Anatomy
The esophagus is a muscular tube about
ten inches (25 cm.) long, extending from
the hypopharynx to the stomach.
The esophagus lies posterior to the trachea
and the heart and passes through the
mediastinum and the hiatus, an opening in
the diaphragm, in its descent from the
thoracic to the abdominal cavity.
The esophagus has no serosal layer; tissue
around the esophagus is called adventitia.
Cervical
Cervical begins at the lower end of
pharynx (level of 6th vertebra or
lower border of cricoid cartilage) and
extends to the thoracic inlet
(suprasternal notch); 18 cm from
incisors.
Thoracic
Upper thoracic: from thoracic inlet to level
of tracheal bifurcation; 18-23 cm.
Mid thoracic: from tracheal bifuraction
midway to gastroesophageal junction; 2432 cm.
Lower thoracic: from midway between
tracheal bifurcation and gastroesophageal
junction to GE junction, including
abdominal esophagus; 32-40 cm.
Abdominal
Considered part of lower thoracic
esophagus; 32-40 cm.
Anatomy
The esophagus
has three distinct
areas of naturally
occurring
anatomic
narrowing
Cervical
constriction
Bronchoaortic
constriction
Diaphragmatic
constriction
Esofagus
1.
2.
3.
4.
Esophagus Atresia
Corrosive Esophagus
Esophagitis
Gastro Esophageal reflux
1. Esophageal Atresia
Defenisi
Etiologi
-Unknown Chromosomal anomalies
(trisomy 18, trisomy 21, and trisomy 13)
-Failure of embryonic development
Digestive tract problems(diaphragmatic
hernia, intestinal atresia or
imperforated anus .)
-Congenital heart diseases
PATHOPHYSIOLOGY
- Esophagus developed from first segment of
Classification
Esophageal Atresia
Sporadic, non-syndromal
2. Corrosive Oesophagitis
DESCRIPTION
Esophageal stricture is narrowing of
the esophagus (the tube connecting
the mouth to the stomach) caused by
inflammation. The narrowing
interferes with swallowing.
Corrosive esophagitis is narrowing of
the esophagus caused by chemical
damage.
Diagnosis
Laboratory
radiologi
CAUSES
Scarring of the esophagus following inflammation or
damage caused by:
Chronic heartburn (reflux esophagitis) or hiatal hernia.
Prolonged use of feeding tubes.
Accidental swallowing of lye or other corrosive
chemicals by a child. This is an emergency!
Deliberate swallowing of lye or other corrosive
chemicals by a suicidal person.
Bulimia.
Radiation therapy to throat, neck or chest.
TREATMENT
GENERAL MEASURES
Diagnostic procedures such as endoscopy (an
endoscope[an optical instrument with a lighted tip] is
inserted into the esophagus, which allows visual
examination of the cavity). A small amount of tissue will
be removed for biopsy to make sure the stricture is
benign. Also Xrays of the esophagus (barium swallow)
may be recommended.
The stricture must be stretched regularly (about once a
month) with large, heavy dilators. The stricture will
eventually return if regular treatments are not continued.
Surgery to remove stricture if other measures fail (rare).
3.Reflux Oesophagitis
Esophagitis is an inflammation of the lining
of the esophagus, the tube that carries
food from the throat to the stomach.
If left untreated, this condition can become
very uncomfortable, causing problems with
swallowing, ulcers, and scarring of the
esophagus. In some instances, a condition
known
as
Barrett's esophagus
may
develop, which is a risk factor for
esophageal cancer.
Oesophagitis
Grading
Savary-Millar
0 Normal
1 Isolated erosion, Streak, Erythema
2 >1 erosion, non confluent
3 Confluent / circumferential without
stenosis
4 Ulceration, Stricture, Barretts
Los Angeles
A 1 mucosal breaks 5mm
B 1mucosal breaks >5mm
C mucosal breaks extending over 2
mucosal folds, <75% circumference
D Mucosal breask involving > 75%
circumference
Treatment :
Medications that block acid production such as
heartburn drugs.
Antibiotics, anti-fungals, or antivirals to treat an
infection.
Pain
Corticosteroid
Intravenous (by vein) nutrition to allow the esophagus
to heal and to prevent dehydration and malnutrition.
Endoscopy
Surgery to remove the damaged part of the esophagus.
Complications
Bleeding
Stricture
Barretts
4.Gastroesophageal Reflux
Disease
1/3 Western population experience
symptoms at least once a month
4-7% daily
Most patients with mild symptoms
carry out self-medication
The prevalence and severity of GERD
is increasing
Dysphagia
up to 40% of pts with GERD have
sensation of food hanging up in the
lower esophagus--esophageal
dysphagia
typically limited to only solid food,
with normal passage of liquids,
suggesting mechanical disorder
develops slowly enough that the
patient may adjust eating habits
unknowingly
Pathophysiology of GERD
Gastroesopha
geal Reflux
Diagnosis of GERD
Diagnosis of GERD
First episode
Initial therapy with H2 blockers or PPI for 12 weeks
Complications of GERD
Mucosal complicationsesophagitis and stricture
Extraesophageal or Respiratory
complications, such
as laryngitis,
recurrent pneumonia, and
progressive pulmonary fibrosis
Reflux (aspiration) vs reflex
(vagal bronchoconstriction)
Metaplastic and Neoplastic
complications, Barrett's and
esophageal adenocarcinoma