Transcript Anatomy - arabblogs.com

Congenital:
Atresia
Traumatic:
FB
Caustic ingestion
Perforation
Neoplastic:
Benign (rare)
Malignant
Functional:
GERD
Neuro-muscular:
Achalasia
Congenital Anomalies
The most common; Atresia with Tracheo-esophageal fistula
Regurgitation of food  aspiration, chocking and cyanosis
A catheter fail to enter the stomach
‫• طفل مولود كل مايرضع اللبن يرجع ويحصل له كحة‬
‫شديدة واختناق وزرقان في اللون‬
‫• نحاول نعدي قسطرة ماتعديش‬
‫• (ممكن القسطرة تعدي )‪)tracheo-esophageal fistula only‬‬
‫‪swallow‬‬
‫‪• Lipoidol‬‬
Atresia with Tracheo-esophageal fistula
The commonest
congenital anomaly of the
Esophagus
The upper segment ends
as a blind pouch
The lower segment is
connected to the trachea
Clinical Picture
Immediately after birth:
Marked regurgitation and
Drolling
Oral Catheter fails to enter the
stomach
Investigations;
Lipidol swallow
Treatment:
Immediate surgical repair
1- Foreign body
2- Caustic ingestion
- Corrosive esophagitis
- Stricture of the esophagus
3-Esophageal perforation
Type of patient
Type of foreign body
In children:
the commonest
commonest is .
Children
: the
coin & disc battery
It In
is adult:
accidental
fish & meat bone
In ‫في‬
elderly
dentures
‫فمه‬
‫األشياء‬: ‫بوضع‬
‫الطفل‬and
‫يلعب‬meat
‫عندما‬
limp
Adult
: suicidal
In suicisal
cases: razor or pins
•
•
•
•
Type of patient
Type of foreign body
Site of impaction
Sequlae:
At the upper end:
below the cricopharyngeal
sphincter. The commonest site
At normal constrictions
Anywhere with sharp FB
Mechanical obstruction dysphagia
& regurgitation
Disc batteries  liquifactive necrosis
and even perforation
Sharp FB  mucosal tears
&even perforation
•
•
•
•
•
•
•
•
•
Type of patient
Type of foreign body
Site of impaction
Sequlae:
Symptoms
Signs
Investigations
Complications: perforation
Treatment :
Removal by esophagoscope
History
Dysphagia
It may be severe with drolling
of saliva
Regurgitation of undigested
food
1- Foreign body
2- Caustic ingestion
- Corrosive esophagitis
- Stricture of the esophagus
3-Esophageal perforation
Etiology
-
-
Strong Alkalies (common) liquid
cleaners &disc batteries
progessive liquifactive necrosis
and even perforation
Strong Acids: (rare) self limited
coagulative necrosis act as a
barrier  protect the mucosa
Symptoms:
History:
Severe mouth and throat pain
Dysphagia: so severe , the patient
cann’t swallow his saliva 
drolling
Stridor and hoarsness: due to
laryngeal edema
‫ماب بطاريات‬
‫في االسعافات األولية يجب استخدام اشياء متوفرة‬
‫حولنا‬
Fist Aid :
Combat shock ; IV fluids and
analgesics
Buffering solution:
-Vinegar or diluted lemon to
neutralize alkalies
- Anti-acid for strong acids
Emoluent solution;
Egg white and milk to protect thr
mucosa
Complications:
Local:
Perforation
Healing by fibrosis stricture
Systemic:
- Dehydration &electrolyte
disturbance
- Scock:
- Neurogenic due to pain
- Hypovolaemic
stricture
Treatment
Analgesic
Antibiotics
Corticosteroids
Nasogastric tube
Endotracheal intubation or
tracheostomy if indicated
i.e if there is signs of
respiratory obstruction
Etiology:
healing of corrosive esophagitis by
fibrosis
Symptoms
Signs: flexible esophagoscopy
Investigations: Barium swallow
Treatment:
- Permeable strictures
Repeated dilatation through an
esophagoscope
- Impermeble strictures
- colon bypass operation
•
After a latent period of a few
weeks
- progressive dysphagia to solids
then to fluids also
- Regurgitation of undigested acid
free food
‫‪Etiology:‬‬
‫‪-Accidental: sharp FB or‬‬
‫‪corrosives‬‬
‫‪- Iatrogenic : unskilled‬‬
‫‪esophgoscopy‬‬
‫‪CORROSIVE‬‬
‫هذه الحالة من الحاالت الطارئة بحق‬
‫ويجب تشخيصها والبدا في العالج قبل‬
‫مرور ‪ 24‬ساعة حيث ان التأخر في‬
‫التشخيص يزيد من نسبة الوفاة في هذه‬
‫الحاالت الي أكثر من ‪%50‬‬
‫‪-‬‬
Sequlae:
Clinically
Investigations:
Plain X ray: air in the neck, pleura,
mediastinum
Gastrografin swallow to detect the
site and size of perforation
Air in the neck surgical emphysema
Air n the pleura pneumothorax
Air in the mediastinum pneumo-mediastinum
‫مريض بعد عمل منظار مرئ أو عنده جسم غريب‬
The patient is feverish and toxic
Dysphagia
Hematemesis
Retrosternal chest pain
dyspnea
Treatment:
In ICU ‫في العناية المركزه‬
Conservative:
-
Nothing by mouth
Massive antibiotic therapy
Nasogastric tube in small
perforation
Gastrostomy in large perforation
Surgical
- Repair and, cervical or transthoracic drainage-
Incidence:
-
The commonest malignant
tumor of the esophagus
Above 50 years old
Commonly males
Predisposing factors:
-
excessive tobacco & alcohol
GERD
Achalasia
Plummer Vinson syndrome
Koilonychia,, Angular stomatitis
Glazed tongue
Spread
Local:
to surrounding structures: trache,
bronchi, spines, recurrent
laryngeal nerve
Lymphatic:
- Cervical part: to lower deep
cervical LN
- Thoracic part: mediastinal LN
- Abdominal part: to coeliac LN
Blood:
spines
trachea
Late and Rare
To Lung, Liver, Bone , Brain
Chet X Ray
Abdominal ultrasound
Bone scan
CT scan of
the brain
Symptoms
Signs
Investigations:
- Barium swallow
- CT scan
- Biopsy
- Metastatic work-up
Treatment:
Surgical resection followed
by reconstruction and
radiotherapy
Prognosis is bad
‫الخمسين‬
‫فوق‬commonly
‫رجل مدخن‬
:‫مثال‬
In elderly
patient
male:
- Rapidly
progressive
dysphagia,
‫البلع منذ‬
‫صعوبة في‬
‫عنده‬
first to solids then to solids & fluids
‫كل‬large
‫باستمرار لأل‬
‫شهرين تزيد‬of
- In
tumors : regurgitation
acid‫لألكل‬
free food
‫وبعد فترة اصبحت‬
- Hematemsis & Melena
‫والسوائل مع فقدان واضح‬
- Later: hoarsness of voice
‫في الوزن‬
- Loss of weight
‫هامة في العملي‬
Carcinoma of
oesphagus
The stricture is
-irregular
-short
-shouldering
prestenotic dilatation
is moderate
Gastro-esophageal Reflux
Disease GERD
Def
Incidence
Etiology:
-
-
Retrograde flow of gastric contents to
the esophagus, pharynx and larynx
due to frequent spontaneous relaxation
of the cardiac sphincter
Deceases pressure of cardiac
sphincter e.g in hiatus hernia
Gastric hypersecretion: stess,
smoking alcohol, caffiene, spicy
foods, citrus frits
Complications:
-
esophagitis ulcer stricture
Chronic pharyngitis & Laryngitis
Cancer esophagus & Larynx
Infants
Above 40
Symptoms:
Esophageal;
Retrosternal burning sensation (frequently absent)
Pharyngeal:
Throat irritation hmemming & Hawking to clear the throat
‫نحنحه وتنخيم‬
Laryngeal:
Chronic irritative cough, hoarsness of voice,
In infants , nocturnal laryngeal irritation 
laryngismus stridulus
Signs:
-esophagitis
-ulcer
May be stricture
Investigations:
24 hours double probe(esophageal &
pharyngeal) ph monitoring
Measure the time the Ph is less than 4
It is diagnostic if the time is more than 5%
Treatment of GERD:
Live style support
-weight reduction
Avoid smoking and foods that worsen symptoms
Avoid lying down for 3 hours after a meal.
Raise the head of your bed 6 to 8 inches
‫تغيير نمط الحياه مهم جدا لعالج هذه الحالة‬
‫ انقاص الوزن‬Medical treatment:
Anti-acids‫من‬
to‫تزيد‬
relieve
heartburn
‫االطعمة التي‬
‫ تجنب التدخين و‬H2 blockers, such as cimetidine decrease
acid
‫الحموضة‬
production
‫النوم‬
‫ساعات من‬
3-2e.g
‫ قبل‬omeprazole
‫ تناول طعام العشاء‬Proton pump
inhibitors
decrease
acid production
‫رأس السرير‬
‫ النوم علي مخدة عالية أو رفع‬Prokinetics help strengthen the LES and make
the stomach empty faster
metoclopramide (Reglan).
Surgical:
After failure of medical treatment
Fundoplication operation
the upper part of the stomach is wrapped
around the LES to strengthen the
sphincter, prevent acid reflux, and repair a
hiatal hernia.
Achalasia of the cardia
Incidence;
commonly middle aged
neurotic female
Etiology:
Degeneration of ganglion cells of
Auerbach’s plexus (parasympathetic)
in the wall of the esophagus  Failure
of relaxation of the cardiac sphincter
during swallowing marked dilatation
Marked Dilatation of the lower
two thirds esophagus above the cardia
of the lower two thirds of the esophagus
Failure of relaxation of
Cardiac sphincter
Symptoms:
Dysphagia: more to fluids
Why?
Regurgitation of undigested acid
free food
No loss of weight Why?
Swalowing of fluids needs highly
co-ordinated act of swallowing
Solids can descend by gravity
Because dysphagia is
intermittent
Signs:
Excessive food stagnation
‫المرئ مليان أكل غير مهضوم‬
Marked dilatation …….
Investigations
Barium swallow
Manometric study: increase pressure
of the lower segment
Marked dilatation of the lower 2/3
of the esophagus (segmoid
esophagus)
Tapering of the lower end
Treatment:
- Conservative:
Muscle relaxant as Amyl nitite before
meals to relax the cardiac
sphincter ‫عالج مؤقت‬
-Repeated dilatation of the sphincter
- Surgical:
Cardiomyotomy operation
) Hiller’s operation(
Division of the muscle fiber
without injury of the mucosa