Congenital:

Atresia

Traumatic:

FB

Caustic ingestion

Perforation

Neoplastic:

Benign (rare)

Malignant

Functional:

GERD

Neuro-muscular:

Achalasia

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

ويحصل • يرجع اللبن مايرضع كل مولود طفلاللون في وزرقان واختناق شديدة كحة له

ماتعديش • قسطرة نعدي نحاولتعدي( • القسطرة ))tracheo-esophageal fistula onlyممكن

• Lipoidol swallow

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 PictureImmediately 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

Children : the commonest .

It is accidental

بوضع الطفل يلعب عندمافمه في األشياء

Adult : suicidal

Type of patient

Type of foreign body

In children: the commonest is coin & disc battery

In adult: fish & meat boneIn elderly : dentures and meat

limpIn suicisal cases: razor or pins

At the upper end:

below the cricopharyngeal

sphincter. The commonest site

At normal constrictions

Anywhere with sharp FB• Type of patient• Type of foreign body• Site of impaction• Sequlae:

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 painDysphagia: so severe , the patient

cann’t swallow his saliva drolling

Stridor and hoarsness: due to laryngeal edema

بطاريات ماب

يجب األولية االسعافات فيحولنا متوفرة اشياء استخدام

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:PerforationHealing by fibrosis stricture

Systemic:- Dehydration &electrolyte

disturbance- Scock:- Neurogenic due to pain- Hypovolaemic

stricture

TreatmentAnalgesic

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

fibrosisSymptoms Signs: flexible esophagoscopyInvestigations: 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

- الحاالت من الحالة هذهتشخيصها ويجب بحق الطارئة

مرور قبل العالج في 24والبدافي التأخر ان حيث ساعةنسبة من يزيد التشخيصالي الحاالت هذه في الوفاة

من 50أكثر %

CORROSIVE

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

جسم عنده أو مرئ منظار عمل مريضبعدغريب

The patient is feverish and toxic

Dysphagia

Hematemesis

Retrosternal chest pain

dyspnea

Treatment: In ICU المركزه العناية فيConservative:- Nothing by mouth- Massive antibiotic therapy- Nasogastric tube in small

perforation- Gastrostomy in large perforation

Surgical- Repair and, cervical or trans-

thoracic 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 stomatitisGlazed tongue

SpreadLocal: 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 LNBlood:

Late and Rare

To Lung, Liver, Bone , Brain

trachea

spines

Chet X Ray Abdominal ultrasound Bone scan CT scan of the brain

SymptomsSignsInvestigations:- Barium swallow- CT scan- Biopsy- Metastatic work-upTreatment:Surgical resection followed

by reconstruction and radiotherapy

Prognosis is bad

SymptomsSignsInvestigations:- Barium swallow- CT scan- Biopsy- Metastatic work-upTreatment:Surgical resection followed

by reconstruction and radiotherapy

Prognosis is bad

فوق: مثال مدخن رجلصعوبة عنده الخمسين

تزيد شهرين منذ البلع فيفترة وبعد لألكل باستمرار

والسوائل لألكل اصبحتفي واضح فقدان مع

الوزن

فوق: مثال مدخن رجلصعوبة عنده الخمسين

تزيد شهرين منذ البلع فيفترة وبعد لألكل باستمرار

والسوائل لألكل اصبحتفي واضح فقدان مع

الوزن

In elderly patient commonly male:

- Rapidly progressive dysphagia, first to solids then to solids & fluids

- In large tumors : regurgitation of acid free food

- Hematemsis & Melena

- Later: hoarsness of voice

- Loss of weight

In elderly patient commonly male:

- Rapidly progressive dysphagia, first to solids then to solids & fluids

- In large tumors : regurgitation of acid free food

- Hematemsis & Melena

- Later: hoarsness of voice

- Loss of weight

Carcinoma of oesphagus

The stricture is

-irregular

-short

-shouldering

prestenotic dilatation

is moderate

العملي في هامة

Gastro-esophageal Reflux Disease GERD

DefIncidenceEtiology:- 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

Retrograde flow of gastric contents tothe esophagus, pharynx and larynxdue to frequent spontaneous relaxationof the cardiac sphincter

Infants Above 40

Symptoms:Esophageal;Retrosternal burning sensation (frequently absent)

Pharyngeal:Throat irritation hmemming & Hawking to clear the throat

وتنخيم نحنحه

Laryngeal:,Chronic irritative cough, hoarsness of voice In infants , nocturnal laryngeal irritationlaryngismus stridulus

:Signs-esophagitisulcer-May be stricture:Investigations& hours double probe(esophageal 24pharyngeal) ph monitoringMeasure the time the Ph is less than 4It is diagnostic if the time is more than 5%

Symptoms:Esophageal;Retrosternal burning sensation (frequently absent)

Pharyngeal:Throat irritation hmemming & Hawking to clear the throat

وتنخيم نحنحه

Laryngeal:Chronic irritative cough, hoarsness of voice,In infants , nocturnal laryngeal irritation laryngismus stridulus

Signs:-esophagitis-ulcerMay be strictureInvestigations:24 hours double probe(esophageal &pharyngeal) ph monitoringMeasure the time the Ph is less than 4It is diagnostic if the time is more than 5%

Treatment of GERD:

Live style support-weight reductionAvoid smoking and foods that worsen symptomsAvoid lying down for 3 hours after a meal. Raise the head of your bed 6 to 8 inches

Medical treatment:Anti-acids to relieve heartburnH2 blockers, such as cimetidine decrease acid

production Proton pump inhibitors e.g omeprazole

decrease acid production Prokinetics help strengthen the LES and make

the stomach empty faster metoclopramide (Reglan).

Surgical:After failure of medical treatmentFundoplication operationthe upper part of the stomach is wrappedaround the LES to strengthen thesphincter, prevent acid reflux, and repair ahiatal hernia.

لعالج جدا مهم الحياه نمط الحالة تغيير هذهالوزن - انقاصمن - تزيد التي االطعمة و التدخين تجنب

الحموضة قبل - العشاء طعام من 3-2تناول ساعات

النومرأس - رفع أو عالية مخدة علي النوم

السرير

Achalasia of the cardia

Incidence;commonly middle agedneurotic female

Etiology:Degeneration of ganglion cells ofAuerbach’s plexus (parasympathetic)in the wall of the esophagus Failureof relaxation of the cardiac sphincterduring swallowing marked dilatation

of the lower two thirds of the esophagus

Failure of relaxation ofCardiac sphincter

Marked Dilatation of the lower two thirds esophagus above the cardia

Symptoms:Dysphagia: more to fluids

Why?Regurgitation of undigested acid

free foodNo loss of weight Why?

Signs:Excessive food stagnation

مهضوم غير أكل مليان المرئ Marked dilatation …….

InvestigationsBarium swallowManometric study: increase pressureof the lower segment

Swalowing of fluids needs highly co-ordinated act of swallowingSolids can descend by gravity

Because dysphagia isintermittent

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 مؤقت عالج

-Repeated dilatation of the sphincter

- Surgical:Cardiomyotomy operation

( Hiller’s operation)

Division of the muscle fiber without injury of the mucosa