Disease Of The Esophagus Flashcards
Anatomy of the esophagus
Esophagus is a hollow organ that connects the oral cavity to the
stomach and the intestines. It has a length of 18-24cm long
which divides into three parts:
Upper esophageal sphincter (1/3)
Middle esophageal body (1/3)
Lower esophageal sphincter (1/3 Cervical part
The first physiological
narrowing is at the point of
transition of the pharynx into
the esophagus.
Thoraie part
The second physiological
narrowing is at the crossing
point of the esophagus with the
left main bronchus.
The third physiological
narrowing is at the level of
esophageal opening of the
diaphragm.
His’s angle
Abdominal part
Structure of the esophageal wall
- mucous membrane
- submucous membrane
- muscular membrane
а). circular fibers
б). longitudinal fibers - adventitial membrane
Functions of the esophagus
Motor-
evacuatory
Movement of the bolus due to the esophageal peristalsis and the force of
gravity
Secretory Discharge of the mucus which envelops the bolus and contributes to its
movement
Defensive-
barrier
The upper esophageal sphincter prevents the reflex of the contents into the
pharynx, oral cavity and respiratory tracts; the lower sphincter prevents the
reflux of the gastric contents into the esophagus. The main condition of
physiological functioning of the lower esophageal sphincter is the presence of
sharp His’s angle
General Methods of examination of the patients with diseases of the esophagus
Complaints-dysphagia (forced swallowing), pain
behind the breastbone, heartburn, regurgitation, esophageal
vomiting.
Diagnosistic workout-CT, NMRT determine the details of morphological changes
(stricture, tumour of the esophagus, its size, spread and
germination into the adjacent tissues)
Esophago-fibroscoppy reveal the morphological substrate of the disease,
to examine the mucous membrane of the esophagus,
рН-metry
Laboratory
investigations total analyses of blood, urine, biochemical tests,
ECG, USI of the heart.-
Diseases of the esophagus
Hiatal Hernia
2. Reflux esophagitis
3. Esophageal Motility Disorders (Dismotility)
4. Cancer of esophagus (Neoplasm)
5. Trauma of esophagus
• Esophageal diverticulum
Achalasia -esophageal motility disorder
characterized by degeneration of the myenteric neurons that
innervate LES and esophageal body
steady spastic narrowing of
the terminal part of the esophagus with
impairment of reflex opening of the lower
esophageal sphincter,
Main symptoms-dysphagia regurgitation pain behind breastbone chest pain
Additional symptoms-heartburn weigh loss nausea cyanosis dyspnea
Diagnosis-chest X-ray barium filled
Upper 4
Esophagoscopy
Esophagotonokymography
Treatment options include medical therapy, botulinum toxin injection,
pneumatic dilation, and surgical myotomy
Conservative therapy
Regimen and character of nutrition:
fractional intake of non-irritating food of
soft consistency.
Nitrates, spasmolytics, tranquilizers.
Acupuncture and reflexotherap
pneumatic dilation- a ballon is inserted endoscopically to the centre of the sphincter
Complicationss of Achalasia
Progressive malnutrition
Aspiration pneumonia
Formation of diverticula’ and eso cancer
ia
Diverticula
steady sac-like
protrusion of the mucous membrane through
the defect in the muscular membrane of the
esophagus into the mediastinal cavity
Pulsion is false
Traction is true
Pulsion is formed under high intraeso. Pressure .
Zenker(false )
Traction formed due to inflammation in the surrounding tissue and scarry formation
Zenker (pharyngoxeso)
Can be congenital or acquired
Can be true or false , true all layers of eso. Walls and for falls just the mucosa and submucosa
Clinical ox dysphagia main symptom
Sticking of throat nagging cough
Diagnosis is made by barium esophagram
Roentgenogram.
Treatment -diverticulectomy resection of eso.
Can be conservative too
small, fast emptying diverticula without
clinical signs of inflammation and
congestion;
- in cases there are contraindications to the
operation (severe accompanying diseases)
-diet (intake of non-irritating T food);
-taking of the vegetable oil, prokinetics
(metoclopramide, motilium) to improve
evacuation of the diverticulum contents
Benign tumours of the esophagus
symptomatics, and are revealed accidentally during
roentgenological or endoscopic investigation. Later on progressing dysphagia appears. For
diagnosis verification roentgenological investigation and esophagoscopy with biopsy play the
decisive role.
Surgical treatment
Polypoid
tumours on the
thin crus –
endoscopic
polypectomy
Intraluminal
tumours on the
wide base –
endoscopic
dissection with the
wall segment
Intramural tumours
- enucleation
without the
impairment of the
mucous membrane
In large tumours –
resection of the
esophagus with its
substitution with
the stomach or
intestinal segmen
Cancer of the esophagus
Predisposing factors
scarry changes of
the mucous
membrane of any
etiology
epithelial benign
tumours
smoking, abuse
of alcohol
Exophytic (nodular,
fungiform,
papillomatous)
According to the form of growth
Endophytic
(ulcerous)
Mixed
Early-stage cancers may be asymptomatic
Pronounced clinical symptomatics usually appears at Т2 – Т4.
Symptoms Feeling of discomfort behind the breastbone at swallowing of food, dysphagia,
pain behind the breastbone, nausea, eructation, hypersalivation, hoarseness of
the voice, loss of weight, weakness.
Systemic metastases to liver, bone, and lung can present with
jaundice, excessive pain, and respiratory symptoms
Diagnostics It is based on the findings of contrasting roentgenological investigation and
endoscopy added by biopsy. CT and NMRT allow to detect germination of the
adjacent tissues by the tumour, as well as metastatic lesion of the lymph
nodes and distal organs.
barium esophagram is recommended for any patient presenting
with dysphagia
Treatment of the cancer of the esophagus-
Radical treatment
Transhiatal subtotal resection of the esophagus with
lymphodissection from the abdominal and cervical
approaches without thoracotomy
palliative
gastrostomy for nutrition
endoscopic stenting
laser and photodynamic destruction of the tumour
Radiation and chemotherapy are more frequently used as components of combined therapy in
combination with resection of the esophagus or as independent methods of palliative
treatment.
Gastro-esophageal reflux disease (GERD
Incompetence of the lower esophageal sphincter
• GERD may occur when the pressure of the high-pressure zone in
the distal esophagus is too low to prevent gastric contents from entering the esophagus
Etiology (risk factors). Pathogenesis.
hernias of
the
esophageal
opening of
the
diaphragm
pyloro-
duode-
nal
stenosis
chole-cystitis,
pancrea-titis
previous
operations
on the
stomach,
esophagus,
vagotomy obesity,
pregnancy,
asthenization,
continuous use
of spasmolytics,
nitrates,
smoking
Symptomatics
Heartburn It occurs after meals, intensifies in lying position,
when bending forward, lifting loads. It is connected
with irritation of the esophagus by acidic gastric
contents.
Pain It is localized behind the breastbone and irradiates to
the back (interscapular region). It is connected with
pronounced esophagitis, spastic esophageal
contractions.
“Wet pillow” symptom Spontaneous leakage of liquid (refluctant) out of the
mouth during sleep.
Cough It intensifies in lying position. It is connected with
irritation of the respiratory tracts by the refluctant.
Complications:
-aspiration pneumonia with the development of the lungs’ destruction;
-esophagitis with the development of ulcers, hemorrhage, scarry stenosis, dysphagia;
-Barret’s esophagus with possible malignization (up to 15%)
Contrasting roentgenological investigation.
It reveals the delivery of barium from the stomach into the esophagus
Esophagoscopy with morphological investigations
Barium swallow
• Endoscopy
• Ambulatory pH monitoring
• Esophageal manometry
Treatment
• Lifestyle Modifications
• Acid Suppression Therapy
• Anti-Reflux Surgery
• Endoscopic GERD Therapy
