BENIGN ESOPH.pptx

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WinstonM3

benign esophageal diseases that present predominantly with dysphagia

Health & Medicine

ESOPHAGUS: BENIGN DISORDERS
Dr Winston Makanga, M.B.Ch.B., M.Med. (Surg)
Consultant General and Laparoscopic Surgeon

Outline
• Surgical gross and microscopic Anatomy
• Physiology of swallowing
• Diseases
• Presentation
• Investigation
• Management

Surgical anatomy
• Propulsion tube distal to UES ~25
• Divided into 3 parts
• 5 anatomical narrowings
• Skeletal muscle proximally
• 2-4 cm intra-abdominal

Microscopy
• Lined by stratified squamous epithelium
• No serosal envelope

Physiology of swallowing
• Pharyngeal phase
• Voluntary
• Coordinated by CN. IX, XII
• Esophageal phase
• Involuntary/peristaltic
• Coordinated by CN. X
• UES and LES are tonic at rest
• Primary vs secondary vs tertiary peristalsis

Spectrum of diseases
• Inflammatory mucosal conditions
• Viral/fungal esophagitis
• Neurological/functional dysphagia
• CVA, bulbar palsy
• Mechanical dysphagia
• Benign: strictures, webs
• Malignant
• Motility disorders
• Scleroderma, Chagas, Achalasia, Diffuse esophageal spasm
• Reflux
• Diverticula
• Zenkers, other diverticulae
• Trauma, corrosive injury

Presentation
• Dysphagia
• Odynophagia
• Chest pain
• Heartburn

Investigation
• CXR, neck ultrasound, blood tests
• Esophaghagogram
• Barium swallow, gastrographin
• Esophagoscopy
• Manometry
• Ph studies
• CT scan: chest, brain…

Management
• Directed to specific cause
• Dilatation
• Bouginage
• Balloon
• Stenting
• Heller’s myotomy
• Esophagectomy

Review
• Anatomy
• Physiology of swallowing
• Diseases
• Presentation
• Investigation
• Management

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