This document discusses disorders of the esophagus, including obstructive and vascular diseases. It describes the normal anatomy of the esophagus and its histology. Specific disorders covered include atresia, stenosis, achalasia, hiatal hernia, esophageal varices, and various types of esophagitis. Achalasia is characterized by incomplete relaxation of the lower esophageal sphincter. Esophageal varices occur due to portal hypertension, most commonly from cirrhosis of the liver. Various types of esophagitis discussed include those caused by reflux, chemicals, infections, and eosinophilic esophagitis.
Different esophageal disorders are discussed in this lecture. The learning objectives are to understand:
The anatomy and physiology of the oesophagus and their relationship to disease.
The clinical features, investigations, and treatment of benign and malignant disease with particular reference to the common adult disorders.
Topics include: Surgical anatomy, Physiology, Symptoms, Investigations, Congenital lesions: TOF and Atresia, Benign tumours, Cancer of oesophagus, Foreign bodies,Oesophageal perforation, Gastro-oesophageal reflux diease, Hiatal hernia,
Oesophageal motility disorders: achalasia and diffuse spasm, Oesophgeal diverticula.
and Others.
Different esophageal disorders are discussed in this lecture. The learning objectives are to understand:
The anatomy and physiology of the oesophagus and their relationship to disease.
The clinical features, investigations, and treatment of benign and malignant disease with particular reference to the common adult disorders.
Topics include: Surgical anatomy, Physiology, Symptoms, Investigations, Congenital lesions: TOF and Atresia, Benign tumours, Cancer of oesophagus, Foreign bodies,Oesophageal perforation, Gastro-oesophageal reflux diease, Hiatal hernia,
Oesophageal motility disorders: achalasia and diffuse spasm, Oesophgeal diverticula.
and Others.
Gastrointestinal bleeding (GI bleed), also known as gastrointestinal hemorrhage, is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.
Image result for gastritis
Gastritis is a general term for a group of conditions with one thing in common: inflammation of the lining of the stomach. The inflammation of gastritis is most often the result of infection with the same bacterium that causes most stomach ulcers.
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A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a number of types. Most commonly they involve the abdomen, specifically the groin. Groin hernias are most commonly of the inguinal type but may also be femoral
In the vedio you can see how the presentation was supposed to be
The link :
http://www.youtube.com/watch?v=MFBdaSF-JqM
To download my Animated presentation vist
https://www.dropbox.com/s/qg6ie3mpcbvp793/Gastric.Ulcer.ToPost.pptx
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Gastrointestinal bleeding (GI bleed), also known as gastrointestinal hemorrhage, is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.
Image result for gastritis
Gastritis is a general term for a group of conditions with one thing in common: inflammation of the lining of the stomach. The inflammation of gastritis is most often the result of infection with the same bacterium that causes most stomach ulcers.
Search Results
Featured snippet from the web
A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a number of types. Most commonly they involve the abdomen, specifically the groin. Groin hernias are most commonly of the inguinal type but may also be femoral
In the vedio you can see how the presentation was supposed to be
The link :
http://www.youtube.com/watch?v=MFBdaSF-JqM
To download my Animated presentation vist
https://www.dropbox.com/s/qg6ie3mpcbvp793/Gastric.Ulcer.ToPost.pptx
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An undergraduate lecture on Congenital Anomalies, Inflammatory & Neoplastic Disorders of Esophagus for medical students delivered by Dr Muhammad Omair Riaz
Vascular disease is a condition that develops when the arteries that supply the intestines with blood become narrowed due to the build-up of plaque. This results in a lack of blood supply to the intestines.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
2. Esophagus
Normal Anatomy
– The esophagus is a muscular tube
extending from the pharynx to
the stomach.
– 25 (10 inches) cm in length in
adults.
From the incisors to lower
esophageal sphincter at 40 cm
The region of proximal oesophagus at
the level of cricopharyngeus muscle is
called the upper oesophageal
sphincter, while the portion adjacent
to the anatomic gastrooesophageal
junction is referred to as lower
oesophageal sphincter (Cardiac
sphincter).
3. Histology
– Lined by stratified
squamous non-keratinized
epithelium.
The wall of the oesophagus consists of
mucosa,
submucosa,
muscularis propria (muscularis externa)
and adventitia/ serosa
(Intraabdominal part).
4.
5.
6.
7.
8.
9. Obstructive & Vascular diseases
• Mechanical Obstruction: Atresia, Stenosis
• Function Obstruction: Achalasia
• Ectopia/developmental rests: upper third of esophagus
• Esophageal Varices:
10. Atresia
Atresia is absence of opening (lumen)/ noncanalization.
Atresia, in which a thin, noncanalized cord replaces a segment of
esophagus, is more common. Atresia occurs most commonly at or
near the tracheal bifurcation and usually is associated with a fistula
connecting the upper or lower esophageal pouches to a bronchus or
the trachea. This abnormal connection can result in aspiration,
suffocation, pneumonia, or severe fluid and electrolyte imbalances.
Fistula: An abnormal passage leading from a suppurating cavity to the body surface.
11. Trachea
Bronchi
Esophageal atresia and tracheoesophageal fistula. A, Blind upper and
lower esophageal segments. B, Blind upper segment with fistula
between lower segment and trachea. C, Fistula between patent
esophagus and trachea. Type B is the most common.
12. Stenosis
Abnormal narrowing of the esophageal lumen is called
esophageal stenosis. Passage of food can be impeded by
esophageal stenosis.
The narrowing generally is caused by fibrous thickening of
the submucosa, atrophy of the muscularis propria, and
secondary epithelial damage. Stenosis most often is due to
inflammation and scarring, which may be caused by chronic
gastroesophageal reflux, irradiation, or caustic (acid) injury.
Stenosisassociated dysphagia usually is progressive;
difficulty eating solids typically occurs long before problems
with liquids.
13. ACHALASIA/ Cardiospasm (Mega Esophagus)
Achalasia is a disorder of motility (neuromuscular disorder) of
esophagus, characterized by incomplete relaxation
of the LES (Cardiac sphincter) in response to swallowing
with dilation of the proximal esophagus.
Increased tone of the lower esophageal sphincter
(LES), as a result of impaired smooth muscle
relaxation, is an important cause of esophageal
obstruction. Achalasia is characterized by the triad
of incomplete LES relaxation, increased LES tone,
and aperistalsis of the esophagus.
14. AETIOLOGY
Achalasia
There is loss of intramural neurons in the wall of the oesophagus.
Most cases are of primary idiopathic achalasia which may be
congenital.
Secondary achalasia may occur from some other causes which includes:
Chagas’ disease (an epidemic parasitosis with Trypansoma cruzi),
infiltration into oesophagus by gastric carcinoma or lymphoma,
certain viral infections, and neurodegenerative diseases.
15. Morphology
There is dilatation above the short contracted
terminal segment of the oesophagus.
Muscularis propria of the wall may be of normal thickness,
hypertrophied as a result of obstruction, or thinned out
due to dilatation. Secondary oesophagitis may supervene
and cause oesophageal ulceration and haematemesis.
16. Ectopia/ developmental rests/ Inlet patch
The most frequent site of ectopic gastric mucosa is the upper third of
the esophagus, where it is referred to as an inlet patch. Although
the presence of such tissue generally is asymptomatic, acid released
by gastric mucosa within the esophagus can result in dysphagia,
esophagitis, Barrett esophagus, or, rarely, adenocarcinoma.
17. Hiatal hernia
Hiatus hernia is the herniation or protrusion of part of the
stomach through the oesophageal hiatus (opening) of the
diaphragm.
Oesophageal hiatal hernia is the cause of diaphragmatic
hernia in 98% of cases.
• Congenital hiatal hernias are recognized in infants and children, but
many are acquired in later life. Hiatal hernia is symptomatic in fewer
than 10% of adults, and these cases are generally associated with
other causes of LES incompetence. Symptoms, including heartburn
and regurgitation of gastric juices, are similar to GERD.
18. Causes
Hiatal Hernia
The basic defect is the failure of the muscle fibres of the diaphragm that form the
margin of the oesophageal hiatus. This occurs due to shortening of the
oesophagus which may be congenital or acquired.
Congenitally short oesophagus may be the cause of hiatus hernia in a small proportion
of cases.
More commonly, it is acquired due to secondary factors which cause fibrous scarring
of the oesophagus as follows:
a) Degeneration of muscle due to aging.
b) Increased intra-abdominal pressure such as in pregnancy, abdominal tumours etc.
c) Recurrent oesophageal regurgitation and spasm causing inflammation and fibrosis.
d) Increase in fatty tissue in obese people causing decreased muscular elasticity of
diaphragm.
19. Morphology
There are 3 patterns in hiatus hernia :
i) Sliding or oesophago-gastric hernia is the most
common, occurring in 85% of cases. The herniated part of the
stomach appears as supradiaphragmatic bell due to sliding
up on both sides of the oesophagus.
ii) Rolling or para-oesophageal hernia is seen in 10% of cases.
This is a true hernia in which cardiac end of the stomach
rolls up para-oesophageally, producing an intrathoracic sac.
iii) Mixed or transitional hernia constitutes the remaining
5% cases in which there is combination of sliding and rolling hiatus
hernia.
20.
21. Esophageal Varices
Oesophageal varices are tortuous, dilated and engorged oesophageal
veins, seen along the longitudinal axis of oesophagus. They occur as a
result of elevated pressure in the portal venous system, most
commonly in cirrhosis of the liver . Less common causes are: portal
vein thrombosis, hepatic vein thrombosis (Budd-Chiari syndrome)
and pylephlebitis. The lesions occur as a result of bypassing of portal
venous blood from the liver to the oesophageal venous plexus. The
increased venous pressure in the superficial veins of the oesophagus
may result in ulceration and massive bleeding.
22. Esophageal Varices
Instead of returning directly to the heart, venous blood from the
gastrointestinal tract is delivered to the liver via the portal vein
before reaching the inferior vena cava. This circulatory pattern is
responsible for the first-pass effect, in which drugs and other
materials absorbed in the intestines are processed by the liver before
entering the systemic circulation. Diseases that impede this flow
cause portal hypertension, which can lead to the development of
esophageal varices, an important cause of esophageal bleeding.
Varix: An abnormally enlarged & twisted blood vessel.
23. Pathogenesis
One of the few sites where the splanchnic (visceral) and systemic
venous circulations can communicate is the esophagus. Thus,
portal hypertension induces development of collateral channels
that allow portal blood to shunt (divert) into the caval system.
However, these collateral veins enlarge the subepithelial and
submucosal venous plexi within the distal esophagus. These
vessels, termed varices, develop in 90% of cirrhotic patients,
most commonly in association with alcoholic liver disease.
Worldwide, hepatic schistosomiasis is the second most
common cause of varices.
24. Morphology
Varices can be detected by angiography and appear
as tortuous dilated veins lying primarily within the
submucosa of the distal esophagus and proximal
stomach. Varices may not be obvious on gross
inspection of surgical or postmortem specimens,
because they collapse in the absence of blood flow .
The overlying mucosa can be intact but is ulcerated
and necrotic if rupture has occurred.
25. Clinical Features
Varices often are asymptomatic, but their rupture can lead to massive
hematemesis and death. Variceal rupture therefore constitutes a
medical emergency. Despite intervention, as many as half of the
patients die from the first bleeding episode, either as a direct
consequence of hemorrhage or due to hepatic coma triggered by
the protein load that results from intraluminal bleeding and
hypovolemic shock. Among those who survive, additional episodes
of hemorrhage, each potentially fatal, occur in more than 50% of
cases. As a result, greater than half of the deaths associated with
advanced cirrhosis result from variceal rupture.
26. Esophagitis
Inflammation of esophagus (after injury to esophageal mucosa).
Predisposing factors/Origins/Causes:
• Prolonged gastric intubation,
• Ureamia
• Ingestion of corrosive or Irritant substances
• Radiation
• Chemotherapy
27. Lecerations: Mallory Weiss tears
Longitudinal and superficial tears in the esophagus
near the gastroesophageal junction are termed
Mallory-Weiss tears, and are most often
associated with severe retching (strain to vomit) or
vomiting secondary to acute alcohol intoxication.
Normally, a reflex relaxation of the gastroesophageal musculature precedes the antiperistaltic
contractile wave associated with vomiting. This relaxation is thought to fail during prolonged
vomiting, with the result that refluxing gastric contents overwhelm the gastric inlet and cause the
esophageal wall to stretch and tear. Patients often present with hematemesis.
Boerhaave syndrome, characterized by transmural esophageal tears and
mediastinitis, occurs rarely and is a catastrophic event.
28. Types/causes of esophagitis
Reflux esophagitis - GERD
CHEMICAL AND INFECTIOUS ESOPHAGITIS
EOSINOPHILIC ESOPHAGITIS
Barrett Esophagus
• Herpes simplex esophagitis
• Cytomegalovirus (CMV) esophagitis
• Candida esophagitis
• Crohn’s disease
• Idiopathic eosinophilic esophagitis
• Other types of esophagitis include those caused by tuberculosis,
blastomycosis, drugs, allergic reactions, irradiation and ingestion of
corrosive chemicals.
29. Reflux Esophagitis GERD
The stratified squamous epithelium of the
esophagus is resistant to abrasion from
foods but is sensitive to ACID.
Submucosal glands, which are most abundant
in the proximal and distal esophagus,
contribute to mucosal protection by
secreting MUCIN and BICARBONATE.
30. Reflux Esophagitis GERD
Constant LES tone prevents reflux of acidic gastric
contents, which are under positive pressure and
would otherwise enter the esophagus.
Reflux of gastric contents into the lower esophagus
(due to decreased LES tone) is the most frequent cause of
esophagitis .The associated clinical condition is
termed gastroesophageal reflux disease (GERD).
31. Pathogenesis
• Reflux of gastric juices (ACID) is central to the
development of mucosal injury in GERD.
• In severe cases, reflux of BILE from the
duodenum may exacerbate the damage.
32. Pathogenesis
• Conditions that decrease lower esophageal
sphincter tone or increase abdominal pressure
contribute to GERD and include:
• Alcohol
• Tobacco use,
• Obesity,
• Central nervous system depressants,
• Pregnancy,
• Hiatal hernia ,
• Delayed gastric emptying, and
• Increased gastric volume.
• In many cases, no definitive cause is identified.
33. Morphology
Endoscopy Microscopy
GROSS:
• Simple hyperemia, evident to the endoscopist as redness,
may be the only alteration.
• Microscopy:
• In mild GERD the mucosal histology is often unremarkable. With more
significant disease, eosinophils are recruited into the squamous
mucosa, followed by neutrophils, which usually are associated with
more severe injury.
Basal zone hyperplasia exceeding 20% of the total epithelial thickness and elongation
of lamina propria papillae, such that they extend into the upper third of the
epithelium, also may be present.
34. Clinical Features
GERD is most common in adults over age 40
but also occurs in infants and children. The
most common clinical symptoms are
dysphagia, heartburn, and, less frequently,
noticeable regurgitation of sour-tasting
gastric contents.
• Rarely, chronic GERD is punctuated by
attacks of severe chest pain that may be
mistaken for heart disease.
35. Treatment
• Treatment with proton pump inhibitors or H2
histamine receptor antagonists, which reduce
gastric acidity, typically provides
symptomatic relief.
37. Chemical & Infectious esophagitis
Chemicals: Acids, alkalies, hot fluids, heavy smocking,
Medicinal pills. Iatrogenic esophageal injury may be caused
by cytotoxic chemotherapy, radiation therapy, or graft-versus host
disease.
Infectious esophagitis caused by: Bacterial, viral or fungal infections.
Esophagitis due to chemical injury generally causes only self-limited pain, particularly
odynophagia (pain with swallowing).Hemorrhage, stricture (narrowing), or perforation
may occur in severe cases.
38. Eosinophilic esophagitis
The incidence of eosinophilic esophagitis is increasing markedly.
Symptoms: food impaction and dysphagia in adults and feeding intolerance or GERD-like
symptoms in children.
The cardinal histologic feature is epithelial infiltration by large numbers of eosinophils,
particularly superficially and at sites far from the gastroesophageal junction.
Their abundance can help to differentiate eosinophilic esophagitis from GERD, Crohn disease,
and other causes of esophagitis.
Certain clinical characteristics, particularly failure of high-dose proton pump inhibitor
treatment and the absence of acid reflux, are also typical.
A majority of persons with eosinophilic esophagitis are atopic (having allergy), and many have atopic
dermatitis, allergic rhinitis, asthma, or modest peripheral eosinophilia.
Treatments include dietary restrictions to prevent exposure to food allergens, such as cow
milk and soy products, and topical or systemic corticosteroids.