Gastrointestinal infections

1. College of Nursing and midwifery
Department of Adult health nursing
Individual Seminar presentation on
Disorder of Easophagus
By Amensisa Debesa (ID 176/15)
Presented to Mr Tadele k. (Assistant
professor)
Salale Ethiopia
Sep 20/2023
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2. OUTLINE
 Objective
 Introduction
Definition of esophagus Function & disorder
Pathologic condition of Esophagus:
Achalasia
Hiatal hernia
GERD
Esophageal Varices
Esophagities
Esophageal cancer
 Summary
Achnowlegment
 Referance
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3. Objectives
 After the end of our sessetion we able:
 To underst anatomy & physiology of esophagus.
 Explain the types of esophageal disorder.
 To know the pathology of each disorder.
 Describe the management of esophageal disorder.
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4. INTRODUCTION
Anathomy &Physiology of Esophagus:
The esophagus extends from the oropharynx to
the stomach.
At the top of the esophagus is the upper
esophageal sphincter (UES).
• This prevent the influx of air into the esophagus
during respiration.
At the bottom of the esophagus is the lower
esophageal sphincter (LES) to prevent the reflux of
acid from the stomach into the esophagus.
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5. Cont…
 Esophagus has two main functions:
1- Transport of food by peristalsis
2- Prevention of gastric regurgitation by LES/UES
- It is supplied by the vagus nerve & sympathetic trunk.
- Dysphagia is sensation of obstruction of food passage
or Difficulty in swallowing, has mechanical and
neuromuscular causes.
- Odynophagia is painful swallowing.
- Both dysphagia and odynophagia will result in weight
loss, eventually.
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6. Disorders of the Esophagus
DYSPHAGIA
It is a difficulty of swallowing and is the most common
symptom of esophageal disease.
This symptom may vary from an uncomfortable feeling in
the upper esophagus to acute pain on swallowing
(odynophagia).
Obstruction of food and even liquids may occur anywhere
along the esophagus.
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7. Pathologic Condition of Esophagus
Often the patient can indicate where the
problem is located in the esophagus.
Pathologic conditions of the esophagus,
includes :
Motility disorders (achalasia, diffuse spasm)
Gastro esophageal reflux disease (GERD)
Hiatal hernias
Esophagits
Perforation
Foreign bodies
Chemical burns
Benign tumors and carcinoma.
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8. ACHALASIA
Achalasia is absent or ineffective peristalsis of the distal
esophagus,
It is accompanied by failure of the esophageal sphincter
to relax in response to swallowing.
Epidemologically Achalasia may progress slowly and
occurs most comman in people 40 years of age or older.
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9. Ethiology
Primary (idiopathic)
Degeneration and loss of ganglion cells cause a
defect in the innervations of the esophagus
Resulting absence of complete LES relaxation and
absence of peristalsis
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10. Clinical manifestation
Difficulty in swallowing both liquids and solids.
Sensation of food sticking in the lower portion of the
esophagus.
Food regurgitation( commonly in advanced stage).
Weight loss can be a late manifestation
Chest pain and heartburn (pyrosis).
Pain may or may not be associated with eating.
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11. Treatment
There is no curative treatment for achalasia
The aim is to decrease the LES pressure either
chemically(medications) or mechanically (by
forceful stretching) .
Smooth muscle relaxants such as
• Calcium channel blockers and
• Nitrates, have been used with limited
success.
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12. CONT…
Ex. Nifedipine, 10–20 mg, or isosorbide
dinitrate, 5–10 mg solution
Forceful dilation of the LES using balloons,
pneumatic (forceful) dilation
Pneumatic dilation has a high success rate
Is effective in 85%cases , with 3–5% risk of
perforation or bleeding.
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13. CONT…
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14. Nursing care of pt’s with achalasia
The patient should be instructed to eat slowly and to
drink fluids with meals
Semisoft ,warm foods are better tolerated than cold,
hard foods ,the client should avoid hot, iced foods as
well as alcohol and tobacco.
All foods should be chewed thoroughly to add saliva
to mixture, providing lubrication and allowing the
bolus to pass more easily.
To prevent nocturnal reflux of food the client should
sleep with head of the bed elevated.
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15. HIATAL HERNIA
• Some times also known as a diaphragmatic or
esophageal hernia.
• A part of the stomach protrudes up through the
diaphragm near the esophagus into the chest.
• Patients may be asymptomatic or have daily
symptoms of gastro esophageal reflux disease
(GERD).
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16. CONT…
Hiatal hernia
Is characterized by separation of the diaphragmatic crura and
widening of the space between the muscular crura and
esophageal wall
Two patterns:
 Sliding hiatal hernia
-constitutes 90% of the cases
-is protrusion of the stomach above the diaphragm creating a
bell shaped dilation
 Paraesophageal(Rolling) hiatal hernia:
-a separate portion of the stomach usually along the greater
curvature enters the thorax
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17. CONT…
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18. CONT…
• The hernia may be:
 A sliding hiatal hernia:- is known as type I hernia.
Accounts about 90% of total hiatal hernia
Allows movement of the upper portion of the stomach
including the lower esophageal sphincter up and down
through the diaphragm.(not intact)
These patients typically have symptoms of GERD.
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19. CONT…
Etiology. The actual cause of sliding h/hernia is
unknown(idiopatic).
Predisposing factors
Structural changes, such as weakening of the
muscles in the diaphragm around the
esophagogastric opening
Factors that increase intraabdominal pressure:
e.g Obesity, pregnancy, ascites, tumors, tight corsets,
intense physical exertion and heavy lifting on a
continual basis
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20. Cont…
Other predisposing factors are:
Increased age
Trauma
Poor nutrition and
A forced recumbent position
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21. CONT…
 Clinical manifestation(a sliding of hiatal hernia)
In sliding hernia 50% patients are asymptomatic
Heart burn, Regurgitation
Dysphagia, symptoms of reflux
Substernal pain, burning, non radiating,
position dependent epigastric pain,
substernal tightness
Symptoms may be exacerbated by gastric
irritants(alcohol, tobacco, caffeine)
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22. CONT…
 B rolling hernia:- known as Paraesophageal (type
II) hernia.
Portion of the stomach separation up through the
diaphragm, but the lower esophageal sphincter
area remains below the level of the diaphragm.
These patients do not generally suffer from
reflux.
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23. Clinical Manifestations
A sense of fullness after eating
Does not have symptoms of reflux
Chest pain
Reflux usually does not occur, because the
gastroesophageal sphincter is intact.
• Complication for both (type I and II)
 Hemorrhage, obstruction, and strangulation can occur
with any type of hernia.
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24. Nursing Management
Frequent, small feedings that can pass easily through the
esophagus.
No food intake several hours before bed
Weight reduction
Sleep with head at 300
Avoid gastric irritants, alcohol, tobacco and caffeine
Regular use of anti acids
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25. CONT…
The patient is advised not to recline for 1 hour after eating,
to prevent reflux or movement of the hernia,
Elevate the head of the bed 10- to 20-cm blocks to prevent
the hernia from sliding upward.
Avoid lifting and straining
If overweight, the patient should be encourage to lose
weight
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26. GERD
 Condition involving LES weakness and
inappropriate opening, leading to reflux of
gastric contents into the esophagus.
 GERD may occur when the pressure of the
high-pressure zone in the distal esophagus is
too low to prevent gastric contents from
entering the esophagus (when the LES is
NOT contracting well).
 Very common condition that affects
approximately 20% of adults.
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27. Risk factors
• Increased body mass index(BMI)
• Dietary factors
• Anatomical condition(ex.hiatal hernia).
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28. S/S
• Heartburn
• Chest pain
• Regurgitation
• Coughing
• Hoarseness
• Sour Taste in mouth
• Excessive salivation
• Dysphagia
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29. Classic GERD: burning, agrev. With position
Complicated GERD: Odynophagia, dyspahagia.
Extra esophegeal GERD: pulmonary, ENT, others
Diagnosis. Ambulatory pH monitoring (gold standard)
-Barium Swallow
-Endoscopy
Treatment:
Lifestyle Modifications #1
-Acid Suppression
-Anti-Reflux Surgery
-Endoscopic AntirefluxTherapies
Symptoms
Cont…
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30. Esophageal varices
• Collaterals that develop in the region of the lower
esophagus during portal hypertension
• The increased pressure in the esophageal plexus
produces dilated tortuous(twisted) vessels called
varices
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31. Etiology
• Liver cirrhosis
• Alcoholics
• Increase portal pressure
• Massive bleeding
• Engorged, serpentine in submucosa
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32. CONT…
• Varices develop in 90% of cirrhotic patients and
are most often associated with alcoholic cirrhosis
• Schistosomiasis is the second most common cause
• Variceal rupture produces massive hemorrhage
• Clinically varices produce no symptoms until they
rupture
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33. Diagnosis
• CBC, PT, PTT, LFT
• Esophago Gastro Duodenoscopy
• EGD
RX: Decrease blood flow
put on rubber band around enlarged vein.
Relieving portal HT
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34. Esophagitis
Condition involving inflammation of the
esophagus.
Reflux esophagitis
reflux of gastric contents into the lower esophagus
is the first and foremost cause of esophagitis
Associated causative factors
 decreased efficacy of esophageal antireflux
mechanisms
 presence of a sliding hiatal hernia
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35. CONT…
inadequate or slowed esophageal clearance of
refluxed material
delayed gastric emptying
reduction in the reparative capacity of the
esophageal mucosa
Morphologic changes include
-simple hyperemia
-inflammatory infiltrate
-basal zone hyperplasia
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36. Types of Esophagitis
1 Erosive esophagitis
2 Infective esophagitis
3 Radiation esophagitis
4 pill-induced esophagitis
5 eosinophilic esophagitis
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37. Clinical manifestation
• dysphagia
• heart burn
• Chest pain
• Oral thrush
• regurgitation of sour brash
• hematemesis or melena
• Complications
• Bleeding& perforation
• Stricture
• Fistulas
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38. Cont…
• Complications
• Bleeding& perforation
• Stricture
• Fistulas
Diagnosis:
• History and patient characteristics
• Endoscopy with biopsy (Gold standard) -barium
swallow
• 24 hour pH monitoring and motility
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39. CONT…
Treatment: based on etiology
• Proton pump inhibitors(ex.pantoprazole)
• Antireflux like Lifestyle modification.
• Acid suppressing agent.
• Surgery
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40. Esophageal Cancer
 Disease more in Males > 50 Years.
 Causation factors:
1) Excess alcohol
2) Cigarette smoking
3)Fungal toxin.- Mucosal damage: A) Hot tea B) Radiation
induced stricture C) Barrett’s esophagus
4) Esophageal web.- 15% affect the upper ⅓ , 45% affect the
middle ⅓ , 40% affect the lower ⅓.
There are two pathologic types: squamous cell carcinoma
(>75% of cases) and adenocarcinoma
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41.  Dysphagia
 Weight loss
 Odynophagia (pain with swallowin
 Tracheoesophageal or Broncho-esophageal fistula
(The tumor penetrates through the esophagus)
 Regurgitation
 Anorexia
 Aspiration pneumonia
 Chest pain
 Hematemesis, hoarseness of voice (recurrent
laryngeal nerve involvement)
Clinical features
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42. 1 Barium swallow useful in evaluation of dysphagia.
2. Upper endoscopy with biopsy
3. After confirming the diagnosis of esophageal
cancer by endoscopy with biopsy, Transesophageal
Ultrasound helps determine the depth of penetration
of the tumor and is the most reliable test for staging
local cancer.
4. Full metastatic workup (e.g., CT scan of
chest/abdomen, CXR).
Diagnosis
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43. Treatment
1. Palliative care is the goal in most patients
because the disease is usually advanced at
presentation.
2. Surgery (esophagectomy) if localized may be
curative for patients with disease in stage 0, 1,
3. Chemotherapy
4. Radiation therapy
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44. summary
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45. ACKNOWLEDGEMEN
Next to Almaight my God I would like to acknowledge
our instructor Mr.Tadele K . (Assistant professors) for
give us the opportunity of doing this individual
assignment, which has given us an extensive
knowledge on Disorder of Esophagus.
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46. Referance
• Levine MS, Rubesin SE, Herlinger H, Laufer I. Double-
contrast upper gastrointestinal examination: technique and
interpretation. Radiology 1988;168:593–602.
• Ott DJ, Chen YM, Hewson EG, et al. Esophageal motility:
assessment with synchronous video tape fluoroscopy and
manometry. Radiology 1989;173:419–422
• Levine MS, Woldenberg R, Herlinger H,
Laufer I. Opportunistic esophagitis in AIDS: radiographic
diagnosis. Radiology1987;165:815–820
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47. END
THANKS!!
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