoluent solution;

Egg white and milk to protect thr mucosa

slide14
Complications:

Local:

Perforation

Healing by fibrosis stricture

Systemic:

- Dehydration &electrolyte disturbance

- Scock:

  • Neurogenic due to pain
  • Hypovolaemic

stricture

slide15
Treatment

Analgesic

Antibiotics

Corticosteroids

Nasogastric tube

Endotracheal intubation or

tracheostomy if indicated

i.e if there is signs of respiratory obstruction

slide16
Etiology:

healing of corrosive esophagitis by fibrosis

Symptoms

Signs: flexible esophagoscopy

Investigations: Barium swallow

Treatment:

Permeable strictures

Repeated dilatation through an esophagoscope

Impermeble strictures

colon bypass operation

After a latent period of a few weeks

- progressive dysphagia to solids

then to fluids also

- Regurgitation of undigested acid free food

Stricture

slide17

Esophageal perforation

Etiology:

-Accidental: sharp FB or corrosives

  • Iatrogenic : unskilled esophgoscopy
  • هذه الحالة من الحالات الطارئة بحق ويجب تشخيصها والبدا في العلاج قبل مرور 24 ساعة حيث ان التأخر في التشخيص يزيد من نسبة الوفاة في هذه الحالات الي أكثر من 50%

CORROSIVE

slide18
Sequlae:

Clinically

Investigations:

Plain X ray: air in the neck, pleura, mediastinum

Gastrografin swallow to detect the

site and size of perforation

Air in the neck surgical emphysema

Air n the pleura pneumothorax

Air in the mediastinum pneumo-mediastinum

مريض بعد عمل منظار مرئ أو عنده جسم غريب

The patient is feverish and toxic

Dysphagia

Hematemesis

Retrosternal chest pain

dyspnea

slide19
Treatment:

In ICU في العناية المركزه

Conservative:

Nothing by mouth

Massive antibiotic therapy

Nasogastric tube in small perforation

Gastrostomy in large perforation

Surgical

- Repair and, cervical or trans-thoracic drainage-

slide20
Incidence:

The commonest malignant tumor of the esophagus

Above 50 years old

Commonly males

Predisposing factors:

- excessive tobacco & alcohol

GERD

Achalasia

Plummer Vinson syndrome

Esophageal carcinoma

Koilonychia,,

Angular stomatitis

Glazed tongue

slide21

spines

Spread

Local:

to surrounding structures: trache, bronchi, spines, recurrent laryngeal nerve

Lymphatic:

- Cervical part: to lower deep cervical LN

  • Thoracic part: mediastinal LN
  • Abdominal part: to coeliac LN

Blood:

trachea

Late and Rare

To Lung, Liver, Bone , Brain

CT scan of

the brain

Abdominal ultrasound

Bone scan

Chet X Ray

slide22

مثال: رجل مدخن فوق الخمسين عنده صعوبة في البلع منذ شهرين تزيد باستمرار للأكل وبعد فترة اصبحت للأكل والسوائل مع فقدان واضح في الوزن

In elderly patient commonly male:

  • Rapidly progressive dysphagia, first to solids then to solids & fluids
  • In large tumors : regurgitation of acid free food
  • Hematemsis & Melena
  • Later: hoarsness of voice
  • Loss of weight

Symptoms

Signs

Investigations:

  • Barium swallow
  • CT scan
  • Biopsy
  • Metastatic work-up

Treatment:

Surgical resection followed by reconstruction and radiotherapy

Prognosis is bad

slide23
Carcinoma of oesphagusThe stricture is

-irregular

-short

-shouldering

prestenotic dilatation

is moderate

هامة في العملي

gastro esophageal reflux disease gerd
Def

Incidence

Etiology:

Deceases pressure of cardiac sphincter e.g in hiatus hernia

Gastric hypersecretion: stess, smoking alcohol, caffiene, spicy foods, citrus frits

Complications:

esophagitis ulcer stricture

Chronic pharyngitis & Laryngitis

Cancer esophagus & Larynx

Retrograde flow of gastric contents to

the esophagus, pharynx and larynx

due to frequent spontaneous relaxation

of the cardiac sphincter

Gastro-esophageal Reflux Disease GERD

Above 40

Infants

slide25

GERD

Symptoms:

Esophageal;

Retrosternal burning sensation (frequently absent)

Pharyngeal:

Throat irritation hmemming & Hawking to clear the throat نحنحه وتنخيم

Laryngeal:

Chronic irritative cough, hoarsness of voice,

In infants , nocturnal laryngeal irritation 

laryngismus stridulus

Signs:

-esophagitis

-ulcer

May be stricture

Investigations:

24 hours double probe(esophageal &

pharyngeal) ph monitoring

Measure the time the Ph is less than 4

It is diagnostic if the time is more than 5%

slide26
Treatment of GERD:

Live style support

-weight reduction

Avoid smoking and foods that worsen symptoms

Avoid lying down for 3 hours after a meal.

Raise the head of your bed 6 to 8 inches

Medical treatment:

Anti-acidsto relieve heartburn

H2 blockers, such as cimetidinedecrease acid production

Proton pump inhibitors e.g omeprazole decrease acid production

Prokinetics help strengthen the LES and make the stomach empty faster

metoclopramide (Reglan).

Surgical:

After failure of medical treatment

Fundoplication operation

the upper part of the stomach is wrapped

around the LES to strengthen the

sphincter, prevent acid reflux, and repair a

hiatal hernia.

تغيير نمط الحياه مهم جدا لعلاجهذه الحالة

انقاص الوزن

تجنب التدخين و الاطعمة التي تزيد من الحموضة

تناول طعام العشاء قبل 2-3ساعات من النوم

النوم علي مخدة عالية أو رفع رأس السرير

achalasia of the cardia
Incidence;

commonly middle aged

neurotic female

Etiology:

Degeneration of ganglion cells of

Auerbach’s plexus (parasympathetic)

in the wall of the esophagus  Failure

of relaxation of the cardiac sphincter

during swallowing marked dilatation

of the lower two thirds of the esophagus

Achalasia of the cardia

Marked Dilatation of the lower

two thirds esophagus above the cardia

Failure of relaxation of

Cardiac sphincter

slide28
Symptoms:

Dysphagia: more to fluids Why?

Regurgitation of undigested acid free food

No loss of weightWhy?

Signs:

Excessive food stagnation

المرئ مليان أكل غير مهضوم

Marked dilatation …….

Investigations

Barium swallow

Manometric study: increase pressure

of the lower segment

Swalowing of fluids needs highly

co-ordinated act of swallowing

Solids can descend by gravity

Because dysphagia is

intermittent

Marked dilatation of the lower 2/3 of the esophagus (segmoid esophagus)

Tapering of the lower end

slide29
Treatment:
  • Conservative:

Muscle relaxant as Amyl nitite before meals to relax the cardiac sphincter علاج مؤقت

-Repeated dilatation of the sphincter

  • Surgical:

Cardiomyotomy operation

( Hiller’s operation)

Division of the muscle fiber

without injury of the mucosa

slide30

شكرا

أد مسعد السيسي