Oesophagus Flashcards
Failure of embryological canalisation of oesophagus. Associated with fistula between the proximal oesophagus and trachea. The affected child cannot swallow and develops aspiration pneumonia. Urgent surgical correction is required.
Atresia
An outpouching of the oesophageal wall. Can develop in the oesophagus due to either traction(external forces pulling on the wall) or pulsion(forcible distension). Frequently becomes permanently distended with retained food and may cause dysphagia
Diverticula
Protrusion of the upper part of the stomach into the thorax via the diaphragmatic orifice. Due to the herniation the lower oesophageal sphincter becomes incompetent resulting in the regurgitation of gastric contents(GORD).
Hiatus hernia
Characterised by the loss of contractility of the oesophagus and failure of the lower oesophageal sphincter to relax. Results in slowing /retention of food bolus with increasing obstruction and dilatation of the oesophagus. Usually treated with pneumatic dilatation or surgical myotomy of the lower sphincter
Achalasia
The lower oesophagus is a junction where portal circulation and systemic circulation connect(known as a portocaval anastomosis). When pressure in the portal vein increases in portal hypertension, portal blood is forced to find a different route back to the heart, via these portocaval anastomoses. In the oesophagus the veins become congested and distended and protrude into the oesophagus where they are vulnerable to trauma from the passage of food. Acute haemorrhage is a frequent complication of varices, and can be life-threatening
Oesophageal varices
Rupture of the oesophageal mucosa at the gastro-oeosophageal junction. Related to repeated retching, forceful vomiting and trauma. Bleeding frequently stops spontaneously
Mallory-Weiss tear
Whole thickness perforation of the oesophageal wall at the gastro-oesophageal junction. Related to repeated retching, forceful vomiting and trauma. Requires immediate surgical repair
Boerhaave syndrome
Bacterial infection from the nasopharynx is a rare occurrence. Herpes, cytomegalovirus or candida infections are seen in particular in immunocompromised patients. Acute inflammation and ulceration can be caused by ingestion of corrosive substances
Acute oesophagitis
Gastro oesophageal reflux disease(GORD). Chronic oesophagitis due to regurgitation of gastric contents into the lower oesophagus. Lifestyle risk factors such as smoking, alcohol, obesity, hot beverages, caffeine play a role alongside other risk factors like hiatus hernia, decreased lower oesophageal sphincter pressure, increased gastric fluid volume and decreased luminal clearance
Reflux oesophagitis
A long term consequence of GORD. There is metaplasia of oesophageal squamous cells to columnar epithelium. Is associated with an increased risk of oesophageal adenocarcinoma with epithelial dysplasia preceding malignancy. Regular surveillance by biopsy is recommended to pick up cancer early
Barrett’s oesophagus
Cancers develop from squamous lining of proximal two thirds of oesophagus. Main risk factors are tobacco, alcohol, vitamin deficiencies and are is more common in “developing countries”.
Usually commences as an ulcer which leads to lumen constriction causing dysphagia. 70% of patients present with widespread local spread or metastatic disease which can no longer be cured by surgical resection. Palliative chemotherapy, chemoradiotherapy or stenting can improve quality of life and long term outlooks for these patients
Squamous carcinoma
Cancers develop in distal one third of the oesophagus and most arise from patients who have already developed Barrett’s oesophagus. Incidence rising dramatically among western countries. GORD and Barrett’s oesophagus are the most common predisposing factors.
Progression of cancer and treatment same as on squamous carcinoma slide
Adenocarcinoma
