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Esophageal Disorders

Esophageal Disorders - The Esophagus Vic Vernenkar D.O...

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The Esophagus Vic Vernenkar, D.O Department of Surgery St. Barnabas Hospital
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Historical Aspects The earliest esophageal procedures were limited to the cervical region (removal of foreign bodies-1863) Modified ureteroscope used to diagnose carcinoma of the thoracic esophagus-1868 Esophagoscopy with distal light source developed around 1900 Flexible fiber-optic esophagoscopy-1964
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Anatomy A hollow muscular tube approximately 25 cm in length divided into four segments Pharyngoesophageal, Cervical, Thoracic and Abdominal The cervical esophagus is a midline structure positioned posterior and slightly to the left of the trachea The thoracic esophagus passes into the posterior mediastinum continuing on the left side of the mainstem bronchus and eventually enters the abdomen through the crus in the diaphragm The abdominal esophagus attaches to the cardia (or EG junction) of the stomach (is of variable length)
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Anatomy (Continued) The esophagus has three distinct areas of naturally occurring anatomic narrowing Cervical constriction Bronchoaortic constriction Diaphragmatic constriction
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Anatomy (Continued) A mucosal-lined muscular tube that lacks a serosa It is surrounded by adventita The adventita surrounds a coat of longitudinal muscle that overlies a inner layer of circular muscle Between the two muscular layers is a thin intramuscular layer of fine blood vessels and ganglion cells The upper (two-thirds) layer of muscle is striated and lower is not The esophageal mucosa consists of squamous epithelium except for the distal 1-2 cm
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Anatomy (Continued) The esophagus has both sympathetic and parasympathetic innervation The esophagus has an extensive lymphatic drainage that consists of two lymphatic plexuses The esophagus has segmental blood supply and is nourished by a number of arteries
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Physiology Its basic function is to transport swallowed material from the pharynx into the stomach Retrograde flow of gastric contents into the esophagus is prevented by the lower esophageal sphincter (LES) Entry of air into the esophagus is prevented by the upper esophageal sphincter (UES)
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Physiology (Continued) Esophageal contractions-three types: Primary peristalsis Secondary peristalsis Tertiary contractions Esophageal peristaltic pressures range from 20- 100 mm Hg with a duration of contraction between 2-4 seconds LES-no anatomic sphincter has ever been demonstrated (resting pressures are elevated in this area)
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Disorders of Esophageal Motility Are classified as functional disorders because they interfere with a normal act of swallowing or produce dysphagia without any associated organic obstruction or extrinsic compression Information from esophageal manometry is extremely helpful Some conditions are indistinguishable by x-rays (barium) but have specific manometric characteristics
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Disorders of Esophageal Motility As a basic rule the tests below constitute the basic evaluation of a patient with suspected disorders of esophageal motility: Barium swallow Esophagoscopy Esophageal manometry Esophageal pH reflux testing
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