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<ul><li>ESOPHAGUS </li></ul><ul><li>Extends from C6 to T11 or T12 </li></ul><ul><li>Atresia and Fistulas </li></ul><ul><li...
www.freelivedoctor.com
<ul><li>Webs, Rings and Stenosis </li></ul><ul><li>a)  webs: shelf-like protrusions into    lumen (max ~ 5 mm) </li></ul><...
www.freelivedoctor.com
www.freelivedoctor.com
i)  at squamocolumnar junction   of lower esophagus    Schatzki    ring or “B” ring. www.freelivedoctor.com
d)  encountered most often in women    > 40 yrs.  i)  etiology unknown ii)  episodic dysphagia with solid      food iii)  ...
MOTOR DYSFUNCTION 1.  Achalasia a)  “failure to relax” i)  aperistalsis ii)  incomplete relaxation of LES    with swallowi...
www.freelivedoctor.com
www.freelivedoctor.com
ii)  degenerative changes in neural    innervation -  extraesophageal vagal -  dorsal motor nucleus c)  2 o  – Chagas dise...
ii)  destruction of myenteric    plexus of esophagus,    duodenum, colon, ureter      dilation of the structures d)  most...
2.   Hiatal Hernia a)  sliding (~ 95% of cases) i)  protrusion of stomach above   diaphragm    bell shaped    dilation ii...
3.   Diverticula a)  “outpouching” of all visceral layers i)  false – only mucosa and sub  -   mucosa b)  types: i)  Zenke...
www.freelivedoctor.com
www.freelivedoctor.com
4.   Lacerations (Mallory-Weiss  syndrome)   a)  longitudinal tears i)  esophagogastric junction b)  severe retching and v...
www.freelivedoctor.com
www.freelivedoctor.com
<ul><li>Esophageal Varices </li></ul><ul><li>portal hypertension </li></ul><ul><li>a)  induces collateral circulation </li...
www.freelivedoctor.com
<ul><li>e)  40-50% of patients die with first    bleeding episode </li></ul><ul><li>i)  does not stop spontaneously </li><...
c)  causes: i)     LES tone ii)  sliding hiatal hernia iii)  slowed esophageal clearance iv)  delayed gastric emptying   ...
e)  clinical: i)  > 40 yrs. ii)  dysphagia iii)  heartburn iv)  hematemesis or melena v)  damage associated with    chroni...
<ul><li>Barrett Esophagus </li></ul><ul><li>Complication of long standing GERD </li></ul><ul><li>Most important risk facto...
www.freelivedoctor.com
www.freelivedoctor.com
www.freelivedoctor.com
<ul><li>patients have long history of heartburn </li></ul><ul><li>Dysplasia may represent areas of </li></ul><ul><li>adeno...
www.freelivedoctor.com
<ul><li>Infections and Chemical Esophagitis </li></ul><ul><li>GERD (chemical injury) </li></ul><ul><li>mucosal irritants <...
www.freelivedoctor.com
www.freelivedoctor.com
<ul><li>Tumors </li></ul><ul><li>Malignant </li></ul><ul><li>a)  in USA ~ 6% of all CA of GI tract </li></ul><ul><li>i)  d...
c)   Squamous cell CA i)  most common type (Worldwide) ii)  adults > 50 yrs iii)  Iran, China, South Africa and    Brazil ...
TYLOSIS A genetic disorder characterized by thickening (hyperkeratosis) of the palms and soles, white patches in the mouth...
vi)  insidious onset -  dysphagia -  obstruction -  aspiration via fistula -  recurrence (local and    distant) is common ...
iii)  clinical: patient usually    present with the following -  dysphagia -  bleeding -  weight loss -  GERD -  sliding h...
e)  benign i)  Leiomyoma   is most common -  Usually asymptomatic          -  May produce dysphagia or    hematemesis if l...
Large filling defect with sharply-marginated border is seen in distal esophagus.   www.freelivedoctor.com
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Oesophagous pathology

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Oesophagous pathology

  1. 1. <ul><li>ESOPHAGUS </li></ul><ul><li>Extends from C6 to T11 or T12 </li></ul><ul><li>Atresia and Fistulas </li></ul><ul><li>a) part of esophagus with a “blind pouch” </li></ul><ul><li>i) usually associated with fistula </li></ul><ul><li>b) associated anomalies: </li></ul><ul><li>i) CH disease </li></ul><ul><li>ii) neurologic disease </li></ul><ul><li>iii) GI malformations </li></ul><ul><li>iv) genitourinary disease </li></ul>www.freelivedoctor.com
  2. 2. www.freelivedoctor.com
  3. 3. <ul><li>Webs, Rings and Stenosis </li></ul><ul><li>a) webs: shelf-like protrusions into lumen (max ~ 5 mm) </li></ul><ul><li>b) when upper esophageal web is associated with iron deficiency anemia, glossitis and cheilosis </li></ul><ul><li>  “ Plummer-Vinson Syndrome” </li></ul><ul><li>i)  risk of post cricoid esophageal CA </li></ul><ul><li>c) Rings protruding into distal esophagus. </li></ul>www.freelivedoctor.com
  4. 4. www.freelivedoctor.com
  5. 5. www.freelivedoctor.com
  6. 6. i) at squamocolumnar junction of lower esophagus  Schatzki ring or “B” ring. www.freelivedoctor.com
  7. 7. d) encountered most often in women > 40 yrs. i) etiology unknown ii) episodic dysphagia with solid food iii) pain infrequent www.freelivedoctor.com
  8. 8. MOTOR DYSFUNCTION 1. Achalasia a) “failure to relax” i) aperistalsis ii) incomplete relaxation of LES with swallowing iii)  resting tone of LES b) 1 o - etiology poorly understood i) dysfunction of inhibitory neurons in distal esophagus - NO - VIP www.freelivedoctor.com
  9. 9. www.freelivedoctor.com
  10. 10. www.freelivedoctor.com
  11. 11. ii) degenerative changes in neural innervation - extraesophageal vagal - dorsal motor nucleus c) 2 o – Chagas disease i) Trypanosoma cruzi www.freelivedoctor.com
  12. 12. ii) destruction of myenteric plexus of esophagus, duodenum, colon, ureter  dilation of the structures d) most cases present as 1 o achalasia e) diabetic neuropathy, infiltrative disorders, etc. f) young adulthood g) Clinical: i) progressive dysphagia ii) nocturnal aspiration iii) 5% incidence of CA www.freelivedoctor.com
  13. 13. 2. Hiatal Hernia a) sliding (~ 95% of cases) i) protrusion of stomach above diaphragm  bell shaped dilation ii) ~ 10% suffer from reflux b) paraesophageal i) separate portion of stomach enters thorax c) etiology unknown d) Clinical: i) strangulation (b) ; ulceration www.freelivedoctor.com
  14. 14. 3. Diverticula a) “outpouching” of all visceral layers i) false – only mucosa and sub - mucosa b) types: i) Zenker - above UES ii) traction - midpoint of esophagus iii) epiphrenic - above LES www.freelivedoctor.com
  15. 15. www.freelivedoctor.com
  16. 16. www.freelivedoctor.com
  17. 17. 4. Lacerations (Mallory-Weiss syndrome) a) longitudinal tears i) esophagogastric junction b) severe retching and vomiting i) commonly seen in alcoholics ii) massive dilation with tearing c) underlying hiatal hernia is also known factor d) 5-10 % of upper GI bleeds i) easily treated ii) rare rupture “Boerhaave” www.freelivedoctor.com
  18. 18. www.freelivedoctor.com
  19. 19. www.freelivedoctor.com
  20. 20. <ul><li>Esophageal Varices </li></ul><ul><li>portal hypertension </li></ul><ul><li>a) induces collateral circulation </li></ul><ul><li> wherever portal and caval systems </li></ul><ul><li> communicate </li></ul><ul><li>b) in area of lower esophagus </li></ul><ul><li>i)  pressure in esophagus </li></ul><ul><li>- tortuous vessels called “varices” </li></ul><ul><li>c) develop in ~ 90% of patients with cirrhosis (USA) </li></ul><ul><li>d) world  schistosomiasis </li></ul>www.freelivedoctor.com
  21. 21. www.freelivedoctor.com
  22. 22. <ul><li>e) 40-50% of patients die with first bleeding episode </li></ul><ul><li>i) does not stop spontaneously </li></ul><ul><li>Esophagitis </li></ul><ul><li>Inflammation of mucosa </li></ul><ul><li>a) ~ 5% in USA </li></ul><ul><li>b) GERD (gastroesophageal reflux disease) </li></ul><ul><li>i) reflux of gastric contents is most important cause of esophagitis </li></ul>www.freelivedoctor.com
  23. 23. c) causes: i)  LES tone ii) sliding hiatal hernia iii) slowed esophageal clearance iv) delayed gastric emptying or  gastric volume v)  repair due to chronic acid exposure d) inflammation: i) neutrophils, eosinophils, lymphocytes in squamous epithelial layer www.freelivedoctor.com
  24. 24. e) clinical: i) > 40 yrs. ii) dysphagia iii) heartburn iv) hematemesis or melena v) damage associated with chronic acid exposure - bleeding - chest pain - ulceration - stricture - Barrett esophagus www.freelivedoctor.com
  25. 25. <ul><li>Barrett Esophagus </li></ul><ul><li>Complication of long standing GERD </li></ul><ul><li>Most important risk factor for </li></ul><ul><li>adenocarcinoma </li></ul><ul><li>distal squamous mucosa replaced by </li></ul><ul><li>metaplastic columnar epithelium as </li></ul><ul><li>response to chronic injury (protective!) </li></ul><ul><li>criteria for diagnosis: </li></ul><ul><li>a) endoscopic evidence of columnar </li></ul><ul><li> cells (  gastroesophageal junction) </li></ul><ul><li>b) histology evidence of metaplasia </li></ul>www.freelivedoctor.com
  26. 26. www.freelivedoctor.com
  27. 27. www.freelivedoctor.com
  28. 28. www.freelivedoctor.com
  29. 29. <ul><li>patients have long history of heartburn </li></ul><ul><li>Dysplasia may represent areas of </li></ul><ul><li>adenocarcinoma </li></ul><ul><li>clinical: </li></ul><ul><li>a) local ulceration with bleeding and stricture </li></ul><ul><li>b) short vs. long Barrett </li></ul><ul><li>- short segment < 3 cm (? % CA) </li></ul><ul><li>- long segment > 3 cm </li></ul><ul><li> (40-fold risk of CA) </li></ul>www.freelivedoctor.com
  30. 30. www.freelivedoctor.com
  31. 31. <ul><li>Infections and Chemical Esophagitis </li></ul><ul><li>GERD (chemical injury) </li></ul><ul><li>mucosal irritants </li></ul><ul><li>a) alcohol </li></ul><ul><li>b) hot fluids (Tea in Iran) </li></ul><ul><li>c) cytotoxic drugs </li></ul><ul><li>d) infections </li></ul><ul><li>i) HSV </li></ul><ul><li>ii) CMV </li></ul><ul><li>e) uremia (via renal failure) </li></ul><ul><li>f) radiation </li></ul><ul><li>g) autoimmune disease </li></ul>www.freelivedoctor.com
  32. 32. www.freelivedoctor.com
  33. 33. www.freelivedoctor.com
  34. 34. <ul><li>Tumors </li></ul><ul><li>Malignant </li></ul><ul><li>a) in USA ~ 6% of all CA of GI tract </li></ul><ul><li>i) disproportionate death rate </li></ul><ul><li>- “silent” killer </li></ul><ul><li>b) in USA - squamous cell and adenocarcinoma </li></ul><ul><li>i) worldwide – 90% are squamous </li></ul><ul><li>ii) rare tumors from submucosa </li></ul>www.freelivedoctor.com
  35. 35. c) Squamous cell CA i) most common type (Worldwide) ii) adults > 50 yrs iii) Iran, China, South Africa and Brazil have  incidence iv) in USA mainly adult males (4:1); blacks 4x higher v) diet and environmental factors (see table 17-1) - nitrosamines (p53) China! - in USA, alcohol and tobacco use www.freelivedoctor.com
  36. 36. TYLOSIS A genetic disorder characterized by thickening (hyperkeratosis) of the palms and soles, white patches in the mouth (oral leukoplakia ), and risk of esophageal cancer . Only genetic syndrome known to predispose to squamous cell carcinoma . Autosomal dominant inheritance. The gene has been mapped to chromosome 17q25 but has not been identified. The syndrome is also called nonepidermolytic palmoplantar keratoderma. www.freelivedoctor.com
  37. 37. vi) insidious onset - dysphagia - obstruction - aspiration via fistula - recurrence (local and distant) is common following surgery d) adenocarcinoma i) most arise from the Barrett mucosa (NOT gastric mucosa) ii) white men, > 40 yrs - more common in USA www.freelivedoctor.com
  38. 38. iii) clinical: patient usually present with the following - dysphagia - bleeding - weight loss - GERD - sliding hiatal hernia - poor prognosis - elimination of Barrett esophagus NOT yet shown to prevent adenocarcinoma www.freelivedoctor.com
  39. 39. e) benign i) Leiomyoma is most common - Usually asymptomatic         - May produce dysphagia or hematemesis if large          - typically occurs in young males          - Found most often in distal third of esophagus          - Usually solitary, but may be multiple (3%) www.freelivedoctor.com
  40. 40. Large filling defect with sharply-marginated border is seen in distal esophagus. www.freelivedoctor.com

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