12 - 34 - 35 Esophagus

Esophagus Dr.
Al-Matary
Esophagus
2013 27
cancer esophagus dysphagia esophageal atresia Achalasia
dislocation fracture clavicle

Pott's fracture neck femur colle's supra condylar
 fractures
Esophagus
dysphagia cancer esophagus Achalasia of the cardia
Esophageal atresia
post corrosive stricture

achalasia

Page | 1
Esophagus Dr. Al-Matary
what is important
what is less important what is the important
Esophageal Atresia
Esophageal atresia
written Esophageal atresia
esophageal atresia
written
esophageal atresia
associated anomalies
VACTREL
spinal bifida << Vertebral 
imperforate anus << Anal 
Fallot tetralogy, VSD, ASD << Cardiac 
Trache-esophageal fistula << Tracheal 
atresia << Esophagus 
polycystic kidney << Renal 
polydactyly << Limb 
esophageal atresia
VACTREL
associated anomalies << commonest cause of death

M.C.Q.
associated anomalies << commonest cause of death

M.C.Q.
esophageal atresia
chest
chest isolated esophageal atresia
Page | 2
VACTREL
other anomalies
VACTREL esophageal atresia
associated anomalies
isolated esophageal atresia

pneumonia << chest
atresia
failure of recanalization
gut fusion
gut fusion
imperforate anus
esophageal atresia
gut failure of fusion
atresia
trachea esophagus
esophagus trachea
fistula esophageal atresia
isolated atresia

esophagus trachea
esophageal atresia
VACTREL 

esophagus trachea 
Page | 3
atresia gut fusion

esophagus trachea fistula
esophageal atresia
trachea esophagus
fistula
incidence
fistula 85 %
incidence
incidence
incidence

esophageal atresia 85 %
fistula
85 %
rare
rare
fistula
fistula
fistula << rare
fistula fistula << rare
fistula
fistula
fistula
fistula fistula
fistula 85 %
Page | 4
mainly << fistula
esophageal atresia

esophageal atresia
esophageal atresia
esophageal atresia
polyhydramnios esophageal atresia
amniotic fluid
esophageal atresia
polyhydramnios
esophageal atresia
antenatal diagnosis
diagnosis

polyhydramnios
polyhydramnios
diagnosis
Page | 5
fistula
stomach trachea
tympanic resonance
HCL bile sputum
fistula
trachea HCL bile
fistula
trachea HCL bile
fistula

trachea HCL bile 
esophageal atresia
antenatal
polyhydramnios
bile sputum
Page | 6
esophageal atresia
esophageal atresia
blind pouch gastrographin
investigations
X-ray
lipidol gastrographin
gastrographin
barium gastrographin
barium 
trachea
gastrographin
X-ray
trachea
trachea
fistula
fistula common
fistula common
trachea
lung saliva
 
Page | 7
cause of death X-ray

trachea gastrographin
X-ray
esophageal atresia
urgent
urgent urgent
chest
pneumonia chest
pain 
swelling 
loss of function 
pneumonia
pneumonia pneumonia
collapse lung
collapsed
urgent
pneumonia
thoracotomy
atresia fistula
pneumonia


Page | 8
gastrotomy
esophagus
saliva
saliva
clear saliva
clear pharynx saliva
gastrotomy esophagotomy
chest
 <<
pneumonia
jejunum intestine colon
discuss esophageal atresia
excessive salivation
tachypnea
Page | 9
what is your diagnosis

esophageal atresia
pneumonia
Neonatal pneumonia
surfactant defect
tachypnea
esophageal atresia excessive salivation
tachypnea
neonatal pneumonia
surfactant
excessive salivation
esophageal atresia
distended clinically
bile sputum
instrumental
blind bowel gastrographin
treatment
Diaphragmatic hernia
Hiatus hernia Diaphragmatic hernia
diaphragmatic hernia << Hiatus hernia
hiatus hernia
diaphragmatic hernia
99 %
Page | 10

diaphragmatic hernia hiatus hernia
hiatus diaphragmatic hernia
diaphragmatic hernia 99 %
hiatus
1%
cancer esophagus esophagus

achalasia


Hernia of Bochdalek
Hernia of Bochdalek
sac pleura peritoneum
sac peritoneum pleura

membrane
membrane
pleuro-peritoneal membrane
diaphragm
sac
pleuro-peritoneal membrane membrane
diaphragm
diaphragm pleuro-peritoneal membrane defect

chest
99 %
sac peritoneum pleura
pleuro-peritoneal membrane membrane
chest << defect
Page | 11
chest
Lung
dyspnea
scaphoid abdomen
respiratory distress neonates

till proved otherwise << diaphragmatic hernia scaphoid abdomen
scaphoid abdomen respiratory distress

considered diaphragmatic hernia till proved otherwise
Hernia of Bochdalek
sac peritoneum Pleura
Membrane
pleuro-peritoneal membrane
chest
dyspnea << chest

scaphoid abdomen << intestine
data
diaphragmatic hernia till proved otherwise scaphoid abdomen + dyspnea
respiratory distress neonates
scaphoid abdomen
scaphoid abdomen respiratory distress
Page | 12
abnormal sound chest

abnormal sounds
intestinal sounds
investigations
X-ray
X-ray
chest
intestine
gastrographin
chest gastrographin
gastrographin chest X-ray
 diaphragmatic hernia
gastrographin chest X-ray diaphragmatic hernia
diaphragmatic hernia clinically

scaphoid abdomen dyspnea

dyspnea 
scaphoid abdomen 
defect intestine
ventilator
mask oxygen
surfactant ventilator
Page | 13
congenital
internal mammary artery
chest wall internal mammary artery
internal
breast
mammary
subclavian artery
first part of subclavian artery


internal mammary artery artery

chest wall
breast

rectus sheath << superior epigastric artery artery
diaphragm abdomen chest
intestine
Hernia of Morgagni
Hernia of Morgagni
hernia of Morgagni
Internal mammary artery
Page | 14
chest abdomen intestine

lung
dyspnea
scaphoid abdomen
neonates << Bochdalek 

adulthood << Morgagni 
hernia of neonates Bochdalek

adulthood Morgagni
neonates Hernia of Bochdalek

adulthood hernia of Morgagni
Eventration of diaphragm
diaphragm
diaphragm
Eventration of the diaphragm
eventration of the diaphragm 
working ala nasi
Eventration of the diaphragm

asymptomatic
Page | 15
diaphragm

asymptomatic eventration of diaphragm
conservative
symptoms
symptoms
hiatus para esophageal hernia
Hiatus hernia congenital para esophageal hernia

Hiatus
diaphragm esophagus hiatus
hiatus
hiatus
diaphragm esophagus
hiatus
Page | 16
Hiatus hernia << para esophageal hernia

para esophageal hernia
Hiatus hernia
stomach esophagus
esophagus
esophagus
esophagus
Morgagni
it needs time to occur
para esophageal
congenital
angle of Hiss
angle of Hiss
angle of Hiss angle
reflux
angle of Hiss
No reflux
angle of Hiss
no reflux
chest intestine
dyspnea lung
chest stomach
Page | 17
Lung
chest abdomen
Lung
lung chest abdomen

dyspnea
G.I.T.
cardiology
cardiology G.I.T.
rare
diaphragmatic hiatus hernia


chest stomach
dyspnea Lung
palpitation
dysphagia esophagus
barium
dysphagia
Page | 18
palpitation dyspnea

reflux
angle of Hiss
Trendelenburg position barium
fundus
Trendelenburg position Barium meal
stomach
Acquired diaphragmatic hernia ( sliding type )

sliding type acquired diaphragmatic hernia
Hiatus hernia
Hiatus hernia
para esophageal 
sliding hernia 
Hiatus hernia
sliding para esophageal
sliding type
angle of Hiss sliding hernia
Page | 19
equal angle of Hiss

reflux
equal reflux << sliding type hiatus hernia
angle of Hiss
gastro-esophageal junction angle of Hiss

Z zone
M.C.Q.
M.C.Q.
sliding type hiatus hernia
there is no angle of Hiss
Z line
disturbed 
not disturbed 
none of the above 
all of the above 
Z zone gastro-esophageal junction

Z line
gastro-esophageal junction
Z zone Z line
esophagus 

chest
pregnancy

engagement
Page | 20
engagement
urinary bladder
pregnancy

greater omentum
greater omentum
greater omentum
intra abdominal pressure
Hiatus hernia
Hiatus hernia
pregnancy 
Obesity 

esophagus 
Esophagus
reflux
reflux hiatus hernia
esophagus esophagus HCL
reflux Hiatus hernia

hiatus hernia reflux
Page | 21

Longitudinal muscle circular muscle fibers submucosa mucosa
fibers
esophagus HCL
epithelium esophagus << mucosa
precancerous << Barret esophagus
circular muscle fibers HCL

esophagus stricture spasm
longitudinal muscle fibers HCL

esophagus


esophagus HCL
precancerous << Barret esophagus << Mucosa
stricture spasm << circular muscle fibers
<< longitudinal muscle fibers
esophagus epithelium mucosa Esophagus HCL
Esophagus HCL
Page | 22
Mucosa HCL
Barret esophagus <<
erosion esophagus
stricture circular muscle fiber
Longitudinal muscle fibers
Longitudinal muscle fibers

reflux
longitudinal muscle fibers HCL
esophagus
stomach
end result
sliding type << Hiatus hernia
disturbed angle of Hiss
esophagus
reflux
reflux
pain
heart burn
regurgitation
regurgitation
Page | 23
HCL
heart burn
odynophagia
dysphagia
esophagus
Odynophagia dysphagia
Water brush
water brush
saliva
HCL
alkaline saliva saliva saliva saliva

reflex
acidic HCL
alkaline << saliva
HCL
saliva, saliva, saliva, saliva
reflux
water brush
water brush
Page | 24
water brush
excessive salivation in response to reflux
excessive salivation in response to reflux

water brush dysphagia regurgitation postural heart burn
bad chest
reflux
HCL
anemia reflux
odynophagia
esophagus
anemia
sliding type << Hiatus hernia investigation
Hiatus hernia
sliding type << Hiatus hernia Upper gastrointestinal endoscopy
stomach Mucosa
stomach mucosa
40
Page | 25
crico pharyngeus incisor teeth 15

esophagus 25
40 25 + 15
40 stomach mucosa
30 stomach mucosa
stomach
rugae
rugae stomach Mucosa
barium meal in Trendelenburg position

stomach
in Trendelenburg position
esophagus bleeding barium

active bleeding
bleeding reflux
reflux
investigation
24 hour ambulatory PH monitoring

investigation
24 hour ambulatory PH monitoring
Page | 26
Peristalsis
fiber optic
reflux stomach
memory
24 PH changes
24 hour PH monitoring
endoscopy 
barium in Trendeleburg position 
24 hour PH monitoring 
Manometry
sphincter
lost << high pressure zone Manometry

sphincter
reflux
Medical
Page | 27
surgery medical
reflux sliding type << hiatus hernia

medical
surgical
medical << Peptic ulcer reflux
main line of treatment

medical treatment
medical treatment

up till now
Medical treatment
peptic ulcer
change life style
Page | 28
 12
12
life style
reflux
reflux
physical and mental rest



reflux
physical and mental rest
reflux
two waves
semisolid
semisolid
antacids
Page | 29
Omeprazole reflux
Omeprazole
reflux cardia tone

emptying of the stomach
vomiting
cardia tone
emptying of the stomach
extra pyramidal manifestations
psychiatric
depression psychiatric
extra pyramidal anticholinergic
twitches
extra pyramidal manifestations
extra pyramidal manifestations extra pyramidal
extra pyramidal manifestation
Page | 30
Omeprazole
 omeperazole
Human Proved cancer
atrophic gastritis
reflux
6
reflux 
6
indication for surgery <<
failure of medical treatment << indication for surgery

complication
indication for surgery

failure of medical treatment 
complications 
malignancy stricture hemorrhage ulcer
Fundoplication
fundus of the stomach
270o 360o
360o << fundus

Nissen
o
270 << fundus

whether performed posteriorly (Toupet)

or anteriorly (Dor,Watson),
Page | 31
reflux
Nissen 

Nissen
chest
chest
360 fundus Nissen

270 << fundus
reflux
Nissen
esophagus 360 fundus

gas bloat syndrome

esophagus fundus Nissen
270 << fundus
Nissen modified Nissen
270
gas bloat syndrome to avoid
gas bloat syndrome reflux

gas bloat syndrome

sliding type hiatus hernia
Page | 32
angle of Hiss
esophagus stomach
esophagus
pregnancy
obesity
esophagus
reflux
sliding type << hiatus hernia

heart burn
regurgitation
dysphagia
water brush
Investigations sliding type << Hiatus hernia

24 Hour PH monitoring
main line of treatment sliding type << hiatus hernia

medical treatment
peptic ulcer
life style
Omeprazole
medical treatment
6
indication for surgery
failure of medical treatment
complications
Nissen fundoplication
Page | 33
chest
Nissen
abdomen
fundus
270
fundus Nissen
360
gas bloat syndrome

Nissen
gas bloat syndrome
Nissen
gas bloat syndrome Nissen
270
Nissen Modified Nissen
written Hiatus hernia
Reflux Esophagitis ( GERD )

reflux
Hiatus hernia
mucosa
bad chest reflux
reflux hiatus Hiatus hernia reflux

smoking
Page | 34
reflux
cancer stomach
cancer bladder
cancer
bronchogenic carcinoma

bronchogenic carcinoma
reflux smoking
reflux
reflux

smoking
obesity
reflux obesity
Hiatus hernia
pregnancy
reflux pregnancy
hiatus hernia
Physiological reflux
CHPS pyloric obstruction
Page | 35
CHPS simple reflux
CHPS << Under weight

CHPS CHPS
congenital hypertrophic pyloric stenosis
physiological reflux
reflux
gastrin
gastrin
gastrin
G cells
gastrin
gastrin
gut tone gastrin
esophagus
Intra abdominal esophagus
esophagus
intra abdominal esophagus
 7 6
pathological reflux
Page | 36
8
6
8
simple reflux reflux

simple reflux
reflux reflux
M.C.Q.
reflux angle of Hiss

reflux Intra abdominal esophagus
abdomen Hight pressure compressed

chest
negativity << chest
pressure Intra abdominal
negativity << Chest
intra abdominal esophagus reflux
diaphragm esophagus reflux
diaphragm esophagus
hiatus 
hiatus diaphragm esophagus

esophagus Hiatus diaphragm hiatus
Page | 37
pinchcock effect
pinchcock effect
<< pinchcock

Esophagus
reflux
angle of Hiss
Hiatus Intra abdominal esophagus
esophagus Mucosa lower end of the esophagus
rosette shaped
reflux rosette
lower end of the esophagus

rosette shaped
reflux rosette
reflux Preventing factors

anatomy M.C.Q.
all of the following except

M.C.Q.
reflux esophagitis
heart burn
regurgitation
water brush dysphagia

reflux investigation
24 hour PH monitoring
barium meal in Trendelenburg
medical
failure of medical treatment
Nissen
Plummer Vinson Syndrome
Page | 38
Plummer Vinson Syndrome

pulmner Vinson syndrome
dysphagia 40
cancer
dysphagia
cancer
cancer
male old age << cancer
plummer
time
dysphagia
dysphagia
esophagus Pharynx epithelial lining atrophy
dysphagia
esophagus pharynx epithelial lining atrophy

dysphagia
atrophy epithelial lining
squamous esophagus squamous

friction
epithelial lining
dysphagia odynophagia
dysphagia
epithelial lining atrophy
Page | 39
reflex
pharynx esophagus
spasm
spasm
Pharynx
epithelial lining atrophy
pain during epithelial lining atrophy

esophagus pharynx spasm

dysphagia
iron deficiency anemia with hypo vitaminosis
dysphagia
iron deficiency anemia and hypovitaminosis
spooning of nails
angular stomatitis
splenomegaly
hypo vitaminosis iron deficiency anemia
Pharynx
packed RBCs iron deficiency anemia
pharynx
iron deficiency anemia
pre cancerous
Plummer vinson syndrome
highly pre cancerous
Post cricoid carcinoma cancer esophagus
Page | 40
post cricoid carcinoma cancer esophagus
Esophageal carcinoma
Esophageal Carcinoma
predisposing factors
M.C.Q.
cancer esophagus Predisposing factors
cancer esophagus predisposing factor
cancer esophagus
Predisposing factors cancer esophagus

Post corrosive stricture
M.C.Q.
all of the following are pre cancerous except
Barret esophagus 
Tylosis type A 
( A.D. characterized by hyperkeratosis of palm and sole, 100 % esophagus carcinoma at age of
40 years )
plummer vinson syndrome 
post corrosive stricture 
except
cancer
predisposing factors
esophagus benign tumors
papilloma 
adenoma 
papilloma << esophgaus benign tumors

squamous epithelium
columnar epithelium adenoma
Page | 41
pathology
macroscopically << cancer esophagus
ulcer 
caluiflower 
infiltrating 
Incidence
M.C.Q. 1/3
macroscopically << cancer esophagus

ulcer, cauliflower, infiltrating
microscopically
squamous cell carcinoma
squamous << lining epithelium
adeno carcinoma
columnar epithelium << lining epithelium

columnar cell carcinoma
mucin columnar cell carcinoma

colloid variety
Undifferentiated
anaplastic
spread
direct, blood, lymph and transcoelomic
spread
direct, blood, lymph and transcoelomic
transcoelomic
Krukenburg's tumor 
Plummer's shelf nodules 
Page | 42
esophagus Lymph spread

esophgaus
cervical neck 
mediastinum chest 
celiac lymph nodes abdomen 
esophagus
cervical lymph nodes Neck
mediastinum lymph nodes chest
celiac lymph nodes abdomen
celiac lymph nodes abdomen

foregut
blood spread
blood 
lung 
bone 
liver 
systemic Portal esophagus

porto-systemic
lung
liver esophagus
systemic esophagus
lung
Portal << esophagus

liver
direct spread
esophagus
neck << direct spread
neck
surgical anatomy
surgical anatomy
surgical anatomy

Page | 43
neck cross section

3
trachea 
esophagus 
vertebrae 
esophagus trachea
recurrent laryngeal nerve
thyroid lobe thyroid Lobe
carotid sheath lobe of thyroid
vagus internal jugular vein carotid artery
carotid sheath sympathetic chain

carotid sheath ansa cervicalis
3
trachea 
esophagus 
vertabrea 
esophagus trachea recurrent laryngeal

thyroid Lobes
vagus nerve internal jugular vein carotid artery carotid sheath
sympathetic chain
ansa cervicalis
direct spread
trachea
recurrent laryngeal nerve
thyorid
carotid sheath
once
Page | 44
chest cancer esophagus

chest esophagus
trachea

trachea
esophagus

trachea trachea
chest esophagus
Lung

lung chest cancer esophagus

heart trachea
cancer esophagus
Page | 45
Page | 46
Page | 47
Page | 48
Page | 49
Page | 50
Page | 51
Page | 52
‫‪Esophagus Dr. Al-Matary‬‬
‫لوزٌد هي الوىاد الوفسؼة‬

‫على الفٍس تىك‬
‫صفحة تفسٌػ الوىاد الطثٍة‬
‫‪www.facebook.com/dr.tafreegh‬‬
‫ًحثنن فً هللا‬
‫إذا عجثل أي شًء هتفسغ تاتع لصفحة أو جسوب‬
‫تفسٌػ الوىاد الطثٍة‬
‫وحثٍت حضستل تٌقله اتفضل‬
‫ترمس الوصدز أو تدوى‬
‫الوهن إى الوعلىهة تىصل لؽٍسك‬
‫واحتسة إًل تتىصل هعلىهة لؽٍسك‬
‫وإى شاء هللا لل هي األجس النثٍس تإذى هللا‬
‫وٌنىى فً خدهة اإلسالم‬
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‫| ‪Page‬‬ ‫‪53‬‬
‫‪Esophagus Dr. Al-Matary‬‬
‫اللهن اجعل عولٌا خالصا ً لىجهل النسٌن‬

‫اللهن آهٍي‬
‫سالم تقا ‪‬‬
‫| ‪Page‬‬ ‫‪54‬‬

12 - 34 - 35 Esophagus

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12 - 34 - 35 Esophagus

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Esophagus Dr.

cancer esophagus dysphagia esophageal atresia Achalasia

dislocation fracture clavicle

post corrosive stricture

associated anomalies << commonest cause of death

associated anomalies << commonest cause of death

chest isolated esophageal atresia

isolated esophageal atresia

fistula esophageal atresia

fistula esophageal atresia

atresia gut fusion

mainly << fistula

HCL bile sputum

trachea HCL bile

blind pouch gastrographin

cause of death X-ray

clear pharynx saliva

discuss esophageal atresia

what is your diagnosis

esophageal atresia excessive salivation

blind bowel gastrographin

diaphragmatic hernia << Hiatus hernia

cancer esophagus esophagus

sac peritoneum pleura

diaphragm pleuro-peritoneal membrane defect

respiratory distress neonates

scaphoid abdomen respiratory distress

dyspnea << chest

respiratory distress neonates

scaphoid abdomen respiratory distress

abnormal sound chest

gastrographin chest X-ray

diaphragmatic hernia clinically

first part of subclavian artery

internal mammary artery artery

internal mammary artery

Internal mammary artery

chest abdomen intestine

neonates << Bochdalek 

hernia of neonates Bochdalek

neonates Hernia of Bochdalek

eventration of the diaphragm 

working ala nasi

Eventration of the diaphragm

asymptomatic eventration of diaphragm

hiatus para esophageal hernia

Hiatus hernia congenital para esophageal hernia

Hiatus hernia << para esophageal hernia

it needs time to occur

chest abdomen intestine

lung chest abdomen

diaphragmatic hiatus hernia

Trendelenburg position barium

Trendelenburg position Barium meal

Acquired diaphragmatic hernia ( sliding type )

angle of Hiss sliding hernia

equal angle of Hiss

gastro-esophageal junction angle of Hiss

Z zone gastro-esophageal junction

reflux Hiatus hernia

esophagus esophagus HCL

circular muscle fibers HCL

longitudinal muscle fibers HCL

esophagus epithelium mucosa Esophagus HCL