esophageal diseases prof. saleh m. al-amri consultant, gastroenterology unit college of medicine...
TRANSCRIPT
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ESOPHAGEAL DISEASES
Prof. Saleh M. Al-AmriConsultant, Gastroenterology Unit
College of Medicine & K.K.U.H.King Saud University
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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
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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
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3. Extrinsic compression
e.g. i) Enlarge thyroid.
ii) Diverticulum.
iii) Left atrial enlargement.
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B) Motor dysphagia:Diseases of striated or smooth muscles of esophagus
Striated muscle disease
* Motor neron dis
* CVA
* Myasthenia gravis
* Polymyositis
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Smooth muscles disorder:
* Scleroderma
* Achalasia
* Esophageal spasm
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History can help DD:
Difficulty with solids implies mechanical dysphagia / which may progress / static.
Motor dysphagia, equally affect solid and liquid from the onset.
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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.
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Physical examination:
Sign of bulbar paralysis
Dysarthria
Ptosis
CVA
Goitre
Changes in skin - CTD
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Odynophagia: Painful swallowing which is characteristic of non-reflux esophagitis.
Heartburn: Burning sensation Moves up/down
Chest pain: GERD
Esophageal motor disorder.
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Haematemesis.
Melena.
Regurgitation.
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GERD (Gastro-oesophageal reflux disease)Reflux esophagitis: Damaged esophageal mucosa
by reflux of gastric content.
PathophysiologyAntireflux mechanism includes: LES Esophageal peristalsis Resistant of esophageal mucosa. Saliva Gastric peristalsis
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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.
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Damage depends on:
Refluxed material
Duration of reflux / frequency.
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Manifestation:
HB
Chest pain
Dysphagia - complication
Regurgitation
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Diagnosis:
Endoscopy & Biopsy
Barium swallow
24 Hours pH - motility
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Complication:
Bleeding
Stricture formation
Barrett’s esophagus
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Treatment:
Antireflux measure.
Acid supressing agent.
Surgery
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Achalasia: A motor disorder of esophageal smooth muscle
Character by:
High LES pressure, that does not relax
properly.
Absent distal peristalsis.
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Pathophysiology: Loss of intramural neurons of esophageal body & LES.
Clinically Dysphagia – both liquid and solid. Regurgitation and pulmonary aspiration. Chest pain.
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Diagnosis:
Chest X-ray - Absent of gastric bubble. Wide mediastinum. Fluid level.
Ba. Swallow
Esophageal dilatation
Terminal part of the esophagus is beak like
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Manometry
Elevated LES P with no or partial relaxation
low amplitude contraction, no propagating
(simultaneous).
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III. A) Medical
Nitroglucerin
Ca – channel blocker.
B) Pneumatic dilatation
C) Surgical
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Infectious Esophagitis:
A) Viral esophagitis
Herpes simplex.
Varicella Zoster.
CMV.
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B) Bacterial
C) Fungal
C/o - Dysphagia - Odynophagia
- Bleeding
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Diagnosis:
Ba. swallow
End.
Bx.
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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.
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Esophageal Cancer:
Disease more in Males > 50 Y.
Causation factors:
Excess alcohol.
Cigarette smoking.
Fungal toxin.
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Mucosal damage:
Hot tea.
Radiation induced stricture.
Barrett’s esophagus.
Esophageal web.
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Clinically15% in upper 1/345% in middle 1/340% in lower 1/3
Pathology Squamous cell carcinoma > 75%adenocarcinoma
Progressive dysphagia Weight loss
Odynophagia Regurgitation T-E Fistula
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Once symptom appear the disease is incurable.
Patient may have Hypercalcaemia
Diagnosis:
Ba. swallow
Endoscopy & Bx
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IV. - Surgical, if localized
- Paliative
Prognosis in poor.
5 Y survival 5%
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