Download - esofagcurs
![Page 1: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/1.jpg)
ESOPHAGUSESOPHAGUS
![Page 2: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/2.jpg)
WHAT ABOUT?WHAT ABOUT?
Simptoms and signsSimptoms and signs InvestigationsInvestigations Gastroesophageal RefluxGastroesophageal Reflux EsophagitisEsophagitis Esophageal CancerEsophageal Cancer Motility Disorders: Achalasia and D. SpasmMotility Disorders: Achalasia and D. Spasm Structural Anomalies and Miscellaneous Structural Anomalies and Miscellaneous
Disorders of the EsophagusDisorders of the Esophagus
![Page 3: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/3.jpg)
Simptoms and signsSimptoms and signs1. DYSPHAGIA1. DYSPHAGIA
Sensation of food being hindered in its Sensation of food being hindered in its passage from mouth to stomachpassage from mouth to stomach
Oropharyngeal - odynophagiaOropharyngeal - odynophagia Esophageal dysphagiaEsophageal dysphagia
![Page 4: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/4.jpg)
Simptoms and signsSimptoms and signsDYSPHAGIADYSPHAGIA
Oropharyngeal - (odynophagia-pain at swallowing)
– Neuromuscular disease (Cerebrovascular accident, Parkinson, Wilson, Brain stem tumors, polymyositis, amyloidosis, systemic lupus erytematus)
– Local mechanical lesions: inflammation (pharyngitis), tumours, Zenker diverticulum
Esophageal dysphagia
– Motility disorders (achalasia, scleroderma, diffuse spasm, nutcracher esophagus)
– Intrinsic mecanical lesions (benign stricture, carcinoma, foreign bodie, esophageal diverticulum, Schatzki ring)
– Extrinsic mechanical lesions (mediastinal abnormalities- pulmonary carcinoma, adenopaty, pericarditis, mitral stenosis, cervical osteoarthrities)
![Page 5: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/5.jpg)
Simptoms and signsSimptoms and signsDYSPHAGIADYSPHAGIA
Onset ( acute, chronic);Onset ( acute, chronic); Total or partial;Total or partial; paradoxical (achalasia).paradoxical (achalasia).
![Page 6: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/6.jpg)
2. HEARTBURN (PIROSIS)(most tipical symptom for GE Reflux D)
![Page 7: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/7.jpg)
3. PAIN: Anterior toracic pain (motility 3. PAIN: Anterior toracic pain (motility disorders, cancer)disorders, cancer)
4. Regurgitation: pasage of food from 4. Regurgitation: pasage of food from stomach to the mouth without nausea: stomach to the mouth without nausea: (vomiting)(vomiting)
![Page 8: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/8.jpg)
InvestigationsInvestigations
Endoscopy (visualisation, histology)Endoscopy (visualisation, histology) Radiology Radiology
– Esophageal XREsophageal XR– Computer tomographyComputer tomography– Magnetic ResonanceMagnetic Resonance
Echography (echo-endoscopy)Echography (echo-endoscopy) Esophageal ManometryEsophageal Manometry pH-metrypH-metry
![Page 9: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/9.jpg)
ENDOSCOPYThe normal esophageal body
![Page 10: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/10.jpg)
The lower esophageal sphincter (LES)
![Page 11: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/11.jpg)
RADIOLOGYBarium esophagram
![Page 12: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/12.jpg)
Schatzki's ring on barium esophagra
![Page 13: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/13.jpg)
Schatzki's ring viewed endoscopically
![Page 14: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/14.jpg)
Esophageal stenosis (a)
![Page 15: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/15.jpg)
Esophageal stenosis (b)
![Page 16: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/16.jpg)
ECHOENDOSCOPYECHOENDOSCOPY
![Page 17: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/17.jpg)
ESOPHAGEAL MOTILITYESOPHAGEAL MOTILITY
![Page 18: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/18.jpg)
ESOPHAGEAL PH-METRYESOPHAGEAL PH-METRY
![Page 19: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/19.jpg)
GASTRO-ESOPHAGEAL REFLUX GASTRO-ESOPHAGEAL REFLUX DISEASEDISEASE
Def. Effortless movement of gastric content Def. Effortless movement of gastric content from stomach to esophagusfrom stomach to esophagus
Disease if producing symptoms and signs of Disease if producing symptoms and signs of tissue injury within the esophagus, tissue injury within the esophagus, oropharinx, larynx and/or respiratory tract.oropharinx, larynx and/or respiratory tract.
![Page 20: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/20.jpg)
![Page 21: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/21.jpg)
![Page 22: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/22.jpg)
Pathophysiology and etiology of reflux esophagitis
Inbalance between aggressive forces and Inbalance between aggressive forces and defences forces of esophagusdefences forces of esophagus– aggressive forces: acid, pepsin, bile salts, pancreatic aggressive forces: acid, pepsin, bile salts, pancreatic
enzimesenzimes– defence: defence:
» antireflux barries: LES, diaphragmatic crura, antireflux barries: LES, diaphragmatic crura, phrenoesophageal ligament, acute angle of His;phrenoesophageal ligament, acute angle of His;
» Hiatus Hernia Hiatus Hernia » luminal acid clearance: gravity, esophageal peristalsis, luminal acid clearance: gravity, esophageal peristalsis,
salivary and esophageal gland secretionssalivary and esophageal gland secretions» tissue resistancetissue resistance
![Page 23: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/23.jpg)
![Page 24: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/24.jpg)
Pathophysiology and etiology of reflux esophagitis
![Page 25: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/25.jpg)
![Page 26: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/26.jpg)
Conditions associeated with GERD
Gastric acid hypersecretions (gastrinoma)Gastric acid hypersecretions (gastrinoma) pregnancy, diabetes, scleroderma, pregnancy, diabetes, scleroderma, prolong nasogastric intubationprolong nasogastric intubation
![Page 27: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/27.jpg)
CLINICAL MANIFESTATIONS
![Page 28: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/28.jpg)
CLINICAL MANIFESTATIONS
TYPICALTYPICAL– HeartburnHeartburn– regurgitationsregurgitations– esophageal painesophageal pain– dysphagiadysphagia
ATYPICAL (respiratory, laryngitis, dental)ATYPICAL (respiratory, laryngitis, dental)
![Page 29: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/29.jpg)
![Page 30: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/30.jpg)
When to Perform Diagnostic TestsWhen to Perform Diagnostic Tests
Uncertain diagnosisUncertain diagnosis Atypical symptomsAtypical symptoms Symptoms associated with complicationsSymptoms associated with complications Inadequate response to therapy Inadequate response to therapy Recurrent symptomsRecurrent symptoms Prior to anti-reflux surgeryPrior to anti-reflux surgery
![Page 31: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/31.jpg)
INVESTIGATIONS
Endoscopy (visualisation, histology)Endoscopy (visualisation, histology) Radiology Radiology
– Gastro-esophageal XRGastro-esophageal XR
Esophageal 24 H pH-metryEsophageal 24 H pH-metry Esophageal ManometryEsophageal Manometry Esophageal impedanceEsophageal impedance
![Page 32: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/32.jpg)
ENDOSCOPY
ESOPHAGITIS/ NO ESOPHAGITISESOPHAGITIS/ NO ESOPHAGITIS COMPLICATIONS BARRETT COMPLICATIONS BARRETT
ESOPHAGUSESOPHAGUS
![Page 33: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/33.jpg)
![Page 34: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/34.jpg)
ENDOSCOPYENDOSCOPY
![Page 35: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/35.jpg)
ENDOSCOPYENDOSCOPY
![Page 36: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/36.jpg)
ENDOSCOPYENDOSCOPY
![Page 37: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/37.jpg)
ENDOSCOPYENDOSCOPY
![Page 38: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/38.jpg)
Barium SwallowBarium Swallow
Was considered first diagnostic Was considered first diagnostic test for patients with dysphagiatest for patients with dysphagia– Stricture (location, length)Stricture (location, length)– Mass (location, length)Mass (location, length)– Bird’s beakBird’s beak– Hiatal hernia (size, type)Hiatal hernia (size, type)
LimitationsLimitations– Detailed mucosal exam for erosive Detailed mucosal exam for erosive
esophagitis, Barrett’s esophagusesophagitis, Barrett’s esophagus
![Page 39: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/39.jpg)
RADIOLOGY
Gastroesophageal X-Ray Gastroesophageal X-Ray Trendelenburg positionTrendelenburg position Hiatal HerniaHiatal Hernia StenosisStenosis
![Page 40: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/40.jpg)
PH- metry
![Page 41: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/41.jpg)
Wireless, Catheter-Free Esophageal pH Monitoring
• Improved patient Improved patient comfort and acceptancecomfort and acceptance
• Continued normal work, Continued normal work, activities and diet studyactivities and diet study
• Longer reporting periods Longer reporting periods possible (48 hours)possible (48 hours)
• Maintain constant probe Maintain constant probe position relative to SCJposition relative to SCJ
Potential AdvantagesPotential Advantages
![Page 42: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/42.jpg)
Esophageal ManometryEsophageal Manometry
Assess LES pressure, Assess LES pressure, location and relaxationlocation and relaxation– Assist placement of 24 hr. Assist placement of 24 hr.
pH catheterpH catheter
Assess peristalsisAssess peristalsis– Prior to antireflux surgery Prior to antireflux surgery
Limited role in GERDLimited role in GERD
![Page 43: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/43.jpg)
Impedance Technology FundamentalsImpedance Technology Fundamentals
High Impedance
No Reflux
Low Impedance
Reflux
Impedance falls when reflux is present because the
reflux bolus conducts electricity between the metallic impedance contacts!
![Page 44: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/44.jpg)
![Page 45: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/45.jpg)
Impedance–pH Catheter
3 cm
5 cm
7 cm
9 cm
15 cm
17 cm
pH - 5 cm
6 impedance channels
2 pH channels
pH at tip
Adult with Gastric pH
Model ZAN-S62C01E
![Page 46: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/46.jpg)
![Page 47: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/47.jpg)
![Page 48: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/48.jpg)
COMPICATIONSEsophageal stricture
![Page 49: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/49.jpg)
BENIGN ESOPHAGEAL STENOSISBENIGN ESOPHAGEAL STENOSIS
![Page 50: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/50.jpg)
ENDOSCOPYENDOSCOPY
![Page 51: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/51.jpg)
![Page 52: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/52.jpg)
![Page 53: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/53.jpg)
COMPLICATIONSBarrett's esophagus
![Page 54: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/54.jpg)
Esophageal CancerEsophageal Cancer
Barium SwallowBarium Swallow EndoscopyEndoscopy
![Page 55: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/55.jpg)
Extraesophageal Manifestations Extraesophageal Manifestations of GERDof GERD
PulmonaryPulmonaryAsthmaAsthmaAspiration pneumoniaAspiration pneumoniaChronic bronchitisChronic bronchitisPulmonary fibrosisPulmonary fibrosis
OtherOther Chest painChest pain Dental erosionDental erosion
ENTENTHoarsenessHoarsenessLaryngitisLaryngitisPharyngitisPharyngitisChronic coughChronic coughGlobus sensationGlobus sensationDysphoniaDysphoniaSinusitisSinusitisSubglottic stenosisSubglottic stenosisLaryngeal cancerLaryngeal cancer
![Page 56: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/56.jpg)
Potential Oral and Laryngopharyngeal Signs Potential Oral and Laryngopharyngeal Signs Associated with GERDAssociated with GERD
• Edema and hyperemia of Edema and hyperemia of larynxlarynx
• Vocal cord erythema, Vocal cord erythema, polyps, granulomas, polyps, granulomas, ulcersulcers
• Hyperemia and lymphoid Hyperemia and lymphoid hyperplasia of posterior hyperplasia of posterior pharynx pharynx
• Interarytenyoid changesInterarytenyoid changes
• Dental erosionDental erosion
• Subglottic stenosisSubglottic stenosis
• Laryngeal cancerLaryngeal cancer
Vaezi MF, Hicks DM, Abelson TI, Richter JE. Clin Gastro Hep 2003;1:333-Vaezi MF, Hicks DM, Abelson TI, Richter JE. Clin Gastro Hep 2003;1:333-344.344.
![Page 57: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/57.jpg)
Pathophysiology of Extraesophageal Pathophysiology of Extraesophageal GERDGERD
![Page 58: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/58.jpg)
HIATAL HERNIATIONHIATAL HERNIATION
![Page 59: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/59.jpg)
![Page 60: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/60.jpg)
Axial hiatus hernia
![Page 61: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/61.jpg)
Paraesophageal hernia
![Page 62: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/62.jpg)
ESOPHAGITIS
![Page 63: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/63.jpg)
Reflux esophagitisReflux esophagitis
![Page 64: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/64.jpg)
Esophagitis with candidaEsophagitis with candida
![Page 65: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/65.jpg)
Esofagitis with eosinophilsEsofagitis with eosinophils
![Page 66: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/66.jpg)
Citomegal virusCitomegal virus herpesherpes
![Page 67: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/67.jpg)
Caustic esophagitisCaustic esophagitis
DrugDrug alcoolalcool
![Page 68: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/68.jpg)
ESOPHAGEAL CANCERESOPHAGEAL CANCER Pathology: squamous cell carcinoma (S), adenocarcinoma (A).Pathology: squamous cell carcinoma (S), adenocarcinoma (A). Epidemiology: (S): 2.5-5 in men and 1.5-2.5 women; High : Epidemiology: (S): 2.5-5 in men and 1.5-2.5 women; High :
North China, India, nort Iran, South Africa; (A) lower but North China, India, nort Iran, South Africa; (A) lower but increasingincreasing
Causes: risc factors (S) tabacco, alcohol (Calvados); diet with Causes: risc factors (S) tabacco, alcohol (Calvados); diet with low contents in vitamins (A,C,folic A, E, B12) green, yelow low contents in vitamins (A,C,folic A, E, B12) green, yelow vegetable; achalasia, Head and Nech Squamous Cell vegetable; achalasia, Head and Nech Squamous Cell Carcinoma; tylosis; (A) Barrett esophagusCarcinoma; tylosis; (A) Barrett esophagus
Symptoms: disphagea (chronic, first to liquid than for solid Symptoms: disphagea (chronic, first to liquid than for solid too)too)
Signs: weigh loss, anemiaSigns: weigh loss, anemia
![Page 69: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/69.jpg)
ESOPHAGEAL CANCERESOPHAGEAL CANCER
Symptoms: disphagia (chronic, first to liquid than Symptoms: disphagia (chronic, first to liquid than for solid too);for solid too);– anorexia, cought, retrosternal pain, hematemesis, anorexia, cought, retrosternal pain, hematemesis,
hoarsenesshoarseness
Signs: weigh loss, anemia, lymphadenopaty, Signs: weigh loss, anemia, lymphadenopaty, hepatomegalyhepatomegaly
![Page 70: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/70.jpg)
ESOPHAGEAL CANCER-ESOPHAGEAL CANCER-INVESTIGATIONSINVESTIGATIONS
GASTROINTESTINAL ENDOSCOPYGASTROINTESTINAL ENDOSCOPY– INCLUDING HISTOLOGYINCLUDING HISTOLOGY
ESOPHAGEAL XrayESOPHAGEAL Xray– EXCENTRIC STENOSISEXCENTRIC STENOSIS
LOCAL+DISTAL EXTENSION OF THE LOCAL+DISTAL EXTENSION OF THE DISEASEDISEASE– COMPUTER TOMOGRAPHYCOMPUTER TOMOGRAPHY
– ECHOENDOSCPYECHOENDOSCPY
– LAPAROSCOPYLAPAROSCOPY
![Page 71: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/71.jpg)
ENDOSCOPYENDOSCOPY
![Page 72: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/72.jpg)
EndoscopyEndoscopy
![Page 73: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/73.jpg)
HistopathologyHistopathology
Adenocarcinoma on Barrett esophagus
Adenocarcinoma
![Page 74: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/74.jpg)
X-RayX-Ray
![Page 75: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/75.jpg)
EcoendoscopyEcoendoscopy
Cancer limited to the esophageal wall
Esophageal cancer invading aorta
![Page 76: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/76.jpg)
Esophageal cancerEsophageal cancerSurviving rate atSurviving rate at 5 5 yearsyears– 5%– 5%
ComplicComplictionstionsEso-bronchial fEso-bronchial fistula istula PneuPneumoniamoniaPerfPerforationorationBleedingBleedingTotal stenosisTotal stenosis
Eso-bronchial fistula
![Page 77: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/77.jpg)
Motility disordersMotility disorders AchalasiaAchalasia Difuse spasmDifuse spasm
ACHALASIAACHALASIADef. Motility disorder characterized by increased
lower esophageal sphincter pressure and failure to relax during swalowing. Peristalsis of body is absent
Et: degeneration of myenteric plexus of unknown cause
![Page 78: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/78.jpg)
Achalasia- clinical features-Achalasia- clinical features-
Occours at any ageOccours at any age Dysphagia -all patients;slowly progressive Dysphagia -all patients;slowly progressive
+paradoxical dysphagia+paradoxical dysphagia Weight loss- quite commonWeight loss- quite common Regurgitations - 30%; undigested food with Regurgitations - 30%; undigested food with
aspirationsaspirations pain- substernal cramps may be severe and pain- substernal cramps may be severe and
precede dysphagiaprecede dysphagia
![Page 79: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/79.jpg)
Radiology:Radiology: Chest Xray + Gastroesophageal Chest Xray + Gastroesophageal Xray: Xray: – esophageal fluid level at the aortic knuckle esophageal fluid level at the aortic knuckle – gastric air bubble absentgastric air bubble absent– dilated esophagus ; barium and food mixing in dilated esophagus ; barium and food mixing in
the dilated esphagus;the dilated esphagus;– tapered distal narrowing;tapered distal narrowing;– aperistaltic contractionsaperistaltic contractions
INVESTIGATIONSINVESTIGATIONS
![Page 80: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/80.jpg)
INVESTIGATIONSINVESTIGATIONS
Radiology:Radiology:
![Page 81: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/81.jpg)
Esophageal manometry:Esophageal manometry:– absence of LOS relaxation with swallowingabsence of LOS relaxation with swallowing– hipertensieve LOShipertensieve LOS– absence of peristaltic contractionsabsence of peristaltic contractions
INVESTIGATIONSINVESTIGATIONS
![Page 82: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/82.jpg)
Manometric LES tracing of pull through in patient with achalasia
![Page 83: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/83.jpg)
Manometric tracing of a patient with achalasia
![Page 84: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/84.jpg)
Manometric tracing of a patient with achalasia
![Page 85: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/85.jpg)
INVESTIGATIONSINVESTIGATIONS
Endoscopy:Endoscopy:– dilated esophagus with dilated esophagus with
food debriefood debrie
– endoscope is passing endoscope is passing easily in the stomacheasily in the stomach
![Page 86: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/86.jpg)
TREATMENTTREATMENT
![Page 87: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/87.jpg)
Motility disordersMotility disorders AchalasiaAchalasia Difuse spasmDifuse spasm
Difuse esophageal spasmDifuse esophageal spasmDef. Motility disorder characterized by high
amplitude aperistaltic esophageal contractions without demonstrable organic lesions
Simptoms:
Disphagia intermittent but associated with pain
Chest pain may mimic cardiac pain and be provoked by stress
![Page 88: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/88.jpg)
Contracţii terţiare, aperistaltice
![Page 89: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/89.jpg)
Manometric tracing of patient with diffuse esophageal spasm (DES)
![Page 90: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/90.jpg)
Structural disorders and Structural disorders and Miscelaneous disordersMiscelaneous disorders
![Page 91: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/91.jpg)
Mid-esophageal diverticulum as seen on barium swallow
![Page 92: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/92.jpg)
Midesophageal diverticulum
![Page 93: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/93.jpg)
Epiphrenic diverticulum as seen on barium swallow
![Page 94: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/94.jpg)
Lower esophageal mucosal ring
![Page 95: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/95.jpg)
Schatzki's ring viewed endoscopically
![Page 96: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/96.jpg)
Schatzki's ring on barium esophagra
![Page 97: esofagcurs](https://reader034.vdocuments.mx/reader034/viewer/2022051411/54672a93b4af9f583f8b56c3/html5/thumbnails/97.jpg)
Esophageal stenosis (b)