Abdominal diseases

1. B Y
D R . L A R A I B J A M I L R P H
ABDOMINAL DISEASES

2. CARCINOMA OF ESOPHAGUS
Carcinome: Carcinoma is a type of cancer that starts in cells
that make up the skin or the tissue lining organs, such as the
liver or kidneys.
Cancer:
abnormal cells that divide without control forming a mass called
a tumor.
Classification: A tumor can be cancerous or benign.
1. A cancerous tumor is malignant, meaning it can grow and
spread to other parts of the body.
2. A benign tumor means the tumor can grow but will not
spread.
Esophageal cancer, also called esophagus cancer, begins in the
cells that line the esophagus.

3. • Esophagus: esophagus is a long, hollow tube that runs
from your throat to your stomach. Your esophagus helps
move the food you swallow from the back of your throat
to your stomach to be digested.
• Esophageal cancer usually begins in the cells that line
the inside of the esophagus. Esophageal cancer can
occur anywhere along the esophagus.

5. • Metastasis: Specifically, cancer of the esophagus
begins in the inner layer of the esophageal wall and
grows outward.
• If it spreads through the esophageal wall, it can travel to
lymph nodes, which are the tiny, bean-shaped organs
that help fight infection,
• as well as the blood vessels in the chest and other
nearby organs.
• Esophageal cancer can also spread to the lungs, liver,
stomach, and other parts of the body, this is known as
metastasis (metastasis)= from primary to secondary
areas

7. Types:
• There are 2 major types of esophageal cancer:
• Squamous cell carcinoma. This type of esophageal cancer starts
in squamous cells that line the esophagus. It usually develops in the
upper and middle part of the esophagus.
• Adenocarcinoma. This type begins in the glandular tissue in the
lower part of the esophagus where the esophagus and the
stomach come together.
Mechanism: To develop adenocarcinoma of the esophagus, squamous
cells that normally line the esophagus are replaced by gland cells. This
type is uncommon. This typically occurs in the lower esophagus near
the stomach and is believed to be largely related to acid exposure to
the lower esophagus.

8. • Epidemiology: Esophageal cancer is the sixth most common
cause of cancer deaths worldwide. Incidence rates vary within
different geographic locations. In some regions, higher rates
of esophageal cancer cases may be attributed to tobacco and
alcohol use or particular nutritional habits and obesity.
• In addition, certain groups -- men, the elderly, and people
who are obese -- are at greater risk for esophageal cancer.
(eat more-stomach acidity)
• Risk of adenocarcinoma of the esophagus is higher in white
men, but squamous cell carcinoma of the esophagus is more
common in Asian men and men of color.

9. Causes:
Esophageal cancer occurs when cells in your esophagus
develop errors (mutations) in their DNA. The errors make
cells grow and divide out of control. The accumulating
abnormal cells form a tumor in the esophagus that can
grow to invade nearby structures and spread to other parts
of the body.

10. • Symptoms:
Signs and symptoms of esophageal cancer include:
• Difficulty swallowing (dysphagia)
• Weight loss without trying
• Chest pain, pressure or burning
• Worsening indigestion or heartburn
• Coughing or hoarseness (dry harsh voice)
Early esophageal cancer typically causes no signs or
symptoms.

11. Different stages of cancer:
• Stage 0 . Abnormal cells (not yet cancer) are found only in the
layer of cells that line the esophagus.
• Stage I . Cancer cells are found only in the layer of cells that line
the esophagus.
• Stage II . The cancer has reached the muscle layer or the outer
wall of the esophagus. In addition, the cancer may have spread to
1 to 2 nearby lymph nodes (small glands that are part of the
immune system).
• Stage III . The cancer has reached deeper into the inner muscle
layer or the connective tissue wall. It may have spread beyond
the esophagus into surrounding organ and/or has spread to more
lymph nodes near the esophagus.
• Stage IV . This is the most advanced stage. The cancer has spread
to other organs in the body and/or to lymph nodes far from the
esophagus.

12. Risk factors:
• Smoking or other use of tobacco
• Being obese
• Heavy alcohol use
• Having a steady habit of drinking very hot liquids
• Not eating enough fruits and vegetables
• Undergoing radiation treatment to the chest or upper abdomen
• Gastroesophageal reflux disease (GERD), in which contents and acid from the
stomach back up into the esophagus
• Barrett's esophagus, a condition that affects the lower part of the esophagus
and can lead to esophageal cancer; Barrett's esophagus may be caused by
GERD. Over time, stomach acid in the esophagus can cause changes in the
cells that increase risk for adenocarcinoma.
• ACID IN STOMACH—GERD---Barrett’s Esophagitis

13. Complications: As esophageal cancer advances, it can
cause complications, such as:
• Obstruction of the esophagus. Cancer may make it
difficult or impossible for food and liquid to pass through
your esophagus.
• Pain. Advanced esophageal cancer can cause pain.
• Bleeding in the esophagus. Esophageal cancer can
cause bleeding. Though bleeding is usually gradual, it
can be sudden and severe at times.

14. Preventions:
You can take steps to reduce your risk of esophageal
cancer. For instance:
• Quit smoking.
• Drink alcohol in moderation, if at all.
• Eat more fruits and vegetables.
• Maintain a healthy weight.

15. Diagnosis:
To diagnose esophageal cancer, your doctor will review
your symptoms, medical history, and examine you. In
addition, he or she may order certain blood tests and X-
rays (Barium X-ray)
• Endoscopy
• endosonography . Used during endoscopy, sound
waves bounce off organs in the body to create pictures
called sonograms. This test can provide more
information on the size and extent of the tumor.
.

16. • Thoracoscopy . (in thorax )
An endoscope is placed into
the chest through an incision
to examine the inside of the
chest to look for lymph nodes
and other chest organs that may
have cancer spread.
Thoracoscopy is a medical procedure involving internal examination,
biopsy, and/or resection of disease or masses within the pleural cavity
and thoracic cavity. Thoracoscopy may be performed either under
general anaesthesia or under sedation with local anaesthetic. It have
camera & different camera ports are located then those parts are
examined

17. • Laparoscopy .
The lighted tube is
inserted through
an incision in the
abdomen to examine
the abdominal organs
and take tissue samples
to check for cancer spread.

18. Treatmment:
• Surgery . Part or all of the esophagus may be removed.

19. • Radiation therapy. Kills cancer cells with radiation.
• Chemotherapy . Powerful drugs that attack cancer cells throughout the body;
typically used in combination with radiation therapy and/or surgery.
• Targeted therapy. Newer treatments that target specific aspects of a cancer to
curb cancer growth and spread.
• Immunotherapy. Helps the immune system to attack cancer cells.
• Photodynamic therapy. Targets cancer cells with a special laser light. (also for
esophagitis)
• Electrocoagulation. Uses electric current to destroy cancer cells.
• Cryotherapy. which uses an endoscope to apply a cold liquid or gas to
abnormal cells in the esophagus. The cells are allowed to warm up and then are
frozen again. The cycle of freezing and thawing damages the abnormal cells
(also for esophagitis)

20. DYSPHAGIA
Definition: Dysphagia refers to a difficulty in swallowing - it
takes more effort than normal to move food from the mouth
to the stomach.
Swallowing seems simple, but it's actually pretty
complicated. It takes your brain, several nerves and
muscles, two muscular valves, and an open,
unconstricted esophagus, or swallowing tube to work just
right.

21. DYSPHAGIA
Swallowing phases:
• First phase- In the first phase, food or liquid is contained in
the mouth by the tongue and palate (oral cavity). This phase is the only
one we can control.
• 2nd phase- The second phase begins when the brain makes the
decision to swallow. At this point, a complex series of reflexes begin.
The food is thrust from the oral cavity into the throat (pharynx). At the
same time, two other things happen: A muscular valve at the bottom of
the pharynx opens, allowing food to enter the esophagus, and other
muscles close the airway (trachea) to prevent food from entering the
airways. This second phase takes less than half a second.

22. DYSPHAGIA
• 3rd Phase- The third phase starts when food enters the
esophagus. This phase produces waves of
coordinated contractions (peristalsis). As the esophagus
contracts, a muscular valve at the end of the esophagus
opens and food is propelled into the stomach. The third
phase of swallowing takes six to eight seconds to
complete.

23. DYSPHAGIA
Symptoms:
• Having pain while swallowing (odynophagia)
• Having the sensation of food getting stuck in your throat or chest or
behind your breastbone (sternum)
• Being hoarse
• Bringing food back up (regurgitation)
• Having frequent heartburn
• Having food or stomach acid back up into your throat
• Unexpectedly losing weight
• Coughing or gagging when swallowing
• Having to cut food into smaller pieces or avoiding certain foods
because of trouble swallowing

24. DYSPHAGIA
Causes:
Achalasia. When your lower esophageal muscle (sphincter) doesn't relax properly to let food
enter your stomach, it may cause you to bring food back up into your throat. Muscles in the wall
of your esophagus may be weak as well, a condition that tends to worsen over time.
Diffuse spasm — the muscles in the esophagus contract in an uncoordinated way.
Esophageal ring. A thin area of narrowing in the lower esophagus can intermittently cause
difficulty swallowing solid foods.
GERD. Damage to esophageal tissues from stomach acid backing up into your esophagus can
lead to spasm or scarring and narrowing of your lower esophagus.
Eosinophilic esophagitis. This condition, which may be related to a food allergy, is caused by
an overpopulation of cells called eosinophils in the esophagus.

25. DYSPHAGIA
• Radiation therapy. This cancer treatment can lead to inflammation
and scarring of the esophagus.
• Esophageal tumors. Difficulty swallowing tends to get
progressively worse when esophageal tumors are present.
• Foreign bodies. Sometimes food or another object can partially
block your throat or esophagus. Older adults with dentures and
people who have difficulty chewing their food may be more likely to
have a piece of food become lodged in the throat or esophagus.

26. • Stroke — brain cells die due to lack of oxygen because blood
flow is reduced. If the brain cells that control swallowing are
affected, it can cause dysphagia.
• Myasthenia gravis (Goldflam disease) — the muscles
under voluntary control become easily tired and weak
because there is a problem with how the nerves stimulate the
contraction of muscles. This is an autoimmune disorder.

27. • Neurological disorders:
Parkinson's disease is a gradually progressive,
degenerative neurological disorder that impairs the
patient's motor skills.

28. Complications
• Difficulty swallowing can lead to:
• Malnutrition, weight loss and dehydration. Dysphagia can make it
difficult to take in adequate nourishment and fluids.
• Aspiration pneumonia. Food or liquid entering your airway when you
try to swallow can cause aspiration pneumonia, because the food can
introduce bacteria to the lungs.
• Choking. When food becomes impacted, choking can occur. If food
completely blocks the airway, and no one intervenes with a successful
Heimlich maneuver, death can occur.
choking= person’s airways are blocked example=child

29. DYSPHAGIA
Diagnosis:
• Cineradiography: An imaging test in which a camera is used to film internal
body structures. During the test, you will be asked to swallow a barium
preparation (liquid or other form that lights up under X-ray). An X-ray machine
with videotaping capability will be used to view the barium preparations
movement through the esophagus. This is often performed under the guidance
of a speech pathologist, an expert in swallowing as well as speech.
• Upper endoscopy: A flexible, narrow tube (endoscope) is passed into the
esophagus and projects images of the inside of the pharynx and esophagus on
a screen for evaluation.
• Manometry: This test measures the timing and strength of
esophageal contractions and muscular valve relaxation.

30. Manometry:
• You are not sedated. However, a topical anesthetic (pain-relieving medication) will be
applied to your nose to make the passage of the tube more comfortable.
• A small, flexible tube is passed through your nose, down your esophagus and into
your stomach. This tube is a high-resolution manometry catheter that is about 4 mm
in diameter. The tube does not interfere with your breathing. You will be seated while
the tube is inserted.
• You may feel some discomfort as the tube is being placed, but it takes only about a
minute to place the tube. Most patients quickly adjust to the tube’s
presence. Vomiting and coughing are possible when the tube is being placed, but are
rare.
• After the tube is inserted, you will be asked to lie on your left side. The end of the
tube exiting your nose is connected to a machine that records the pressure exerted
on the tube. Sensors at various locations on the tubing sense the strength of the
lower esophageal sphincter and muscles of the esophagus. During the test, you will
be asked to swallow a small amount of water to evaluate how well the sphincter and
muscles are working. The sensors also measure the strength and coordination of the
contractions in the esophagus as you swallow.
• The test lasts 10 to 15 minutes. When the test is over, the tube is removed. The
gastroenterologist will interpret the recordings that were made during the test.

31. Treatment:
• Swallowing therapy — this will be done with a speech and language therapist.
The individual will learn new ways of swallowing properly. Exercises will help
improve the muscles and how they respond.
• Diet — Some foods and liquids, or combinations of them, are easier to swallow.
While eating the easiest-to-swallow foods, it is also important that the patient
has a well-balanced diet.
• Feeding through a tube — if the patient is at risk of pneumonia, malnutrition, or
dehydration they may need to be fed through a nasal tube (nasogastric tube) or
PEG (percutaneous endoscopic gastrostomy). PEG tubes are surgically
implanted directly into the stomach and pass through a small incision in the
abdomen.

32. DYSPHAGIA
• Dilation — if the esophagus needs to be widened (due
to a stricture, for example), a small balloon may be
inserted and then inflated (it is then removed).
• Botulinum toxin (Botox) — commonly used if the
muscles in the esophagus have become stiff (achalasia).
Botulinum toxin is a strong toxin that can paralyze the
stiff muscle, reducing constriction.

33. STOMATITIS
• Definition: Stomatitis is inflammation of the mouth and lips.
It refers to any inflammatory process affecting the mucous
membranes of the mouth and lips, with or without oral
ulceration. In its widest meaning, stomatitis can have a
multitude of different causes and appearances.
• Types:
1. Herpes Stomatitis (Cold sore)
2. Aphthous Stomatitis/Canker sore
3. Denture Stomatitis (inflammation of mouth due to dentures)

34. • Symptoms:
Same as cold sore & canker sore
• Treatment:
Same as cold sore & canker sore