Medical Archive

S3 Esophagus

C344 Embryology, Anatomy, and Function of the Esophagus

FIG. 344.1 A continuous tracing of esophageal motility showing 2 swallows, as indicated by the pharyngeal contraction associated with relaxation of the upper esophageal sphincter (UES) and followed by peristalsis in the body of the esophagus. The lower esophageal sphincter (LES) also displays a transient relaxation (arrow) unassociated with a swallow. There is an episode of gastroesophageal reflux (*) recorded by a pH probe at the time of the transient LES relaxation.

C344.1 Common Clinical Manifestations and Diagnostic Aids

C345 Congenital Anomalies

C345.1 Esophageal Atresia and Tracheoesophageal Fistula

FIG. 345.1 Diagrams of the 5 most commonly encountered forms of esophageal atresia and tracheoesophageal fistula, shown in order of frequency.

Presentation

????? ??, ?? ?? ? ???, choking, coughing, and regurgitation with initial feeding attempts
?? ??? ??
O : ????
X : airless abdomen
H : ???? ??, ??? ??

Diagnosis

Prox. Atresia w/ distal TEF : m/c

Management

??? ?? XR, ???? ??.
Aspiration pneumonia ?? ?? L-tube? ????.
Extrapleural thoracotomy (through Rt 4th ICS)

Surgery

?? ?
- Prone position
- ???? ?? – ????? ??
- Preop echocardiogram ->aortic arch ?? ?? (????? ?? ????? ?? ??)

Outcome

????(50%) ?? – VACTERL
Vertebral, Anerectal, Cardiac, Tracheal, Esophageal, Renal, Limb

C345.2 Laryngotracheoesophageal Clefts

C345.3 Congenital Esophageal Stenosis

C346 Obstructing and Motility Disorders of the Esophagus

Extrinsic

Esophageal duplication cysts
Neuroenteric cysts
Vertebral anomalies
Enlarged mediastinal or subcarinal lymph nodes
Vascular anomalies

Intrinsic

Schatzki ring
Eosinophilic esophagitis

C347 Dysmotility

Achalasia
??? air-fluid level, ????? bird-beak ? ??? ?? (?? ??)
TOC : Ballon dilatation / ??? : Heller esophagomyotomy

C348 Hiatal Hernia

C349 Gastroesophageal Re?ux Disease

4?? ? ?, ???? ??? ????? ?? ??
?? : ???? 24hr pH test (?? ???)
?? : ? ?? ?? ???, ? ? ?? ? ?????
?? : PPI, H2 blocker, erythromycin, metoclopromide (??? ?? ??)
?? : Nissel fundoplication (??? ??, ??? ???)

Differential diagnosis: infant regurgitation

S4 Stomach and Intestines

C349.1 Complications of Gastroesophageal Reflux Disease

C350 Eosinophilic Esophagitis, Pill Esophagitis, and Infective Esophagitis

Eosinophilic esophagitis

Pathogenesis
- Chronic, immune-mediated esophageal inflammation
- Triggered by food allergens
Clinical features
- Dysphagia, chest/epigastric pain, reflux/vomiting, solid food impaction
- Eczema or other allergic conditions (eg, asthma, rhinitis)
Diagnosis
- 2-month trial of PPI therapy as diagnostic evaluation
- If there is no improvement, …
  - Endoscopy: The eosinophilic esophagitis endoscopic reference score (EREFS), based on commonly observed features of edema (E), rings (R), exudates (E), furrows (F), strictures (S)
  - Esophageal biopsy: >15 eosinophils per HPF
- Circular rings and esophageal furrows are nonspecific findings.
Treatment
- Dietary modification to avoid potential food triggers.
- Topical (eg, swallowed) fluticasone