Gastrointestinal Surgery Clinical - Gastro Esophageal Reflux Disease - Penn Surgery
You may never have heard of a rare condition called “nutcracker esophagus.” Many doctors aren't familiar with the condition, also called. The esophagus is a median structure that lies first behind the trachea and then and it resembles that arising from the stomach or heart ("heartburn"). Other close relations include the brachiocephalic and left common carotid arteries. The esophagus runs behind the windpipe (trachea) and heart, and in front of the spine. Just before entering the stomach, the esophagus.
The Oesophagus - Location - Sphincters - TeachMeAnatomy
Many genes with elevated expression are also shared with skin and other organs that are composed of squamous epithelia. For a more complete list, see esophageal disease. Esophagitis Inflammation of the esophagus is known as esophagitis. Reflux of gastric acids from the stomach, infection, substances ingested for example, corrosivessome medications such as bisphosphonatesand food allergies can all lead to esophagitis.
Esophageal candidiasis is an infection of the yeast Candida albicans that may occur when a person is immunocompromised.
File:Relations of the aorta, trachea, esophagus and other heart structures.png
As of [update] the cause of some forms of esophagitis, such as eosinophilic esophagitisis not known. Esophagitis can cause painful swallowing and is usually treated by managing the cause of the esophagitis - such as managing reflux or treating infection. Barrett's esophagus Prolonged esophagitis, particularly from gastric reflux, is one factor thought to play a role in the development of Barrett's esophagus.
In this condition, there is metaplasia of the lining of the lower esophagus, which changes from stratified squamous epithelia to simple columnar epithelia.
Barrett's esophagus is thought to be one of the main contributors to the development of esophageal cancer. Esophageal cancer There are two main types of cancer of the esophagus.
Squamous cell carcinoma is a carcinoma that can occur in the squamous cells lining the esophagus. This type is much more common in China and Iran. The other main type is an adenocarcinoma that occurs in the glands or columnar tissue of the esophagus. This is most common in developed countries in those with Barrett's esophagus, and occurs in the cuboidal cells.
Chapter 21: The esophagus, trachea and main bronchi
When severe, esophageal cancer may eventually cause obstruction of the esophagus, making swallowing of any solid foods very difficult and causing weight loss. The progress of the cancer is staged using a system that measures how far into the esophageal wall the cancer has invaded, how many lymph nodes are affected, and whether there are any metastases in different parts of the body.
Esophageal cancer is often managed with radiotherapy, chemotherapy, and may also be managed by partial surgical removal of the esophagus. Inserting a stent into the esophagus, or inserting a nasogastric tubemay also be used to ensure that a person is able to digest enough food and water.
As of [update]the prognosis for esophageal cancer is still poor, so palliative therapy may also be a focus of treatment. Esophageal varices Esophageal varices are swollen twisted branches of the azygous vein in the lower third of the esophagus. These blood vessels anastomose join up with those of the portal vein when portal hypertension develops.
These blood vessels develop as part of a collateral circulation that occurs to drain blood from the abdomen as a result of portal hypertensionusually as a result of liver diseases such as cirrhosis. Because of the extensive venous plexus that exists between this vein and other veins, if portal hypertension occurs, the direction of blood drainage in this vein may reverse, with blood draining from the portal venous system, through the plexus. Veins in the plexus may engorge and lead to varices.
A ruptured varix is considered a medical emergency, because varices can bleed a lot. A bleeding varix may cause a person to vomit bloodor suffer shock. To deal with a ruptured varix, a band may be placed around the bleeding blood vessel, or a small amount of a clotting agent may be injected near the bleed.
A surgeon may also try to use a small inflatable balloon to apply pressure to stop the wound. IV fluids and blood products may be given in order to prevent hypovolemia from excess blood loss. This can cause difficult swallowing, called dysphagiaor painful swallowing, called odynophagia. Achalasia refers to a failure of the lower esophageal sphincter to relax properly, and generally develops later in life.
This leads to progressive enlargement of the esophagus, and possibly eventual megaesophagus. A nutcracker esophagus refers to swallowing that can be extremely painful. Diffuse esophageal spasm is a spasm of the esophagus that can be one cause of chest pain. Cardio-oesophageal reflex in humans as a mechanism for "linked angina'. Esophageal perception and noncardiac chest pain.
Gastroenterol Clin North Am. Exercise-induced ST depression in the diagnosis of coronary artery disease. Long-term prognosis of patients with anginalike chest pain and normal coronary angiographic findings.
J Am Coll Cardiol. The contribution of gastroesophageal reflux to chest pain in patients with coronary artery disease. Sensitivity of the esophageal mucosa to pH in gastroesophageal reflux disease. Sensitization of esophageal mucosa by prior acid infusion: Sensitization to painful distention and abnormal sensory perception in the esophagus. Contribution of central sensitisation to the development of non-cardiac chest pain.
Esophageal acid perfusion in coronary artery disease. Induction of myocardial ischemia. Oesophageal stimulation lowers exertional angina threshold. Prior sensitization of esophageal mucosa by acid reflux predisposes to reflux-induced chest pain.
Gastroesophageal reflux in patients with angiographically normal coronary arteries: Acute noncardiac chest pain in a coronary care unit. The esophagus is a median structure that lies first behind the trachea and then behind the left atrium.Barrett’s Esophagus Screening
It begins to deviate to the left below the left main bronchus. In the posterior mediastinum it is related to the vertebral column as a string is related to a bow. Hence there is a retrocardiac space between it and the vertebrae, which is visible radiographically in oblique and lateral views. The esophagus has constrictions 1 at its commencement, 2 frequently where it is crossed by the left main bronchus, and 3 commonly where it traverses the diaphragm.
These are sites where swallowed objects can lodge notwithstanding the fact that the esophagus is distensible and can accommodate almost anything that can be swallowed, e. The impressions of adjacent structures, and their alterations in disease, can be seen radiographically after barium is swallowed fig.
The esophagus transports food and liquid and can be replaced successfully by a non-muscular tube. The muscular layer is striated above supplied by the vagi and smooth below supplied by parasympathetic, or vagal, and sympathetic fibers.
The process of swallowing may be watched fluoroscopically. A thin barium meal or liquid is "shot down" to the cardiac orifice, whereas a thick meal or a bolus of food travels more slowly. The esophagus is supplied by arteries in the neck inferior thyroid arteriesthorax bronchial arteries, direct branches of the aorta, and phrenic arteriesand abdomen left gastric artery.
Veins of the lower part of the esophagus communicate with the left gastric vein, thereby forming an important portal-systemic anastomosis. Pain fibers from the esophagus accompany the sympathetic system. A vague, deep-seated, esophageal pain may be felt behind the sternum or in the epigastrium, and it resembles that arising from the stomach or heart "heartburn".
In esophagoscopy, measurements are taken from the upper incisor teeth to indicate the beginning of the esophagus 18 cmthe point at which it is crossed by the left bronchus 28 cmand its termination 43 cm.
File:Relations of the aorta, trachea, esophagus and other heart victoryawards.us - Wikimedia Commons
Trachea The trachea, or windpipe figs. It is about 9 to 15 cm in length. The trachea descends anterior to the esophagus, enters the superior mediastinum, and divides into right and left main bronchi.