• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Esophagus review 1  Nir Hus MD., PhD.
 

Esophagus review 1 Nir Hus MD., PhD.

on

  • 860 views

Part 1 of 3, review on esophagus lecture, http://www.nirhus.com

Part 1 of 3, review on esophagus lecture, http://www.nirhus.com

Statistics

Views

Total Views
860
Views on SlideShare
860
Embed Views
0

Actions

Likes
0
Downloads
28
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Esophagus review 1  Nir Hus MD., PhD. Esophagus review 1 Nir Hus MD., PhD. Presentation Transcript

    • Esophagus Nir Hus MD, PhD. ABSITE Review Department of Surgery Mount Sinai Medical Center Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Esophagus: Anatomy Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Esophagus: Anatomy Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Esophagus: Anatomy Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Esophageal Studies
      • Anatomic
        • Esophagogram
        • CT-Scan
        • Endoscopy(Biopsy/Ultrasound)
      • Functional
        • Esophageal manometry
        • 24 hour pH probe
      Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Esophagus: Physiology Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Esophageal Manometry Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Esophageal Manometry: Swallowing Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
      • Intramural pressure
      • Length of LES
      • Abdominal length LES
      Characteristics of Lower Esophageal Sphincter Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Manometry LES: Pressure/Length Relationship Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • 24-Hour pH Monitoring Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Esophageal Motility Disorders
      • Esophageal Diverticula
        • Zenker ’ s (pulsion)
        • Epiphrenic
        • Traction (pulsion)
      • Functional Disorders
        • Achalasia
        • Diffuse esophageal spasm
        • Nutcracker esophagus
      Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Zenker ’ s Diverticulum
      • Dysphagia
      • Regurgitation undigested food
      • Aspiration
      • Unyielding cricopharingeous
      • Dx: barium swallow
      • No endoscopy
      • Tx: diverticulectomy/myotomy
      • Left cervical incision
      Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Achalasia
      • Dysphagia and regurgitation undigested food
      • Substernal/epigastric pain
      • Diagnosis and work-up: CXR, UGIS
      • endoscopy/bx: esophagitis, r/o Ca
      • Manometry:
        • aperistalsis
        • incomplete relaxation of LES
        • High resting pressure LES (>30 mmHg)
      Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Achalasia Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Achalasia: Treatment
      • Esophageal dilations, success rate: 70%
      • Botulinum toxin injections: short lived
      • Surgery: Heller myotomy, success rate: 95%
      • Indications:
        • children
        • vigorous achalasia
        • medical failures
      Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Achalasia: Heller Operation Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Diffuse Esophageal Spasm and Nutcracker Esophagus
      • Intermittent chest pain and dysphagia
      • Negative cardiac work-up
      • Manometry: normal LES, tertiary peristalsis
      • Treatment:
        • Medical: reduce stress and precipitating factors
        • NTG, Isosorbide, Nifedipine
        • Surgery: Full length myotomy, success rate 65%
      Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Nutcracker Esophagus Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • GERD
      • Abnormal exposure of distal esophagus to refluxed gastric juice
      • Etiology
        • Mechanically defective LES (60%)
        • Poor esophageal clearance
        • Gastric outlet obstruction
        • Functional delayed gastric emptying
        • Increased gastric acid secretion
        • inappropriate relaxation of LES
      Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • GERD
      • Symptoms
        • Substernal/epigastric burning pain
        • Regurgitation
        • Effortless emesis
        • Dysphagia
        • Flatulence
        • Atypical symptoms
      Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • GERD
      • Complications (20%)
        • Esophagitis
        • Stricture
        • Barrett ’ s esophagus
        • Ulceration
        • Esophageal shortening
      Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • GERD: Work-up
      • UGIS and EGD
      • Manometry: characterizes LES and motility
        • LES pressure < 6 mm Hg
        • Overall length < 2 cm
        • Abdominal length < 1 cm
      • Esophageal pH testing (sens/specif - 90%)
        • pH < 4 more than 1 hour and a half/24 hours (6%)
        • Composite score derived from: total time pH <4, upright time pH <4, supine time pH <4, # episodes, episodes >5 min, longest episode.
      Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • GERD: Treatment
      • Medical
        • Postural alterations
        • Dietary alterations
        • Pharmacologic
      • Surgery
        • Symptomatic reflux, manometric evidence of incompetent LES, and failure of medical therapy
        • Development of complications
      Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Nissen Fundoplication Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Belsey-Mark IV Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Collis Gastroplasty Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Barrett ’ s Esophagus
      • Columnar metaplasia of the distal esophagus at least 3-cm above GE junction or any length with intestinal metaplasia
      • Incidence
        • 2% of all endoscopies
        • 15% of all esophagitis
      • Types
        • Fundic
        • Junctional
        • Intestinal
      Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Barrett ’ s Esophagus
      • Dx; endoscopy/bx
      • Complications
        • Ulceration (50%)
        • Stricture (30%)
        • Low grade dysplasia (5-10%)
        • High grade dysplasia/ Ca in situ
        • Adenocarcinoma (2%)
      Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital
    • Barrett ’ s Esophagus
      • Asymptomatic uncomplicated Barret ’ s
        • Surveillance and yearly biopsies
      • Symptomatic uncomplicated Barret ’ s
        • treat as GERD
      • Barret ’ s Ulcers
        • aggressive medical therapy, recurrence or failure to heal - surgery
      • Barret ’ s Strictures
        • medical management and esophageal dilation
        • recurrence or persistence - surgery
      Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital