Understanding the Esophagus and Related Conditions
Explore the anatomy of the esophagus, including its structure, function, blood supply, and common conditions such as achalasia and esophageal cancer. Learn about swallowing difficulties, diagnostic methods, and treatment options for esophageal disorders.
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Presentation Transcript
OESOPHAGUS BY WAM MD
ANATOMY - IT IS A MUSCULAR TUBE 25 CM IN ADULTS. - HAS THREE CONSTRICTIONS 1. AT ITS COMMENCEMENT (15 CM FROM UPPER INCISOR) 2. SITE OF CROSSING BY AORTIC ARCH, AND LT.MAIN BRONCHUS. 3. WHERE IT PIERCES DIAPHRAGM (40 CM FROM UPPER INCISORS). UPPER OESOPH.SPHINCTER: IS CONTINUOUSLY IN STATE OF TONIC CONTRACTION. LOWER OESOPH.SPHINCTER: MEASURES 3-4 CM, AT TIME OF SWALLOWING IT RELAXES FOR 5 SECONDS, PINCHCOCK ACTION OF DIAPHRAGM IS IMPORTANT TO PROTECT AGAINST REFLUX.
ANATOMY IT HAS 4 COATS. 1. MUCOSA: ST.SQ EPITHELIUM. 2. SUBMUCOSA. 3. MUSCULAR: INT.CIRCULAR CONTINUOUS ABOVE WITH CRICOPHARYNGEUS. EXT.LONGITUDINAL . FORMS COMPLETE INVESTMENT EXCEPT AT UPPER 1/3. 4. FIBROUS COVER. RELATIONS: IN CERVICAL PART ANT. TRACHEA, LT.LOBE OF THYROID. POST. VERTEBRAE WITH PREVERTEBRAL MS. ON EACH SIDE: CAROTID SHEATH, LOBE OF THYROID GLAND, RLN IN GROOVE BETWEEN OESOPH. AND TRACHEA
BL.SUPPLY OF OESOPHAGUS -INF.THYROID A. IN CERVICAL PART. -DESCENDING THORACIC AORTA IN THORACIC PART. -LT.GASTRIC A.IN ABDOMINAL PART. VEINS DRAIN TO -INF.THYROID V. -AZYGOS V. -LT.GASTRIC V. TRIBUTARY OF PORTAL VEIN.
FB FB SWALLOWING SWALLOWING -COMMON SITE OF IMPACTION IS AT CRICOPHARYNGEAL SPHINCTER. - MOST COMMON OBJECTS ARE COINS, MEAT BONES CP:DYSPHAGIA, SOME OBJECTS MAY BE IMPACTED FOR WEEKS. OCCASIONALLY REGURGITATION, EXCESSIVE SALIVA IN PYRIFORMS. INVES. PLAIN X RAY, BARIUM SWALLOW, ENDOSCOPIC EXAMINATION. TREATMENT: ENDOSCOPIC REMOVAL EXT.APPROACHES IN DIFFICULT CASES.
ACHALASIA -AE IS UNKNOWN, DEGENRATION OF AUERBACH PLEXUS HAS BEEN DOCUMENTED WITH LOSS OF POSTGANGLIONIC INHIBITORY NEURONES .INSUFFICIENT RELAXATION. - AFFECTS MALES MORE -CP: DYSPHAGIA MORE TO SOLIDS, REGURGITATION, HEARTBURN. -INVESTIGATIONS: BARIUM SWALLOW, ESOPH.MANOMETRY. -TREATMENT: NON SURGICAL, SURGICAL.
ESOPHAGEAL CANCER -SQ.CELL CARCINOMA (90%). -AFFECTS ELDERLY MORE. - PRECANCEROUS LESIONS: ACHALASIA, CAUSTIC INGESTION,PVS, GERD. -CP: DYSPHAGIA FIRST TO SOLIDS THEN TO FLUIDS. WT.LOSS, PAIN WITH SWALLOWING, RESPIRATORY SYMPTOMS (REGURGITATION AND ASPIRATION) , DYSPHONIA. INVEST. BARIUM SWALLOW, ENDOSCOPY, CT SCAN TREATMENT: ESOPHAGECTOMY. PALLIATIVE MEASURES.
