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ESOPHAGEAL DISEASES

Esophageal Diseases. Two function of esophageal - Transport of food by peristalsis.- Prevention of gastric regurgitation by LES/UES.Dysphagia:* Sensation of obstruction of food passage.* Difficulty in swallowing. A) Mechanical dysphagia my be due to:. 1. Large food bolous.2. I

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ESOPHAGEAL DISEASES

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    1. ESOPHAGEAL DISEASES Prof. Saleh M. Al-Amri Consultant, Gastroenterology Unit College of Medicine & K.K.U.H. King Saud University

    2. Esophageal Diseases Two function of esophageal - Transport of food by peristalsis. - Prevention of gastric regurgitation by LES/UES. Dysphagia: * Sensation of obstruction of food passage. * Difficulty in swallowing

    3. A) Mechanical dysphagia my be due to: 1. Large food bolous. 2. Instrinsic narrowing. e.g. i) Esophagitis (viral/ fungal) ii) Stricture (benign) iii) Tumor iv) Web/ rings

    4. 3. Extrinsic compression e.g. i) Enlarge thyroid. ii) Diverticulum. iii) Left atrial enlargement.

    5. B) Motor dysphagia: Diseases of striated or smooth muscles of esophagus Striated muscle disease * Motor neron dis * CVA * Myasthenia gravis * Polymyositis

    6. Smooth muscles disorder: * Scleroderma * Achalasia * Esophageal spasm

    7. History can help DD: ? Difficulty with solids implies mechanical dysphagia / which may progress / static. ? Motor dysphagia, equally affect solid and liquid from the onset.

    8. Character: Episodic dysphagia to solid for long duration esophageal ring. ? Nasal regurgitation Pharyngeal paralysis ? Tracheobronchial aspiration Achalasia Zenker diverticulum ? Severe weight loss Malignancy ? Horseness and dysphagia Recurrent laryngeal nerve involvement by malignancy.

    9. Physical examination: ? Sign of bulbar paralysis ? Dysarthria ? Ptosis ? CVA ? Goitre ? Changes in skin - CTD

    10. Odynophagia: Painful swallowing which is characteristic of non-reflux esophagitis. Heartburn: Burning sensation Moves up/down Chest pain: ? GERD ? Esophageal motor disorder.

    11. Haematemesis. Melena. Regurgitation.

    12. GERD (Gastro-oesophageal reflux disease) Reflux esophagitis: Damaged esophageal mucosa by reflux of gastric content. Pathophysiology Antireflux mechanism includes: ? LES ? Esophageal peristalsis ? Resistant of esophageal mucosa. ? Saliva ? Gastric peristalsis

    13. Major factor involved in GERD ? Loss of LES pressure: TLESR Sustained Scleroderma Surgical resection ? Hiatus hernia ? Aperistalsis ? Reduce saliva ? Delayed gastric emptying : Mech. Obstruction and motor disorder.

    14. Damage depends on: ? Refluxed material ? Duration of reflux / frequency.

    15. Manifestation: ? HB ? Chest pain ? Dysphagia - complication ? Regurgitation

    16. Diagnosis: Endoscopy & Biopsy Barium swallow 24 Hours pH - motility

    17. Complication: ? Bleeding ? Stricture formation ? Barretts esophagus

    18. Treatment: ? Antireflux measure. ? Acid supressing agent. ? Surgery

    19. Achalasia: A motor disorder of esophageal smooth muscle Character by: ? High LES pressure, that does not relax properly. ? Absent distal peristalsis.

    20. Pathophysiology: Loss of intramural neurons of esophageal body & LES. Clinically ? Dysphagia both liquid and solid. ? Regurgitation and pulmonary aspiration. ? Chest pain.

    21. Diagnosis: Chest X-ray - ? Absent of gastric bubble. ? Wide mediastinum. ? Fluid level. Ba. Swallow Esophageal dilatation Terminal part of the esophagus is beak like

    22. Manometry Elevated LES P with no or partial relaxation low amplitude contraction, no propagating (simultaneous).

    23. III. A) Medical Nitroglucerin Ca channel blocker. B) Pneumatic dilatation C) Surgical

    24. Infectious Esophagitis: A) Viral esophagitis ? Herpes simplex. ? Varicella Zoster. ? CMV.

    25. B) Bacterial C) Fungal C/o - Dysphagia - Odynophagia - Bleeding

    26. Diagnosis: Ba. swallow End. Bx.

    27. Diverticula: Outpouchings of the wall of the esophagus Zenker - upper Epiphrenic lower part C/o - Asymptomatic Typical Regurgitation of food consumed several days ago. Dysphagia.

    28. Esophageal Cancer: Disease more in Males > 50 Y. Causation factors: ? Excess alcohol. ? Cigarette smoking. ? Fungal toxin.

    29. Mucosal damage: ? Hot tea. ? Radiation induced stricture. ? Barretts esophagus. ? Esophageal web.

    30. Clinically 15% in upper 1/3 45% in middle 1/3 40% in lower 1/3 Pathology Squamous cell carcinoma > 75% adenocarcinoma ? Progressive dysphagia ? Weight loss ? Odynophagia ? Regurgitation ? T-E Fistula

    31. Once symptom appear the disease is incurable. Patient may have Hypercalcaemia Diagnosis: ? Ba. swallow ? Endoscopy & Bx

    32. IV. - Surgical, if localized - Paliative Prognosis in poor. 5 Y survival ?? 5%

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