OESOPHAGUS
ACUTE OESOPHAGITIS
Acute inflammation of oesophagus due to
1. Ingestion of hot liquid
--- Content provided by FirstRanker.com ---
2. Ingestion of caustic or corrosive agents3. laceration due to swallowed foreign body or trauma of
oesophagoscopy
4. Infection of oesophagus from oral thrush
5. Systemic disorders like pemphigus
--- Content provided by FirstRanker.com ---
6. GERDSymptoms Diagnosis
Dysphagia
From history
--- Content provided by FirstRanker.com ---
RetrosternalX ray study
burning
oesophagoscopy
Hematemesis
--- Content provided by FirstRanker.com ---
Treatment? Antacids-proton pump
inhibitors,H2 receptor
blocker
? Steroids
--- Content provided by FirstRanker.com ---
AETIOLOGY
Instrumental trauma-oesophagoscopy or
dilatation of strictures with bougies
Spontaneous rupture-following
--- Content provided by FirstRanker.com ---
vomiting.Involve lower thirdBOERHAAVE SYNDROME- post emetic
rupture of all layers of oesophagus
DIAGNOSIS
H/o of pain in the neck or interscapular region ,following
--- Content provided by FirstRanker.com ---
an oesophagoscopyFeatures 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
--- Content provided by FirstRanker.com ---
pain,referred to the interscapular region,fever 102-104deg F, signs of shock,surgical emphysema in the
neck,crunching sound over the heart(HAMMAN'S SIGN) and
pneumothorax
INVESTIGATION
--- Content provided by FirstRanker.com ---
X ray chest and neckReveal widening of mediastinum and
retrovisceral space, surgical
emphysema,pneumothorax,pleural
effusion or gas under diaphragm.
--- Content provided by FirstRanker.com ---
TREATMENT
All oral feeds are stopped immediately
Nutrition through IV route
Massive dose of antibiotic given IV
drainage is required only if suppuration develops
--- Content provided by FirstRanker.com ---
If diagnosis is made within 6hrs perforation surgicallyrepaired and pleural cavity drained
If diagnosis is delayed repair is not possible,then drain the
infected area
--- Content provided by FirstRanker.com ---
AETIOLOGY
Acid, alkali or chemicals
Accidental swallow by children
Suicidal purpose in adults
PATHOLOGY
--- Content provided by FirstRanker.com ---
Severity is based onNature of corrosive substance
Its quantity and concentration
Duration of contact
Alkalies are more destructive and penetrate deep
--- Content provided by FirstRanker.com ---
into the layers of oesophagus3 stages of oesophageal burn
1. Stage of acute necrosis
2. Stage of granulations ? slough
separates leaving granulating ulcer
--- Content provided by FirstRanker.com ---
3. Stage of stricture : begins at 2wksand continues for 2months or longer
Evaluation of patients
Evaluate and determine type of caustic
ingested,signs and symptoms of shock,upper airway
--- Content provided by FirstRanker.com ---
obstruction,mediastinitis,peritonitis,acid-baseimbalance and associated burns of face,lips,oral
cavity
INVESTIGATION
X ray of chest and soft tissue lateral view of neck
--- Content provided by FirstRanker.com ---
MANAGEMENT
Hospitalize
Treat shock and acid-base imbalance
Relieve pain
relieve airway obstruction (tracheostomy)
--- Content provided by FirstRanker.com ---
Neutralization of corrosives (upto 6hrs)Parenteral antibiotic
Pass a nasogastric tube
Oesophagoscopy
Steroids (to prevent stricture)
--- Content provided by FirstRanker.com ---
Follow up with oesophagoscopy every 2wks till healing is completeIf 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
--- Content provided by FirstRanker.com ---
Corrosive injury may require life long follow upAETIOLOGY
--- Content provided by FirstRanker.com ---
Usually occurs when muscular coat is damagedCommon causes
1. Corrosive burns
2. Trauma due to impacted FB,instrumentation,injuries
3. Ulceration due to reflux oesophagitis
--- Content provided by FirstRanker.com ---
4. Ulceration due to diphtheria or typhoid5. Sites of Surgical anastomosis
6. Congenital (lower third)
CLINICAL FEATURES
Dysphagia
--- Content provided by FirstRanker.com ---
Regurgitation and coughmalnourishment
DIAGNOSIS
Barium swallow
Oesophagoscopy to exclude
--- Content provided by FirstRanker.com ---
malignancyTREATMENT
Prograde dilatation with bougies
Gastrostomy
Surgery-excision of strictured segment and
--- Content provided by FirstRanker.com ---
reconstruction of food passage.HIATUS HERNIA
DISPLACEMENT OF STOMACH INTO CHEST VIA
OESOPHAGIAL OPENING OF DIAPHRAGM
MOSTLY ELDERLY; PAST 40 YRS
--- Content provided by FirstRanker.com ---
2 TYPES1.SLIDING
2.PARAOESOPHAGIAL
SLIDING TYPE
--- Content provided by FirstRanker.com ---
Stomach pushed into thorax in line with oesophagus.Reflux oesophagitis is commonulceration
and stenosis
Haematamesis may occur due to increased intra
abdominal pressure
--- Content provided by FirstRanker.com ---
PARAOESOPHAGIAL TYPE
A PART OF STOMACH AND PERITONEUM PASSES THROUGH
THORAX BY THE SIDE OF OESOPHAGUS
GASTROOESOPHAGEAL JUNCTION REMAINS BELOW
--- Content provided by FirstRanker.com ---
DIAPHRAGM AND ANGLE BETWEEN OESOPHAGUS ANDSTOMACH IS MAINTAINED
NO REFLUX OESOPHAGITIS
MAIN SYMPTOMS; DYSPNOEA ON EXERTION AND BLEEDING
--- Content provided by FirstRanker.com ---
DIAGNOSISBARIUM SWALLOW
TREATMENT
Surgical - reduction of hernia and diaphragmatic
opening repaired
--- Content provided by FirstRanker.com ---
Early cases and cases unfit forsurgeryconservatively managed
1.sleeping with head and chest raised
2.avoid smoking
3.antacids and proton pump inhibitors
--- Content provided by FirstRanker.com ---
4.reduce obesity5.attention to the cause of raised intra abdominal
pressure
PLUMMER?VINSON (PATTERSON?BROWN?
KELLY) SYNDROME
--- Content provided by FirstRanker.com ---
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
--- Content provided by FirstRanker.com ---
10%-post cricoid carcinomaInvestigations
Barium swallow
Oesophagoscopy
Shows a Web in postcricoid region
--- Content provided by FirstRanker.com ---
Treatment
correct anaemia by oral/parenteral iron
Associated B12 and B6 deficiency should also be
corrected.
Dilatation of the webbed area by oesophageal
--- Content provided by FirstRanker.com ---
bougiesThank you