ESOPHAGUS
ANATOMY ESOPHAGUS
STRUCTURE
FOOD PIPE
25cm long fibro muscular tube [8 10cm at birth]
Travels behind trachea
Connects pharynx and stomach
Lower border of cricoid cartilage to cardiac orifice of stomach
2 gentle curves
SPHINCTERS
4 LAYERS
Tunica Mucosa
Stratified squamous non-keratinised
epithelium
Lamina propria
Loose connective tissue
Mucous glands
Small blood vessels
Lymphatic nodules
Muscularis mucosae
Thin layer of smooth muscle
Tunica Submucosa
Thick layer of connective tissue
Mucous [esophageal] glands [branched
tubular]**
Larger branches of blood vessels and nerves
LAYERS
Esophago-gastric
junction/cardio-esophageal
junction
Stratified squamous non-
keratinised epithelium -> simple
columnar epithelium
Lamina propria of cardiac mucosa
contains larger accumulation of
lymphoid tissue [lymphatic
follicle]
Cardia
Mucosa forms pits and cardiac
glands
Mucus secreting cells
PHYSIOLOGY ESOPHAGUS
SWALLOWING
Primary peristalsis
Controlled by swallowing center in brain stem
Continuation of peristaltic reflex wave that begins in pharynx
Spreads into esophagus during pharyngeal stage of swallowing
Secondary peristalsis
Partially mediated by smooth muscle fibres
If bolus/food becomes stuck in lumen [primary is inadequate],
distention of wall stimulates 2ndary peristalsis
Movement continues until all food moves into stomach
LES
Medication
Proton pump inhibitors: decrease gastric acid production [kids,
persistent reflux]
Histamine-2 receptor antagonists: block histamine at histamine H2
receptors of parietal cells of stomach = decrease acid production
[kids, persistent reflux]
Prokinetics: enhance GI motility = increase frequency of small
intestine contraction [not recommended in kids, side effects]
Antacids: neutralize stomach acidity to relieve heartburn and
indigestion [commonly used for kids, over the counter]
Elavation of head of bed 6 inches
Weight reduction
Cessation of smoking
Laparoscopic fundoplication: surgical intervention
No lying down for up to 3hrs after meal
PATHOPHYSIOLOGY BARRETTS
ESOPHAGUS
BARRETT ESOPHAGUS
Surgical
Ligation and end-to-end anastomosis
Temporary ligation and insertion of gastrostomy tube
Preoperative management:
Maintain airway
Prevent lung damage from aspiration of gastric contents
Position adjustments to prevent gastric secretion entering distal
fistula
Esophageal suction
OTHER ESOPHAGEAL DISEASES
Erosive esophagitis
Esophageal carcinoma
Cancer arising in the esophagus with symptoms of dysphagia and weight
loss
Hiatal hernia
the protrusion of stomach through the esophageal opening in the
diaphragm
Esophageal diverticulum
out pouching of mucosa through the muscular layer which can be
asymptomatic or cause dysphagia and regurgitation
Mallory -Weiss syndrome
bleeding from a laceration in the mucosa at the junction of the stomach
and esophagus
Achalasia
rare disease of the muscle of the lower esophageal body and the lower
esophageal sphincter that prevents relaxation of the sphincter and an
absence of contractions, or peristalsis, of the esophagus
Dysphagia
difficulty or discomfort in swallowing, as a symptom of disease
CASE STUDY
Heartburn
DUE TO ACID REFLUX
Chest pain
NON-CARDIAC
After eating
STOMACH IS ACTIVE AND PRODUCING GASTRIC JUICE
Overweight
INCREASES ABDOMINAL PRESSURE
Lies down on the sofa and watches T V after dinner
GASTRIC JUICE MORE ABLE TO TRAVEL INTO ESOPHAGUS
Smoking
NICTONIE IS AN LES RELAXER
Takes Nifedipine [CCB] for hypertension
DECREASES LES PRESSURE
CASE STUDY
A 6 year old boy comes to the clinic and his mum has
observed that he has vomited blood on may occasions,
experienced pain while eating, is irritable has dif ficultly
feeding. He suf fers from asthma and a recent blood test
shows that he suf fers from anemia. What are your clinical
recommendations and what is the most likely cause of his
problems?
Atresia with distal fistula [most common form]
Atresia with proximal fistula
GERD
ADHD
ANALYSIS
6 year old
TEF OR ATRESIA WOULD NOT GO UNDIAGNOSED FROM BIRTH
Pain while eating
SYMPTOMATIC INDICATION OF INJURY
Irritability and dif ficultly feeding
BEHAVIOURAL INDICATION OF DISCOMFORT
Asthma
WHEN ACID ENTERS ESOPHAGUS, NERVE REFLEX IS TRIGGERED =
AIRWAYS NARROW TO PREVENT ACID ENTERING, LES RELAXING BY
BRONCHODIALATORS
Vomited blood and anemia
DUE TO ESOPHAGEAL BLEEDING
Thank you
THE END
REFERENCES
C O L O R AT L A S O F PAT H O P H Y S I O L O GY, S T E FA N S I L B E R N AG L , F L O R I A N
LANG, PG 136 - 139
PAT H O P H Y S I O L O GY: T H E B I O L O G I C B A S I S F O R D I S E A S E I N A D U LT S A N D
C H I L D R E N , 7 T H E D I T I O N , K AT H R Y N L . M C C A N C E , S U E E . H U E T H E R P G
1429, 1453, 1466, 1487
H T T P S : / / W W W. N C B I . N L M . N I H . G O V / P U B M E D / 17 37 8 91 0
H T T P : / / G U T. B M J . C O M / C O N T E N T / 4 9 / 1 / 1 4 5 . F U L L
HTTPS://EN.WIKIPEDIA.ORG/WIKI/NIFEDIPINE
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