Congenital: Atresia Traumatic: FB Caustic ingestion Perforation Neoplastic: Benign (rare) Malignant...
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Transcript of Congenital: Atresia Traumatic: FB Caustic ingestion Perforation Neoplastic: Benign (rare) Malignant...
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 ®urgitation
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