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The Oesophagus

The Oesophagus. A muscular tube. Conduction of food and drink Sphincters at top and bottom. Histology . Non-keratinising squamous epithelium. Congenital and mechanical disorders (1). Atresia – often with fistula to trachea

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The Oesophagus

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  1. The Oesophagus

  2. A muscular tube • Conduction of food and drink • Sphincters at top and bottom

  3. Histology • Non-keratinising squamous epithelium

  4. Congenital and mechanical disorders (1) • Atresia – often with fistula to trachea • Hiatus hernia (presence of stomach in thoracic cavity) – due to increased intra-abdominal pressure

  5. …Mechanical disorders (2) • Achalasia • Failure of relaxation of lower oesophageal sphincter (destruction or degeneration of nerve plexus) • Similar features in Chagas’ disease (South American trypanosomiasis)

  6. Oesophageal varices • Localised dilatation of lower oesophageal veins • Secondary to portal hypertension (portal vein thrombosis or hepatic cirrhosis) • Haemorrhage can be catastrophic

  7. Inflammation (oesophagitis) • Acute infective – Herpes virus, Candida. Both seen most commonly in immunosuppressed. • Ingestion of corrosives • Chronic reflux through lower oesophageal sphincter

  8. Herpes oesophagitis

  9. Herpes oesophagitis • Punched-out ulcers • Viral intranuclear inclusions • Formation of multinucleated giant cells (cytopathic effect)

  10. Candida oesophagitis • Haemorrhagic mucosa with white plaques • Fungal hyphae and yeast forms on microscopy

  11. Reflux oesophagitis • Common – often without symptoms • Mucosa exposed to acid-pepsin and bile • Increased cell loss and regenerative activity

  12. Consequences of reflux oesophagitis • Ulceration • Stricture • Glandular metaplasia (Barrett’s oesophagus) • Carcinoma

  13. Barrett’s oesophagus • Columnar epithelial cells in lower oesophagus • Variable extent • Presence of goblet cells “intestinal metaplasia” associated with risk of progression to dysplasia/cancer

  14. Oesophageal neoplasms • Benign tumours (rare): squamous papilloma, leiomyoma • Malignant tumours • Squamous carcinoma • Adenocarcinoma Presenting symptom - dysphagia

  15. Epidemiology of oesophageal cancer • Squamous carcinoma commonest worldwide • Adenocarcinoma has very different risk factors and is now the commonest type in Europe/N.America

  16. Squamous carcinoma • High incidence in Southern Africa (incl. Malawi), China, Iran • Probably diet related (A and B vitamin deficiency, fungal contamination) – tobacco and alcohol also risk factors • Associated with chronic non-specific oesophagitis

  17. Squamous carcinoma • Often large exophytic occluding tumours • Invasive disease preceded by dysplasia and carcinoma in situ

  18. Adenocarcinoma • Occurs in lower oesophagus • Often associated with Barrett’s oesophagus (progresses through dysplasia to cancer)

  19. Clinical course of oesophageal cancer • Grim! (even with best available resource) • Tumours have commonly spread to regional nodes and/or liver at presentation • No peritoneal lining in mediastinum – local invasion (heart, trachea, aorta) often limits surgery

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