Esophageal diseases • Carcinomaof Esophagus • Achalasia of the esophagus • EsophagealVarices
EsophagealCarcinoma -Causes Causes are unknown. Predisposing factors are- • smoking • Alcoholism • Chewing betel nuts or tobacoo • Achalasia of esophagus • Post-cricoid web • Postcaustic strictrue • Tylosis(familial hyperkeratosis of the palm andsole,dysphasia) • Coeliac disease
Carcinomaof Esophagus- Presentations • Dysphagia-initially solid, later both solid and liquid. It is progressive, painless. • Retrosternal discomfort or chest pain at the site of obstruction (patient can localise the site) • Anorexia, regurgitation, weight loss. • Features of metastasis and tracheooesphageal fiscula
Carcinomaof Esophagus- Sites • Upper part—15% • Middle part—45% • Lower part—40%
Carcinomaof Esophagus- Pathological Types • Mainly two types- • Squamous cell carcinoma (upper and middle part). • Adenocarcinoma (lower third, from Barret’s esophagus or cardia of stomach). • Rarely, small cell carcinoma.
Carcinomaof Esophagus- Diagnosis • Hard barium flow • Esophageal strictures • Filling defects • Niche sign • Dilatation
a. Double contrast barium study, demonstrates a flat filling defect (arrows) on the dorsolateral border of the middle segment of the oesophagus with smooth surface. • b. advanced tumor of the distal third of the oesophagus. The lesion has an ulcerative polypoid aspect with marked irregularity of the mucosa and causes narrowing of the organ over a distance of about 12 cm. • c. There is a marked stenosis and mucosal irregularity seen in this carcinoma of the cervical oesophagus invading cranially the upper oesohpageal sphincter.
Carcinomaof Esophagus- Confirm the diagnosis • Endscopy • Biopsy
Carcinomaof Esophagus- Investigations • X-ray chest • ultrasonography • CT or MRI of chest • abnomen endoscopic ultrasonography
Carcinomaof Esophagus- Differential diagnosis • Leiomyoma. • Lymphoma. • Commonest tumor in the esophagus is gastrointestinal stromal tumor（GIST）. • Others: Esophageal VaricesEsophagitis, InfectiousEsophagus, Foreign BodyHiatal HerniaSchatzki Ring
Carcinomaof Esophagus- Management • Upper and middle part –high voltage radiotherapy • Lower part-surgery (oesophago-gastrectomy) • Chemotherapy-using 5-Fluorouracil and cisplatin may be tried • Palliative therapy-endoscopic laser therapy,stent,endoscopic gastrostomy and tube feeding • Palliative radiotherapy
Im 7 perforate to mediastinum
Achalasia of the esophagus • A motility disorder charaterised by failure to dilate the lower esophagus sphincter due to absence or reduction of the ganglion cells of Auerbach’s plexus. • There may be degenerative change of vagus nerve nuclei in the brain system.
Achalasia of the esophagus-Presentations • Commonly in middle age • Dysphagia-may be intermittent initially, worse for solid, both solid and liquid. • Regurgitation of food. • Chest discomfort or pain (due to spasm). Sometimes, severe chest pain called vigorous achalasia. • Repeated respiratory infection or aspiration pneumonia. • Loss of weight.
Achalasia of the esophagus-Imaging • Stricture with smooth tapering at the lower end of esophagus • Dilatation of the esophagus in the middle and upper part with loss of peristalsis
Dilatation • Stricture smooth tapering Like the root of the carrot Like the bill of a bird
Differential diagnosis • Carcinoma of the esophagus (usually there is irregular narrowing) • Benign stricture of the esophagus (due to reflux esophagitis)
EsophagealVarices • Irregular worm-like filling defects
EsophagealVarices • Middle and lower part • Stripped or nodosity • Dilatation • Irregular wall
食管静脉曲张 • Involving whole of the esophagus • Stripped or nodosity • Dilatation • Irregular wall