Universidad de Guadalajara

Septiembre 2011

EsophagealEsophageal PathologyPathology

Centro Universitario Ciencias de la Salud

Clínicas Quirúrgicas

Mayra C. Silva Camarena206558747

Dr. Benjamin Robles MariscalDr. Héctor Manuel Virgen Ayala

AnatomyAnatomy

40-45 cm

aortic arch aortic arch

left main left main bronchiole bronchiole

esophageal esophageal hiatus hiatus

HHistology

Physiologyhysiology

Motor funcion

UpperUpper Esophageal Esophageal SphincterSphincter

LowerLower Esophageal Esophageal SphincterSphincter

EsophagealEsophageal BodyBody

Gastroesophageal reflux diseasedisease

75% of esophageal diseasesdiseases

20-40% of the adultadult population suffers

PPathogenesisathogenesis

Retrograde reflux of gastric contents into the esophagus, which produces symptoms

and damages the mucosa

Transient relaxation

Hiatal hernia

secondary to gastric abnormalities

Clinical Manifestations

Pyrosis Regurgitation

Dysphagia

Cough Nausea Vomiting Postprandial Fullness Drowning Wheezing Chest pain Dysphonia Dental erosions

Differential diagnosis

Irritable bowel syndrome

Achalasia

Cholelithiasis

Coronary Coronary artery disease

Complications

NoneErosive esophagitis

StenosisBarrett's Esophagus

58%

23%

11%0%

42%77%89%

100%

Esophagitis

Grade 1Grade 2

Grade 3Grade 4

TTreatment

Changes in lifestyle

Medical Treatment

Surgical treatment

Surgical treatment

1Restore the LES pressure and length

2Sphincter placement in the abdomen

3Allow the cardia to relax during deglution

4Not increase the resistance of the sphincter above the capacity peristaltic esophageal body

5Allow the fundoplication is in place

Nissen fundoplication

Toupet Funduplication

Belsey Mark Funduplication

Gastroplasty

Nissen fundoplication

FForecastorecast

ControlControl

Characteristic 90%

Atypical 70%

Hiatal hernia

Type IType IIType III

Hiatal hernia

Type I

Type IIType III

Hiatal hernia

Type I

Type II

Type III

Symptoms

Pyrosis Regurgitation

Mechanical failure of the LES have

IDysphagia Postprandial fullness Anemia Dyspnoea Pneumonia

II

Diagnosis

X-ray

Barium test

Esophagoscopy

Diagnosis

X-ray

Barium test

Esophagoscopy

Diagnosis

X-ray

Barium test

Esophagoscopy

Treatment

ParasternalRetrosternal

Pleuroperitoneal Hernia

Morgagni

BochdalekBochdalek

Traumatic Diaphragmatic Hernia

Clinical Manifestations

Acute Chronic

Bibliography

G. M. Doherty. “Diagnóstico y tratamiento Quirúrgicos”, thirteenth edition, México; 2006. Page. 366-367; 375-388

F. C. Brunicardi, “Principios de Cirugia” , octave edition, Mexico; 2004.

Page.860-872;916-923.