A muscular tube lined
mostly with squamous epithelium
Waves of peristalsis
facilitate swallowing
Congenital disorder
with a blind end to the oesophagus, at first feed the infant coughs and may become
cyanosed.
May be a fistula to
the trachea
Aspiration
bronchopheumonia often follows
A fairly uncommon
disorder
Aetiology
A primary
neurological disorder of unknown cause
Failure of the
cardiac sphincter to relax
Faulty peristalsis of
the oesophagus due to defective parasympatheric innerveation
Pathophysiology
Dilation of the
oesophagus
Clinical features
Dysphagia Food
is retained in the oesophagus
Food stagnates in
oesophagus and smells Regurgitation
of stagnant food
Episodic chest pain Aspiration
Weight loss
Management
Dilation of the
cardiac sphincter Myotomy
These treatments will
allow the emptying of the oesophagus by gravity but will lead to potentially
severe reflux
This is very common Reflux
of gastric contents in to the oesophagus
The oesophagus is
lined by squamous epithelium which can not resist gastric juice
Aetiology Relative incompetence of the cardiac sphincter
Factors Factors which increase intra- abdominal pressure
Lying down Stooping Lifting Obesity Tight
clothes After large meals Straining
at stool
Factors which reduce
cardiac sphincter tone - Smoking Anticholinergic
drugs Dietary
fat Pregnancy,
(probably a hormonal effect)
Investigations Endoscopy Barium
studies Electrical 24 hour recordings
of oesophageal acid
Features
Painful heartburn Entry of
gastric juices into the mouth
Inflammation of
lining Odynophagia Bleeding
Complications
Oesophagitis Over
time fibrosis and stricture may develop
Barrett`s oesophagus
--------- malignancy Pulmonary
aspiration
Management
Reduce reflux Use of cholinergic drugs Reduce acid burden
Protect oesophageal
mucosa, eg. alginate preparations such as Gaviscon
Treat anaemia
Hiatus – gap Hernia
- the protrusion of viscus outside it`s natural cavity
Most common
mechanical disorder of the oesophagus
Factors Increased intrabdominal pressure eg obesity, pregnancy
Protrusion of part of
the fundus of the stomach into the chest via the oesophageal opening in the
diaphragm. Often
older patients, over 50 years
Clinical features May be asymptomatic Those
of reflux
Two principle forms
i. Squamous
cell carcinoma
Can effect any part
of the oesophagus
Aetiological factors
Smoking Strong
alcoholic drinks Tannic
acid
Lack of riboflavin
and vitamin A Fungal
contamination of food Opium
use
Thermal injury Human
Papillomavirus
ii Adinocarcinoma
Found in the lower
third
Mostly associated
with Barrett`s oesophagus which is oesophagus lined with metaplastic columnar
cells
Investigations
Endoscopy Histology Cytology
Clinical features
Remorselessly
progressive dysphagia for solids then liquids
Patient can often
point to the level of obstruction
Regurgitation Retrosternal
discomfort
Pain Weight
loss
Anaemia - occult
blood loss Pressure
on the trachea
Metastases my be
palpable in liver or cervical glands
Complications
Aspiration Inanition Perforation
in to mediastinum Fistula
in to trachea Invasion
of the aorta
Management
Surgery -
oesophago-gastrostomy Radiotherapy
Stents Palliative
Laser
photocoagulation
This disorder carries
a very poor prognosis, about 10% survival at 5 years
Benign tumours of the
oesophagus account for about 5% of neoplaysia
Aetiology - Hepatic
hypertension secondary to cirrhosis
Complications - Massive
haemorrhage
Differential diagnosis - Other
causes of chest and epigastric pain must always be considered
This may occur in
immunocompramised patients and be caused by Candidiasis, herpes simplex or
cytomegalovirus. All
will cause oesophagitis
Episodic severe chest
pain with dysphagia Cause
unknown
Treat by reducing
oesophageal muscle tone with GTN or crushed Nifedipine
No obvious prognostic
implications Reassure
pain is not cardiac