Oesaphagus Flashcards
Achlasia def
Progressive destruction of the ganglion cells of the myenteric plexus in the oesophageal wall the inability of the sphincter to relax and a loss of peristalsis of the distal end therefore it will dilate the distal oesophagus
Signs of achlasia
Dysphagia heartburn regurgitation of non-acidic food reflux weight loss chest pain that is unresponsive to ant acids
Halitosis
Function of upper oesaphageal sphincter
- Prevent air from coming into oesophagus during breathing
- Prevents aspiration into the lungs
Causes
- Neurological
- Hsv-1
- Antibodies against plexus (people at risk for autoimmune disorders )
- Neurological problem
- Chagas’ disease t.cruzi can cause toxic oesaphagus
What is almost 100 percent found in achlasia people
Antibodies and hsv1 infection
Diagnosis
Barium swallow will show proximal dilated and gtypical bird beak appearance endoscopy dilated wall and will see food and saliva
Chest x ray- no air in stomach
Manometey
Pseudo achlasia
- Tumour - gastric or gullet cancer
- Scleroderma
- Ischemix stricture
4.
What are achlasia at risk for
Autoimmune disorders
Squamous cell carcinoma > 10 years
Tx achlasia
Goal to decrease pressure and relief pressure
- Botulinum toxin (causes less ach) If that does work can try calcium channel blockers
- Surgery to cut the sphincter oesaphagomyotomy
- Dilate the LES with a ballon
- Calcium channel blockers - ca2+ blockers and nitrates
Complications achlasia
Pneumonia from aspiration
Weight loss
Pain
Squamous cell carcinoma
Symptoms of hiatal hernia
Dysphasia, odonophagia
Regurgitation
Chest pain
S.o.b
Chronic cough
Signs when lying flat (same as achlasia )
Diagnosis of hiatal
Same as achlasia
Chest x ray will show- mass
Tx hiatal her is
Lifestyle advice
- Don’t eat straight away before bedtime
avoid alcohol(makes GERD worse) and acidic foods
avoid smoking because nicotine relaxes the lES just sphincter
certain foods such as chocolate peppermint coffee fatty foods also can relax
Medications like calcium Chanel blockers and nitrates (same as achlasia)
pPI for the reflex- 1st line in essay
Surgery- Nissens fundoplicatioj
What is nissen fundiplication
It’s a Surgery to correct gastro-oesophageal reflux disease because it tightens the junction between the oesophagus and the stomach. The fund is is wrapped around the lower end of eospahagus
Gold standard diagnosis hiatal hernia
But quesmed says it’s a barium swallow as a hiatal hernia can’t be confirmed 100 percent by endoscopy
Oesaphago- gastro- duodeno scopy
When is surgery indicated for hiatal hernia
Despite conservative management symptoms Persist
Patient is loosing too much weight
Acute abdomen in the case of rolling hernia
Types of surgery in haital
Cruroplasty - prevents reherniation and also helps the reflux
Nissens fundiplication
Barret oespahgus
Change from lower third of espahgus metaplasic change from squamous epithelium to columnar epithelium with goblet cells which are only present small and large intestine
How do u diagnose barret
Endoscopy and you can take a sample
Clasificayion of barret (wiki)
- Non dysplastix
- Low grade dysolasia
3.high grade dysplasia - Frank carcinoma
What can we do in the early stages of Barry oesophagus
Endoscopic reception or radio frequency ablation
rF for cancer of gullet
Hot foods
Smoking
Having achlasia- squamous
Types of gullet cancer
Squamous - usually top 2/3rds
Adenocarcinoma - lower third - associated with obesity +GERD
small cell carcinoma- very rare
rf gullet cancer
Smoking
GERD and therefore also obesity
Alcohol
Diet: betal nuts, nitrosamines - smoked fish and meats
Hot beverages
Achlasia
Zenkers
Oesophageal web-
Plummer-Vinson syndrome.
Signs of gullet carcinoma
- Dysphasia - which is progressive!!! Solids first then liquids unlike motility where both are from the start
- Odonophagia
- Hoarsenessof voice if recurrent laryngeal nerve involved
- Weight loss - 2nd most common
fistulas causing coughing
Why is gullet cancer diagnosed late
Because dysphagia only happens when more than 2/3 of the lumen is included
Initial investigation when you suspect is off of your cancer
Endoscopy - take a Sample then stage with CT and other methods
What type of cancer subtype is barret more likely to progress to
Adenocarxiboma
Achlasia and barret what types of cancer are they associated with
Achlasia : sCC- irritation of oespaggus because of food
Barret- adenocarcinoma
hence why you find goblet cells in the lower third
Borchard’s triad- what does it show
Severe Epigastric pain
Retching without vomiting
Inability to pass an NG tube
stomach volvulus
oesophageal webs
Its main symptoms are pain and difficulty in swallowing
membranes of normal esophageal tissue consisting of mucosa and submucosa that can partially protrude/obstruct the esophagus. They can be congenital or acquired. Congenital webs commonly appear in the middle and inferior third of the esophagus, and they are more likely to be circumferential with a central or eccentric orifice. Acquired webs are much more common than congenital webs and typically appear in the cervical area (postcricoid).[citation n
most common risk factor for squamous
smoking and alcohol
rf gerd
RF: age, obesity, male, alcohol, smoking, caffeine, fatty and spicy food
true diverticula
false
true - traction - all 3 layers rare , associated with perioesaphgeal inflammation
false- pulsion , more common only contains mucosa and submucosa
true diverticula
false
true - traction - all 3 layers rare , associated with perioesaphgeal inflammation
false- pulsion , more common only contains mucosa and submucosa
what muscle is associated with zenkers
cricipharygeus as it forms part of the upper oesapageal sphicter
killians triangle
lies between the inferior pharyngeal constrictors and the cricopharyngeus muscle - its a potential area of weakness
killians triangle
lies between the inferior pharyngeal constrictors and the cricopharyngeus muscle - its a potential area of weakness
epiphrenic diverticula
happnes in the distal esoagus (last 10 cm) also classed as pseudo as not all the layers so its a pulsion force associated with underlyinh motilty
epiphrenic diverticula
happnes in the distal esoagus (last 10 cm) also classed as pseudo as not all the layers so its a pulsion force associated with underlyinh motilty
classic triad of achlasia - nov
dysphagia, regurgtiion , wieght loss
classic triad of achlasia - nov
dysphagia, regurgtiion , wieght loss
4 criteria of achlasai
- increased intraesophageal pressure
- a lES that does not open in response to food
- a high pressure of the LES
- absence of peristalsis
what is the most effective no surgical option of achlasia
pneumatic dilation - endocscopically
definitve tx achlasia
hellers myotomy
whats more likelt to be worse acids or alkalis
alkalis cause more damage
3 sites of injury pron to caustic damage
- proximal near uES
- mid oesapgahus just where the aorta abts the left mainstream bronchus
- distal near LES
3 sites of injury pron to caustic damage
- proximal near uES
- mid oesapgahus just where the aorta abts the left mainstream bronchus
- distal near LES
acid on the oesapgaus
causes cagulative necorsis forming an eshar
alkaline
liquiefactive necrosis so deeper penetration
how to treat oesapageal stricture
dilation with a baloon
3 gross patterns of oesapgeal cancer
ulcerating type fungating type and infiltrative type
local staging of cancer and regional
L- ENODLUMINAL US SCAN
R: CT SCARN
local staging of cancer and regional
L- ENODLUMINAL US SCAN
R: CT SCARN
IVOR LEWis procedure is what
THOROCOABDOMIANAL ESOPHAGETCTOMY
he esophageal tumor is removed through an abdominal incision and a right thoracotomy (a surgical incision of the chest wall). The esophagogastric anastomosis (reconnection between the stomach and remaining esophagus) is located in the upper chest.
Transhiatal Esophagectomy
only s cervical incsion unlike ivor lewis
then you rbing the rest of the stomach to the neck
