Download Esophagus - OU Medicine

Esophagus
Dr. Pennington
Things to Know
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Definition
Pathophysiology (Natural History)
Epidemiology
Clinical Presentation
Differential diagnosis (5, at least)
Diagnostic tests
Rx (Medical/Surgical)
Outcomes
Anatomy
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Tube connecting mouth to stomach
23-25cm long
Lined by squamous epithilium
Striated muscle upper 1/3, smooth lower 1/3
No adventitia
Rich submucosal plexus of lymphatics
Blood supply is segmental
Mucosa is the strongest layer
Problems
• Trauma (The Cause Is Never Manifest)
– Borhaaves, Iatrogenic perforation, Mallory Weiss
• Congenital
– Atresia, fisulae, Rings
• Infections
– Yeast, Herpes
• Metabolic
– Reflux - Barrett’s - Varicies, Diabetes, Hernias (Hiatal and
paraesophageal), Diverticuli, Scleroderma, Diabetes,
Neurological Disorders, Spasm.
• Neoplastic
– Benign, Malignant
Trauma
• Borhaaves
– Perforation of Esophagus from retching ofter in
older alcoholics,
• Iatrogenic
– Perforation of Esophagus by Endoscopy
• Mallory Weiss
• Arterial tear at GE junction from retching
• Varicies
– Engorgement of Veins at GE junction.
– Decreased flow in Portal or Splenic Veins
Congenital Deformities
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Atresia
Fistlae
Vascular Rings
Duplication
Infections
Yeast, Herpes
• Yeast
– Overgrowth of Normal Flora in
immunocompromised patients or those on broad
spectrum antibiotics
• Herpes
– Viral infection in immunocompromized pts
Benign Neoplasms
• Leiomyoma
• Lipoma
• Other
Malignant Neoplasms
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Squamous Cell Cancer
Adenocarcinoma
Melanoma
Other
Esophageal Hernias
• Hiatal Hernias
• Paraesophageal
Esophageal Diverticuli
• Pulson vs Traction, Definition, PP, Epidemiology Clinical
Presentation, DD, Tests, Treatment, Outcomes
• Zenker’s
• Mid thoracic
• Distal
Metabolic
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GE Reflux
Barrett’s Esophagitis
Diabetes
Diverticuli,
Scleroderma,
Neurological Disorders
Spasm