Gerd

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Gerd

  1. 1. GERD Dr/ Hytham Nafady
  2. 2. Definition • Excessive retrograde movement of the acid containing gastric secretions into the esophagus.
  3. 3. Patho-physiology of GERD The esophagus is Poor esophageal result in decrease in clearance an antegrade pump motility of the acidic secretions. The LES is a valve. LES dysfunction result in reflux of large (this is the most amounts of acidic gastric common cause). secretions. The stomach is a reservoir. Delayed gastric emptying result in increased gastric volume & pressure.
  4. 4. Role of hiatus hernia in GERD • Hiatus hernia  Intrathoracic migration of the LES  loss of its abdominal high pressure.
  5. 5. Complications of GERD Esophagitis Inflammation of the esophageal mucosa with erythema, erosions & ulcers. Stricture Circumferential fibrosis due to deep injury. Barret’s esophagus (premalignant) Columnar metaplasia of the esophageal stratified squamous epithelim.
  6. 6. C.P • Heart burn, • Regurgitation & • Dysphagia for solids and liquids.
  7. 7. CXR • Hiatal hernia. • Aspiration pneumonia.
  8. 8. Trendlenberg position
  9. 9. Findings of reflux esophagitis 1. 2. 3. 4. Granular mucosal pattern. Shallow ulcers in the distal esophagus. Esophago-gastric pseudo-polyp. Transverse fixed mucosal folds (step ladder pattern). 5. Buckering & sacculations. 6. Feline esophagus. 7. Peptic stricture. 8. Schatizki ring. 9. Barret’s esophagus. 10.Pseudo-diverticulosis.
  10. 10. Granular or finely nodular mucosa • Numerous ill defined lucencies on mucosal surface. Pathology: • inflammation & edema.
  11. 11. GERD Candida esophagitis Fine granular mucosa Foamy esophagus Mucosal edema Plaques or pseudomembranes Nodules have illdefined margins that fade out peripherally. Nodules have well defined margins.
  12. 12. Shallow ulcers in the distal esophagus
  13. 13. inflammatory esophago-gastric polyp • A single thickened mucosal fold arising at the gastric cardia & extending through the gastroesophageal junction.
  14. 14. Thick fixed transverse folds (step ladder pattern) • Crinkled mucosa due to longitudinal scarring.
  15. 15. Step ladder pattern Feline esophagus Thick fixed transverse folds Fine transient transverse folds Longitudinal scarring. Contraction of muscularis mucosa. Localized. Extend for more than 1/2 way across the esophagus.
  16. 16. Puckering & sacculations: • Due to eccentric scarring.
  17. 17. Feline esophagus: • Transient transverse folds due to contraction of longitudinal muscularis mucosa.
  18. 18. Hiatal hernia  reflux esophagitis (feline esophagus)
  19. 19. Peptic stricture • Smooth tapered area of concentric narrowing of the distal esophagus due to circumferential scarring.
  20. 20. Schatizki ring = narrowed B ring • Pathological ring at the gastro-esophageal junction that causes dysphagia & measures less than 13 mm in diameter.
  21. 21. Schatzki ring
  22. 22. Esophageal rings
  23. 23. Esophageal rings A ring Muscular ring at the junction between tubular and vestibular esophagus. B ring Mucosal ring at the squamocolumnar junction (z line) If narrowed < 13 mm  pathological Schatizki ring
  24. 24. Barret esophagus Pathology: • Columnar metaplasia of the esophageal stratified squamous epithelium. Findings: • Mid esophageal stricture • Reticular mucosal pattern.
  25. 25. Pseudo-diverticulosis
  26. 26. TTT • Laparoscopic Nissen fundoplicatoin.
  27. 27. Nissen fundoplication • Smooth narrowing of the GEJ 2-3 below the diaphragmatic hiatus.
  28. 28. Post-operative complications • Dysphagia (tight Nissen fundoplication). • Perforation.
  29. 29. Tight Nissen fundoplication
  30. 30. Perforation after Nissen fundoplication

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