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OESOPHAGUS
ACUTE OESOPHAGITIS
Acute inflammation of oesophagus due to
1. Ingestion of hot liquid
2. Ingestion of caustic or corrosive agents
3. laceration due to swallowed foreign body or trauma of
oesophagoscopy
4. Infection of oesophagus from oral thrush
5. Systemic disorders like pemphigus
6. GERD
Symptoms Diagnosis
Dysphagia
From history
Retrosternal
X ray study
burning
oesophagoscopy
Hematemesis
Treatment
? Antacids-proton pump
inhibitors,H2 receptor
blocker
? Steroids
AETIOLOGY
Instrumental trauma-oesophagoscopy or
dilatation of strictures with bougies
Spontaneous rupture-following
vomiting.Involve lower third
BOERHAAVE SYNDROME- post emetic
rupture of all layers of oesophagus
DIAGNOSIS
H/o of pain in the neck or interscapular region ,following
an oesophagoscopy
Features of cervical oesophageal rupture
pain,fever,difficulty to swallow and local tenderness,along
with signs of surgical emphysema in the neck
Features of thoracic oesophageal rupture
pain,referred to the interscapular region,fever 102-104
deg F, signs of shock,surgical emphysema in the
neck,crunching sound over the heart(HAMMAN'S SIGN) and
pneumothorax
INVESTIGATION
X ray chest and neck
Reveal widening of mediastinum and
retrovisceral space, surgical
emphysema,pneumothorax,pleural
effusion or gas under diaphragm.
TREATMENT
All oral feeds are stopped immediately
Nutrition through IV route
Massive dose of antibiotic given IV
drainage is required only if suppuration develops
If diagnosis is made within 6hrs perforation surgically
repaired and pleural cavity drained
If diagnosis is delayed repair is not possible,then drain the
infected area
AETIOLOGY
Acid, alkali or chemicals
Accidental swallow by children
Suicidal purpose in adults
PATHOLOGY
Severity is based on
Nature of corrosive substance
Its quantity and concentration
Duration of contact
Alkalies are more destructive and penetrate deep
into the layers of oesophagus
3 stages of oesophageal burn
1. Stage of acute necrosis
2. Stage of granulations ? slough
separates leaving granulating ulcer
3. Stage of stricture : begins at 2wks
and continues for 2months or longer
Evaluation of patients
Evaluate and determine type of caustic
ingested,signs and symptoms of shock,upper airway
obstruction,mediastinitis,peritonitis,acid-base
imbalance and associated burns of face,lips,oral
cavity
INVESTIGATION
X ray of chest and soft tissue lateral view of neck
MANAGEMENT
Hospitalize
Treat shock and acid-base imbalance
Relieve pain
relieve airway obstruction (tracheostomy)
Neutralization of corrosives (upto 6hrs)
Parenteral antibiotic
Pass a nasogastric tube
Oesophagoscopy
Steroids (to prevent stricture)
Follow up with oesophagoscopy every 2wks till healing is complete
If stricture develops
a. oesophagoscopy and prograde dilatation if permeable
b. Gastrotomy and retrograde dilatation if impermeable
c. Oesophagial reconstruction or bypass if dilatations are impossible
Corrosive injury may require life long follow up
AETIOLOGY
Usually occurs when muscular coat is damaged
Common causes
1. Corrosive burns
2. Trauma due to impacted FB,instrumentation,injuries
3. Ulceration due to reflux oesophagitis
4. Ulceration due to diphtheria or typhoid
5. Sites of Surgical anastomosis
6. Congenital (lower third)
CLINICAL FEATURES
Dysphagia
Regurgitation and cough
malnourishment
DIAGNOSIS
Barium swallow
Oesophagoscopy to exclude
malignancy
TREATMENT
Prograde dilatation with bougies
Gastrostomy
Surgery-excision of strictured segment and
reconstruction of food passage.
HIATUS HERNIA
DISPLACEMENT OF STOMACH INTO CHEST VIA
OESOPHAGIAL OPENING OF DIAPHRAGM
MOSTLY ELDERLY; PAST 40 YRS
2 TYPES
1.SLIDING
2.PARAOESOPHAGIAL
SLIDING TYPE
Stomach pushed into thorax in line with oesophagus.
Reflux oesophagitis is commonulceration
and stenosis
Haematamesis may occur due to increased intra
abdominal pressure
PARAOESOPHAGIAL TYPE
A PART OF STOMACH AND PERITONEUM PASSES THROUGH
THORAX BY THE SIDE OF OESOPHAGUS
GASTROOESOPHAGEAL JUNCTION REMAINS BELOW
DIAPHRAGM AND ANGLE BETWEEN OESOPHAGUS AND
STOMACH IS MAINTAINED
NO REFLUX OESOPHAGITIS
MAIN SYMPTOMS; DYSPNOEA ON EXERTION AND BLEEDING
DIAGNOSIS
BARIUM SWALLOW
TREATMENT
Surgical - reduction of hernia and diaphragmatic
opening repaired
Early cases and cases unfit for
surgeryconservatively managed
1.sleeping with head and chest raised
2.avoid smoking
3.antacids and proton pump inhibitors
4.reduce obesity
5.attention to the cause of raised intra abdominal
pressure
PLUMMER?VINSON (PATTERSON?BROWN?
KELLY) SYNDROME
Classical features-dysphagia, iron-deficiency anaemia,
glossitis, angular stomatitis, koilonychia (spooning of nails)
and achlorhydria
atrophy of the mucous membrane of the alimentary tract
Affects females more than 40 years of age
10%-post cricoid carcinoma
Investigations
Barium swallow
Oesophagoscopy
Shows a Web in postcricoid region
Treatment
correct anaemia by oral/parenteral iron
Associated B12 and B6 deficiency should also be
corrected.
Dilatation of the webbed area by oesophageal
bougies
Thank you
This post was last modified on 12 August 2021