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12 - 34 - 35 Esophagus
12 - 34 - 35 Esophagus
Al-Matary
Esophagus
2013 27
Esophagus
dysphagia cancer esophagus Achalasia of the cardia
Esophageal atresia
Page | 1
Esophagus Dr. Al-Matary
what is important
what is less important what is the important
Esophageal Atresia
Esophageal atresia
written Esophageal atresia
esophageal atresia
written
esophageal atresia
associated anomalies
VACTREL
spinal bifida << Vertebral
imperforate anus << Anal
Fallot tetralogy, VSD, ASD << Cardiac
Trache-esophageal fistula << Tracheal
atresia << Esophagus
polycystic kidney << Renal
polydactyly << Limb
esophageal atresia
VACTREL
esophageal atresia
chest
Page | 2
Esophagus Dr. Al-Matary
VACTREL
other anomalies
VACTREL esophageal atresia
associated anomalies
atresia
failure of recanalization
gut fusion
gut fusion
imperforate anus
esophageal atresia
gut failure of fusion
atresia
trachea esophagus
esophagus trachea
fistula esophageal atresia
isolated atresia
esophageal atresia
VACTREL
esophagus trachea
Page | 3
Esophagus Dr. Al-Matary
esophageal atresia
trachea esophagus
fistula
incidence
fistula 85 %
incidence
incidence
incidence
esophageal atresia 85 %
fistula
85 %
rare
rare
fistula
fistula
fistula << rare
fistula fistula << rare
fistula
fistula
fistula
fistula fistula
fistula 85 %
Page | 4
Esophagus Dr. Al-Matary
esophageal atresia
esophageal atresia
esophageal atresia
esophageal atresia
polyhydramnios esophageal atresia
amniotic fluid
esophageal atresia
polyhydramnios
esophageal atresia
antenatal diagnosis
diagnosis
polyhydramnios
polyhydramnios
diagnosis
Page | 5
Esophagus Dr. Al-Matary
fistula
stomach trachea
tympanic resonance
fistula
fistula
trachea HCL bile
fistula
trachea HCL bile
esophageal atresia
antenatal
polyhydramnios
bile sputum
Page | 6
Esophagus Dr. Al-Matary
esophageal atresia
esophageal atresia
investigations
X-ray
lipidol gastrographin
gastrographin
barium gastrographin
barium
trachea
gastrographin
X-ray
trachea
trachea
fistula
fistula common
fistula common
trachea
lung saliva
Page | 7
Esophagus Dr. Al-Matary
esophageal atresia
urgent
urgent urgent
chest
pneumonia chest
pain
swelling
loss of function
pneumonia
pneumonia pneumonia
collapse lung
collapsed
urgent
pneumonia
thoracotomy
atresia fistula
pneumonia
Page | 8
Esophagus Dr. Al-Matary
gastrotomy
esophagus
saliva
saliva
clear saliva
gastrotomy esophagotomy
chest
<<
pneumonia
jejunum intestine colon
excessive salivation
tachypnea
Page | 9
Esophagus Dr. Al-Matary
tachypnea
neonatal pneumonia
surfactant
excessive salivation
esophageal atresia
distended clinically
bile sputum
instrumental
treatment
Diaphragmatic hernia
Hiatus hernia Diaphragmatic hernia
hiatus hernia
diaphragmatic hernia
diaphragmatic hernia
99 %
Page | 10
Esophagus Dr. Al-Matary
diaphragmatic hernia hiatus hernia
hiatus diaphragmatic hernia
diaphragmatic hernia 99 %
hiatus
1%
Hernia of Bochdalek
Hernia of Bochdalek
sac pleura peritoneum
sac
pleuro-peritoneal membrane membrane
diaphragm
99 %
sac peritoneum pleura
pleuro-peritoneal membrane membrane
chest << defect
Page | 11
Esophagus Dr. Al-Matary
chest
Lung
dyspnea
scaphoid abdomen
diaphragmatic hernia
Hernia of Bochdalek
sac peritoneum Pleura
Membrane
pleuro-peritoneal membrane
chest
data
diaphragmatic hernia till proved otherwise scaphoid abdomen + dyspnea
scaphoid abdomen
Page | 12
Esophagus Dr. Al-Matary
investigations
X-ray
X-ray
chest
intestine
gastrographin
chest gastrographin
diaphragmatic hernia
gastrographin chest X-ray diaphragmatic hernia
dyspnea
scaphoid abdomen
defect intestine
ventilator
mask oxygen
surfactant ventilator
diaphragmatic hernia
Page | 13
Esophagus Dr. Al-Matary
congenital
internal mammary artery
chest wall internal mammary artery
internal
breast
mammary
subclavian artery
intestine
Hernia of Morgagni
Hernia of Morgagni
hernia of Morgagni
Page | 14
Esophagus Dr. Al-Matary
lung
dyspnea
scaphoid abdomen
diaphragmatic hernia
Eventration of diaphragm
diaphragm
diaphragm
Eventration of the diaphragm
Page | 15
Esophagus Dr. Al-Matary
diaphragm
conservative
symptoms
symptoms
hiatus
hiatus
diaphragm esophagus
hiatus
Page | 16
Esophagus Dr. Al-Matary
stomach esophagus
esophagus
esophagus
esophagus
Morgagni
internal mammary artery
para esophageal
congenital
angle of Hiss
angle of Hiss
angle of Hiss angle
reflux
angle of Hiss
No reflux
angle of Hiss
no reflux
chest intestine
dyspnea lung
chest stomach
Page | 17
Esophagus Dr. Al-Matary
Lung
chest abdomen
Lung
G.I.T.
cardiology
cardiology G.I.T.
rare
chest stomach
dyspnea Lung
palpitation
dysphagia esophagus
barium
dysphagia
Page | 18
Esophagus Dr. Al-Matary
palpitation dyspnea
reflux
angle of Hiss
fundus
stomach
Hiatus hernia
para esophageal
sliding hernia
Hiatus hernia
sliding para esophageal
sliding type
Page | 19
Esophagus Dr. Al-Matary
M.C.Q.
sliding type hiatus hernia
there is no angle of Hiss
Z line
disturbed
not disturbed
none of the above
all of the above
gastro-esophageal junction
Z zone Z line
esophagus
chest
pregnancy
engagement
Page | 20
Esophagus Dr. Al-Matary
engagement
urinary bladder
pregnancy
greater omentum
greater omentum
greater omentum
intra abdominal pressure
Hiatus hernia
Hiatus hernia
pregnancy
Obesity
esophagus
Esophagus
reflux
reflux hiatus hernia
esophagus esophagus HCL
Page | 21
Esophagus Dr. Al-Matary
esophagus HCL
epithelium esophagus << mucosa
precancerous << Barret esophagus
esophagus HCL
precancerous << Barret esophagus << Mucosa
stricture spasm << circular muscle fibers
<< longitudinal muscle fibers
Esophagus HCL
Page | 22
Esophagus Dr. Al-Matary
Mucosa HCL
Barret esophagus <<
erosion esophagus
end result
sliding type << Hiatus hernia
disturbed angle of Hiss
esophagus
reflux
reflux
pain
heart burn
regurgitation
regurgitation
Page | 23
Esophagus Dr. Al-Matary
HCL
heart burn
odynophagia
dysphagia
esophagus
Odynophagia dysphagia
Water brush
water brush
saliva
HCL
HCL
saliva, saliva, saliva, saliva
reflux
water brush
water brush
Page | 24
Esophagus Dr. Al-Matary
water brush
excessive salivation in response to reflux
excessive salivation in response to reflux
bad chest
reflux
HCL
anemia reflux
odynophagia
esophagus
anemia
Hiatus hernia
sliding type << Hiatus hernia Upper gastrointestinal endoscopy
stomach Mucosa
stomach mucosa
40
Page | 25
Esophagus Dr. Al-Matary
30 stomach mucosa
stomach
rugae
rugae stomach Mucosa
in Trendelenburg position
investigation
24 hour ambulatory PH monitoring
investigation
24 hour ambulatory PH monitoring
Page | 26
Esophagus Dr. Al-Matary
Peristalsis
fiber optic
reflux stomach
memory
24 PH changes
24 hour PH monitoring
endoscopy
barium in Trendeleburg position
24 hour PH monitoring
Manometry
sphincter
reflux
Medical
Page | 27
Esophagus Dr. Al-Matary
surgery medical
surgical
medical << Peptic ulcer reflux
medical treatment
up till now
Medical treatment
peptic ulcer
Page | 28
Esophagus Dr. Al-Matary
12
12
life style
reflux
reflux
reflux
physical and mental rest
reflux
two waves
semisolid
semisolid
antacids
Page | 29
Esophagus Dr. Al-Matary
Omeprazole reflux
Omeprazole
cardia tone
emptying of the stomach
psychiatric
depression psychiatric
extra pyramidal anticholinergic
twitches
Page | 30
Esophagus Dr. Al-Matary
Omeprazole
omeperazole
Human Proved cancer
atrophic gastritis
reflux
6
reflux
6
Fundoplication
fundus of the stomach
270o 360o
Page | 31
Esophagus Dr. Al-Matary
reflux
Nissen
Nissen
chest
chest
reflux
Nissen
esophagus fundus Nissen
270 << fundus
Nissen modified Nissen
270
gas bloat syndrome to avoid
Page | 32
Esophagus Dr. Al-Matary
angle of Hiss
esophagus stomach
esophagus
pregnancy
obesity
esophagus
reflux
medical treatment
6
indication for surgery
failure of medical treatment
complications
Nissen fundoplication
Page | 33
Esophagus Dr. Al-Matary
chest
Nissen
abdomen
fundus
270
fundus Nissen
360
Nissen
gas bloat syndrome Nissen
270
Nissen Modified Nissen
mucosa
Page | 34
Esophagus Dr. Al-Matary
reflux
cancer stomach
cancer bladder
cancer
bronchogenic carcinoma
bronchogenic carcinoma
reflux smoking
reflux
reflux
obesity
reflux obesity
Hiatus hernia
pregnancy
reflux pregnancy
hiatus hernia
Physiological reflux
Page | 35
Esophagus Dr. Al-Matary
physiological reflux
reflux
gastrin
gastrin
gastrin
G cells
gastrin
gastrin
gut tone gastrin
esophagus
Intra abdominal esophagus
esophagus
7 6
pathological reflux
Page | 36
Esophagus Dr. Al-Matary
8
6
8
reflux reflux
M.C.Q.
diaphragm esophagus
hiatus
Page | 37
Esophagus Dr. Al-Matary
pinchcock effect
pinchcock effect
<< pinchcock
Esophagus
reflux
angle of Hiss
Hiatus Intra abdominal esophagus
esophagus Mucosa lower end of the esophagus
rosette shaped
reflux rosette
reflux esophagitis
heart burn
regurgitation
Page | 38
Esophagus Dr. Al-Matary
dysphagia 40
cancer
dysphagia
cancer
cancer
male old age << cancer
plummer
time
dysphagia
dysphagia
esophagus Pharynx epithelial lining atrophy
dysphagia
epithelial lining
dysphagia odynophagia
dysphagia
epithelial lining atrophy
Page | 39
Esophagus Dr. Al-Matary
reflex
pharynx esophagus
spasm
spasm
Pharynx
epithelial lining atrophy
dysphagia
iron deficiency anemia with hypo vitaminosis
dysphagia
iron deficiency anemia and hypovitaminosis
spooning of nails
angular stomatitis
splenomegaly
Pharynx
packed RBCs iron deficiency anemia
pharynx
iron deficiency anemia
pre cancerous
Plummer vinson syndrome
highly pre cancerous
Post cricoid carcinoma cancer esophagus
Page | 40
Esophagus Dr. Al-Matary
Esophageal carcinoma
Esophageal Carcinoma
predisposing factors
M.C.Q.
cancer esophagus Predisposing factors
cancer esophagus
post corrosive stricture
M.C.Q.
all of the following are pre cancerous except
Barret esophagus
Tylosis type A
( A.D. characterized by hyperkeratosis of palm and sole, 100 % esophagus carcinoma at age of
40 years )
plummer vinson syndrome
post corrosive stricture
except
post corrosive stricture
cancer
predisposing factors
esophagus benign tumors
papilloma
adenoma
Page | 41
Esophagus Dr. Al-Matary
pathology
macroscopically << cancer esophagus
ulcer
caluiflower
infiltrating
Incidence
M.C.Q. 1/3
microscopically
squamous cell carcinoma
squamous cell carcinoma
squamous << lining epithelium
adeno carcinoma
columnar epithelium << lining epithelium
Undifferentiated
anaplastic
spread
direct, blood, lymph and transcoelomic
spread
direct, blood, lymph and transcoelomic
transcoelomic
Krukenburg's tumor
Plummer's shelf nodules
Page | 42
Esophagus Dr. Al-Matary
esophagus
cervical lymph nodes Neck
mediastinum lymph nodes chest
celiac lymph nodes abdomen
blood spread
blood
lung
bone
liver
systemic esophagus
lung
direct spread
esophagus
neck << direct spread
neck
surgical anatomy
surgical anatomy
surgical anatomy
Page | 43
Esophagus Dr. Al-Matary
trachea
esophagus
vertebrae
esophagus trachea
recurrent laryngeal nerve
thyroid lobe thyroid Lobe
carotid sheath lobe of thyroid
vagus internal jugular vein carotid artery
3
trachea
esophagus
vertabrea
direct spread
trachea
recurrent laryngeal nerve
thyorid
carotid sheath
once
Page | 44
Esophagus Dr. Al-Matary
trachea
trachea
esophagus
trachea trachea
chest esophagus
Lung
cancer esophagus
Page | 45
Esophagus Dr. Al-Matary
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Esophagus Dr. Al-Matary
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Esophagus Dr. Al-Matary
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Esophagus Dr. Al-Matary
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Esophagus Dr. Al-Matary
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Esophagus Dr. Al-Matary
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Esophagus Dr. Al-Matary
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Esophagus Dr. Al-Matary
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Esophagus Dr. Al-Matary
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