OESOPHAGUS

SNEHA P
Roll No:120
CONTENTS:
• Plummer vinson syndrome
• Schatzki’s Ring
• Boerhaave’s Syndrome
• Mallory weiss tear
• Diverticulum in esophagus
PLUMMER_VINSON SYNDROME
• Also known as Paterson-Kelly Syndrome
• It is a premalignant condition
• Characterised by:
1.Esophageal web
2.Iron deficiency anemia
3.Dysphagia

• Risk factors:
1.Females>>Males
2.Long-standing iron deficiency anemia
• Etiology:
Associated with long-standing iron
deficiency anemia in genetically
predisposed

• Clinical features:
Symptoms:
Dysphagia(initially solids then liquid)
O/E:
pallor,chelitis,glossitis,splenomegaly
Management
• Investigations:
A. Anemia:
1.Complete blood count
2.Peripheral smear
3.Iron profile

B.Esophageal Web:
1.Barium swallow
2.Upper GI endoscopy
3.Biopsy to rule out malignancy
Treatment
A.Correction of Anemia:
1.Oral Iron therapy: FeSo4 300mg TDS
2.Blood transfusion in severe anemia
3.Vitamin supplementation

B.Esophageal web:
1.Usually, disappers with iron therapy
2.Baloon dilatation in severe cases

FOLLOW-UP: regular endoscopy

SCHATZKI’S RING
• It is semicirclular protrusion of lower esophageal
mucosa at the level or just above OG Junction
lined by gastric columnar epithelium

• Clinical features:
1.Reflux
2.Episodic dysphagia or Aphagia
 Management
• Investigations:
Radiological imaging with barium contrast
shows constricting ring proximal to OG junction
with size usually < 13mm

• Treatment:
1. Anti-reflux drugs
2. Endoscopic dilatation
BOERHAAVE’S SYNDROME
• It is a full thickness tear in esophagus causing
leak into mediastinum, pleural cavity and
peritoneum.
• MC site: Lower left posterior esophagus
• Etiology:
Vomiting after binge
alcohol or spontaneous
. against closed glottis
• Clinical features:
MACKLER’S TRIAD:
1.Vomiting
2.Chest pain
3.Left side pleural effusion

MANAGEMENT
• Investigations:
Chest X-ray:
1.Subcutaneous emphysema
2.V sign of Naclerio
. (Pneumomediastinum)
Treatment
1.Start on IV fluids and antibiotics
2. <24hours:
- urgent thoractomy with repair
- Antral lavage
- Insert ICD tube
3. >24hours:
- repair is mostly impossible,
so esophagostomy with Fj
- ICD tube insertion
MALLORY WEISS TEAR
• It is longitudinal tear in mucosa of stomach at or
just below cardia causing severe hemetemesis
• MC site= Lesser curve near OG junction
• Etiology:
Vomiting against closed LES results in
longitudinal tear in stomach
• Clinical features:
Hemetemesis(self-limiting: 90%)

Management
• Investigations:
1.CBC
2. Blood grouping
3. Upper GI endoscopy
Treatment:
• Correction of Anemia:
1.IV fluids
2.Blood transfusion
• Bleeding:
1.Hemostatic agents: Vasopressin
2.Endoscopic ligation
DIVERTICULUM IN ESOPHAGUS
• It is a outpouching of hollow structures through a weak
wall

• Types:
A.Based on location:
1.Zenker’s diverticulum
2.Mid-esophageal diverticulum
3.Lower-esophageal diverticulum

B.Based on layers involved:

1.True Diverticulum:all layers outpouching
2.False Diverticulum: only mucosa or submucosal
outpouching
1. ZENKER’S DIVERTICULUM:
• It is outpouching through kilian’s dehiscence
which is present in between thyropharyngeus
and cricopharyngeus

• Pathophysiology:
Due to abnormally high intra-
luminal esophageal pressure
>60mmhg,leading to outpouching

• Clinical features:
Dysphagia,regurgitation, halitosis
• Management:
Investigations:
1.Barium swallow(lateral oblique view)
2.Manometry

Treatment:
1.Gold standard:
Diverticulectomy +
cricopharygeal myotomy

2.Dohlman’s technique
Endoscopic stappling
2.Traction Diverticlum:
It is a outpouching in mid-esophagus due to
mediastinal granulomatous disease

MC =right side of esophagus

Clinical features: Dysphagia,

regurgitation,chest pain

Investigations: Barium study,

CT chest, Manometry

Treatment: Diverticulopexy
3.Epiphrenic pulsion:
Outpouching in lower esophagus
due to incoordinated LOS relaxation

MC : Left sided

Clinical features:
Regurgitation ,chest pain

Investigations:
CT Chest and manometry

Treatment:Diverticulectomy
THANK YOU