Dr.Muthanna Alassal MBChB FICMS(CTVS) Lecturer/ Al- kindy college of medicine

1. Esophagus 2 Dr.MuthannaAlassal MBChB FICMS(CTVS) Lecturer/ Al-kindy college of medicine Cardiothoracic and Vascular Surgeon Cardiothoracic and Vascular Department Surgical Specialization Hospital Medical City Baghdad

2. Corrosive injury of the esophagus • Corrosive injuries of the esophagus are caused by ingestion of strong acid or alkali which is more serious, it could be accidental especially in children below 5 years old or suicidal or homicidal especially in adults. • the patient usually presented with: • Sever oral pain and ulceration of the mouth, pharynx and larynx. • drooling and excessive salivation • inability to swallow or to drink • hoarseness of voice • Aphonia, dyspnia, and stridor.

3. Corrosive injury of the esophagus • Management • History. • Chest X-ray. • Barium swallow & esophagoscopy. • Treatment • Induction of vomiting and dilution are forbidden. • Admittion to hospital. • Nil by mouth. • Correction of fluid and electrolytes disturbances. • Broad spectrum antibiotics. • Steroids. • Antacids.

4. Gastro-Esophageal Reflux Disease (GERD) • It s due to reflux of gastric juice (acid and pepsin) up t the esophagus leading to inflammation (esophagitis) at the lower end of the esophagus, this is mainly due to failure of the anti reflux barrier at the esophago gastric junction. • Predisposing factors • Obesity. • Aging process. • Hiatal hernia. • Previous surgery at the gastro esophageal junction

5. Gastro-Esophageal Reflux Disease (GERD) • Clinical manifestation • Chronicity. • Severity. • Age of the patient. • Diagnosis • Barium swallows. • Gastro esophago-dudonoscopy(OGD) • 24hour PH monitoring of the esophagus. • Treatment

6. Hiatal Hernia • It is a herniation of part of the stomach through the esophageal hiatus to the thoracic cavity. • Types • Sliding (85%). • Rolling (Para esophageal type) (10%) • Mixed type (5%). • Clinical manifestation • Causes • Diagnosis. • Treatment

7. Tumors of the esophagus Benign tumors • papilomas • polyps • lipomas • fibromas • leiomyomas • duplication cyst. • Foregut cyst.

8. Malignant tumors of esophagus • Primary: Carcinoma of the esophagus is a common tumor with high predilection in certain geographical areas (esophageal belt) which includes the northern part of Iraq, Iran and southern parts of Russia, with equal incidence in both sexes affecting people usually in their third decade of life • Etiology • Genetic factors. • Carcinogens. • Certain premalignant conditions.

9. Malignant tumors of esophagus • Pathology • 50% in the lower third of the esophagus. • 17% in the middle third (thoracic part). • 33% in the lower esophagus. Clinical features • Progressive Dysphagia. • Progressive weight loss, catchaxia, dehydration, and anemia. • repeated chest infection.

10. Malignant tumors of esophagus • Diagnosis • Radiological • Abdominal ultrasound. • Esophagoscopy. • Endoscopic ultrasonography (EUS). • Biochemical and blood studies. • Treatment • Palliative. • Definitive surgical treatment.

11. Malignant tumors of esophagus • Palliative • bypass conduits. • Endoscopic stenting. • Self expandable recent stents. • Feeding jejunostomy or gastrostomy in advanced cases. • Definitive surgical • Left lower thoraco-abdominal approach. • Ivor lewis esophagectomy. • Trans-Hiatal esophagectomy. • Modified McKeowen or tri-incisional technique

12. Miscellaneous Esophageal Diverticula • Diverticulum is a pouch in the gastro intestinal tract. • Types • Pulsion diverticulum • Traction diverticulum • Clinical presentation • Diagnosis &Treatment

13. Miscellaneous Plummer Vinson syndrome (Paterson Kelly syndrome) • clinical features • Atrophy of the tongue. • Angular stomatitis. • Koilonychia(spoon shaped finger nails). • Hypochromic anemia. • Achlorhydria. • Treatment • Surgical dilatation of the stricture. • Iron replacement with other vitamins.