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Esophagus

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Esophagus Powered By Docstoc
					Normal esophagus
                       Atresia
 Noncanalized segment

 Proximal – pharynx

 Distal pouch –
 stomach

 MC site – tracheal
 bifurcation
Fistula


     Connects lower/upper
     pouch with bronchus
     or trachea
              Most life threatening
              Cough & suffocate




Most common
type
                   Achalasia
 means : “Failure to
  relax”
 Characterised by
   Aperistalsis
   Incomplete or partial
    relaxation of LES with
    swallowing
   Increased resting tone
    of LES
             Clinical features
 Affects adults


 Progressive dysphagia


 Regurgitation & aspiration
Pathogenesis
   Primary
       Dysfunction of inhibitory neurons
       Absence of myenteric ganglia
   Secondary
       Chaga’s disease (Trypanosoma cruzi)
       Diabetic autonomic neuropathy
Dilation of
esophagus above
the level of LES
           Hiatal Hernia
Sliding Hernia      Paraesophageal hernia
              Complications
 Ulcerate – bleeding & perforation


 Strangulation & obstruction


 Reflux esophagitis
                   Diverticula
 Outpouching of esophageal wall containing all
  visceral layers

 3 types                                       Z

    Zenker diverticulum
                                             T
    Traction diverticulum
    Epiphrenic diverticulum
                                            E
        Zenker diverticulum

 Pharyngoesophageal
  diverticulum
 Above UES
 Affects elderly
 Disordered
  cricopharyngeal motor
  dysfunction
 Food regurgitation &
  dysphagia
        Traction diverticulum
 Near midpoint of esophagus


 Asymptomatic


 Scarring from mediastinal lymphadenitis exerting
  traction on the esophagus
     Epiphrenic diverticulum
 Above LES
 Dyscoordinated
  peristalsis/ motor
  dysfunction of LES
 Regurgitation
 Aspiration pneumonia
Mallory Weiss Syndrome
               Longitudinal tear at
                esophagogastric
                junction/ gastric
                cardia
               Excessive vomiting in
                presence of spasm of
                LES
               Most common in
                alcoholics &
                Pregnancy
Mallory Weiss tear
        Boerhaave Syndrome
 Tear penetrating all layers of esophagus


 Mediastinitis or peritonitis
         Esophageal Varices
 Dilated tortuous
 submucosal veins

 Cirrhotics with portal
 hypertension

 50% cases bleed &
 die
Infectious
esophagitis
CANDIDIASIS
Adherent grey white pseudomembrane
Herpetic esophagitis

                  Punched
                 out ulcers
Multinucleate giant cells with intranuclear inclusions
CMV esophagitis




                  Owl eye inclusion
                        cells
GERD
                       GERD
 Reflux esophagitis
 Most common type of esophagitis
 Reflux of gastric contents in lower esophagus
 Affects adults >40yrs
              Clinical features
 Heartburn
 Dysphagia
 Regurgitation
 Hematemesis & Melena
 Long standing cases
    Bleeding, ulceration
    Stricture formation
    Barrett esophagus
               Morphology
 Hyperemia
 Inflammatory cells –
  eosinophils,
  neutrophils,
  lymphocytes
 Basal zone hyperplasia
 Elongation of lamina
  propria, capillary
  congestion
Complications
 Bleeding
 Ulceration
 Development of stricture
 Development of Barrett esophagus
          Barrett esophagus

 Complication of long standing GERD


 Columnar metaplasia of distal esophagus


 30 times > risk of esophageal adenocarcinoma
Barrett’s esophagitis
              Morphology
 Red velvety mucosa


 Tongues/ patches/
 circumferential bands
Esophageal squamous epithelium replaced by
        gastric columnar epithelium
             Clinical features
 40-60yrs


 Symptoms of reflux esophagitis


 Local ulceration, bleeding, stricture
         Criteria for diagnosis
    2 criteria
1.   Endoscopic evidence of columnar lining above GE
     junction
2.   Histological evidence of intestinal metaplasia
Esophageal Carcinoma in Barrett's esophagitis
   2 most common types of esophageal carcinoma

      Squamous cell
        carcinoma
                                      Adenocarcinoma

 Most common type                  2nd most common type
                                    Incidence increasing
 Occurs usually middle third
                                    Lower third of esophagus
 Risk factors: smoking, alcohol
                                    GERD : Barrets esophagus
    Squamous cell carcinoma
 MC type
 M>F
 >50yrs
 Risk factors
    Smoking, alcohol
    Dietary factors
            GROSS




Polypoid/ flat/ excavated
    Squamous cell carcinoma
 Insidious in onset – wt. loss
 Spreads locally to mediastinal structures & lymph
  nodes
 5 yr survival rate is 25 – 70%
            Adenocarcinoma
 Primary risk factor – Barrett esophagus
 Affects > 40yrs
 M>F
 MC in distal 1/3rd
 present with progressive dysphagia
Flat / raised nodular mass
  Malignant cells
in glandular pattern
Adenocarcinoma
 Prognosis poor – 20% 5 yr survival rate
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posted:12/1/2011
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