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Esophag e al diseases. Carcinoma o f Esophag us Achalasia of the esophagus Esophag e al V arices. Esophag e al Carcinoma -Causes . Causes are unknown. Predisposing factors are- smoking Alcoholism Chewing betel nuts or tobacoo Achalasia of esophagus Post-cricoid web

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esophag e al diseases
Esophageal diseases
  • Carcinomaof Esophagus
  • Achalasia of the esophagus
  • EsophagealVarices
esophag e al carcinoma causes
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
carcinoma o f esophag us presentations
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
carcinoma o f esophag us sites
Carcinomaof Esophagus- Sites
  • Upper part—15%
  • Middle part—45%
  • Lower part—40%
carcinoma o f esophag us pathological types
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.
carcinoma o f esophag us diagnosis
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.
carcinoma o f esophag us investigations
Carcinomaof Esophagus- Investigations
  • X-ray chest
  • ultrasonography
  • CT or MRI of chest
  • abnomen endoscopic ultrasonography
carcinoma o f esophag us differential diagnosis
Carcinomaof Esophagus- Differential diagnosis
  • Leiomyoma.
  • Lymphoma.
  • Commonest tumor in the esophagus is gastrointestinal stromal tumor(GIST).
  • Others:

Esophageal VaricesEsophagitis, InfectiousEsophagus, Foreign BodyHiatal HerniaSchatzki Ring

carcinoma o f esophag us management
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
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
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
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
  • Stricture

smooth tapering

Like the root of the carrot

Like the bill of a bird

differential diagnosis
Differential diagnosis
  • Carcinoma of the esophagus (usually there is irregular narrowing)
  • Benign stricture of the esophagus (due to reflux esophagitis)
esophag e al v arices
  • Irregular worm-like filling defects
esophag e al v arices33
  • Middle and lower part
  • Stripped or nodosity
  • Dilatation
  • Irregular wall
  • Involving whole of the esophagus
  • Stripped or nodosity
  • Dilatation
  • Irregular wall