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    Esophagus

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    Esophagus

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    7 views26 pages

    Esophagus

    Uploaded by

    amadoorahmed

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 26

    GIT SURGERY MODULE

    Dr. Mumin Farah


    Outline
    • Lesions of the esophagus
    • Esophageal atresia
    • Achalasia
    • GERD
    • GI bleeding
    • Esophageal Ca
    • Hiatal hernia
    • Esophageal Verices
    Outline
    Other GIT
    •Gastritis
    •PUD
    •Gastric Ca
    •Schemic bowel disease
    •Intestinal Obstruction
    •Appendicitis
    • Inflammatory Bowel disease
    • Peritonitis
    • Hemorrhoids
    • Anal fissure
    • Anal fistula
    • Hernia
    LESSIONS OF THE EOSOPHAGUS
    EOSOPHAGEAL ATRESIA
    When a segment of the esophagus is congenitally
    malformed and consists of only a thin,
    noncanalized end, the lesion is termed
    esophageal atresia. It is manifested by
    swallowing difficulties from birth.
    Clinical features difficult swallowing after birth,
    inability to pass NG tube through esophagus
    Management: Resuscitation, surgery
    ACHALASIA( MEGA ESOPHAGUS)
    • This is a disorder of esophageal motility characterized
    by incomplete relaxation of the lower esophageal
    sphincter in response to swallowing. This produces
    functional obstruction of the esophagus, with
    consequent dilation of proximal esophagus.
    There are three abnormalities in achalasia:
     Ineffective peristalsis in the lower two thirds of the
    esophagus.
     Inadequate relaxation of the lower esophageal
    sphincter during swallowing.
     Increased basal tone of the lower esophageal
    sphincter.
    Achalasia
    Pathophysiology
    • Probably cause is loss of myenteric ganglion cells in the
    wall of the body of the esophagus. Which aids the
    contraction of esophagus to propel food down to
    stomach.
    CLINICAL FEATURES
    Progressive dysphagia(difficult swallowing) and inability
    to convey food to stomach especially liquid foods.
    Regurgitation(effortless vomiting of food),
    Weight loss and sensation of lump at the chest.
    TREATMENT
    Surgery - Esophagocardiomyotomy
    GI BLEEDING
    • Hematomesis is vomiting of blood,
    • Melena is defecation of blood with feces or
    very black stool.
    • Hematochezia is fresh bleedind from rectum
    • Gastrointestinal bleeding is divided into
     Upper GI bleeding
     Lower GI bleeding
    Upper GI bleeding
    • Bleeding from a lesion in the esophagus, stomach
    or duodenum above the ligament of Treits( at the
    middle of duodenum) is called upper GI bleeding.
    Bleeding from upper GIT may present with
    hematemesis or melena.
    In the order of frequenc, the causes are following
     Chronic duodenal ulcer
     Chronic gastric ulcer
     Esophageal varices
     Esophagitis
    LOWER GI BLEEDING
    • It is defined as bleeding arising below the
    ligament of Treitz i.e. the small intestine and
    colon. Majority of cases, arise from colon and
    particularly the anorectal region.

    • The causes of lower GI bleeding are:


    Young pt below 50yrs

    • Anorectal disease e.g. hemorrhoids,


    • Infectious colitis: due to shigalla, E.coli.
    • Ulcerative colitis

    Old age above 50 yrs


    • Neoplams
    • Diverticulitis
    Esophageal Cancer
    1. Definition: Relatively uncommon malignancy with high
    mortality rate, because it is usually diagnosed late
    2. Pathophysiology
    • a. Squamous cell carcinoma
    1.Most common affecting middle or distal portion of
    esophagus
    2.More common in African Americans than
    Caucasians
    3.Risk factors: cigarette smoking and chronic alcohol
    use
    • b. Adenocarcinoma
    1.Nearly as common as squamous cell affecting distal
    portion of esophagus
    2.More common in Caucasians
    3.Associated with Barrett’s esophagus, complication
    of chronic GERD and achalasia
    o Usually occur over 50 years of age
    Esophageal tumor
    Manifestations
    a) Initially asymptomatic then progressive
    dysphagia (difficult swallowing) with solids at
    first and then to liquids , he/she may also feel
    pain while swallowing
    b) Choking, hoarseness, cough
    c) Anorexia, weight loss
    Diagnosis
    Barium meal, endoscopy, chest-xray, Hb
    TREATMENT
    Depend on the stage of presentation
    Esophagitis
    Is the inflammation of the esophagus, flowing
    are the causes of esophagitis:
    1)Reflex of gastric content.
    2)Prolonged gastric intubation.
    3)Ingestion of alcohol, acids, pills and hot tea.
    4)Viral, Bacterial, and Fungus.
    Pathophysiology
    In acute stage hyperemia to ulcerative lesions
    are seen.
    In chronic stage fibrous thickening and then
    stricture of the esophageal wall are seen.
    Complication
    Bleeding, stricture formation, barett’s
    esophagitis.
    HIATAL HERNIA
    • It is a disorder of gastroesophageal junction
    that results in a saclike dilation of the stomach
    through the esophageal hiatus (opening) such
    that a portion of the stomach comes to lie
    above the diaphragm.
    Types of Hiatal Hernia
    1.Sliding hiatal hernia
    2.Rolling hiatal hernia
    Slidding hiatal hernia
    In this type, there is an abnormally short
    esophagus(congenital or due to fibrous
    scaring) that pulls a portion of the stomach
    above the diapharagm, it the most common
    type of hiatal hernia
    Rolling hiatal hernia
    In this type, a defect or weakening of the diaghragmatic hiatus
    such that a portion of the gastric fundus roles up alongside
    the esophagus into the thorax. The junction between the
    esophagus and stomach remains in its normal position.
    CLINIACAL FEATURES
     Rolling type: sensation of fullness after eating, sometimes
    twisting and srangulation of the herniated portion
    produces an emergency
     Sliding type: only heart burn due to gastroesophageal
    reflex.
    TREATMENT
    Medical; anti acid, proton pump inhibitors(Omeprazole)
    Surgery
    ESOPHAGEAL VARICES
    Abnormal dilation of the esophageal veins and
    venous plexus is called esophageal varices.
    ETIOLOGY AND PATHOPHYSIOLOGY
    The basic cause of esophageal varices is the portal
    hypertension which resulted usually from liver
    cirrhosis. Normally venous blood returning from
    the spleen, stomach and small intestine passes
    through the liver were detoxification occurs and
    then drained into inferior venacava to the right
    atrium of the heart. The blockage of this system
    inside the liver causes portal hypertention.
    Varices
    • As a result of this blockage bypass develops
    and the blood flows from the portal system
    into the systemic circulation especially at the
    lower end of the esophagus. The increased
    pressure in the esophageal plexus produces
    dilated tortuous vessels called varices.
    Varices occur in approximately 2/3 of all
    cirrhotic patients. The varices may rupture
    and result in hematemeses.
    Esophageal varices

    Turtous dilated viens in the submocusa of distal


    esophagus
    Clinical features
    Varices produce no symptoms untill they
    rupture. Rupture of varices produce massive
    hemorrhage and about 15% death in
    advanced cirrhosis is due to rupture of varices.
    TREATMEN
    Medical: Propanalol – decrease esophageal
    pressure
    Surgery: Ligations/compression
    Thanks

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