Diseases of the Oesophagus

Study Notes

Anatomy of the Oesophagus

The oesophagus is approximately 25 cm long and divided into three parts: cervical, thoracic (upper, middle, lower), and intra-abdominal.
Traverses the diaphragm at the T10 level, anchored to the diaphragm via the phrenoesophageal ligament.
Two major sphincters present:
- Proximal sphincter formed by the cricopharyngeal muscle and inferior constrictor muscle.
- Distal sphincter at the oesophagogastric junction, characterized by a 3-5 cm high-pressure area.

Blood Supply

Arterial supply includes:
- Neck: Inferior thyroid artery.
- Thoracic: Bronchial arteries and branches from the thoracic aorta.
- Abdomen: Inferior phrenic artery and left gastric artery.
Venous drainage:
- Neck: Inferior thyroid veins.
- Thoracic: Hemiazygos and azygos veins.
- Abdomen: Left gastric vein, which drains into the portal system.

Lymphatic Drainage

Local lymph nodes and posterior mediastinal, supraclavicular, and coeliac lymph nodes facilitate lymphatic drainage.

Diseases of the Oesophagus Overview

Conditions impacting the oesophagus vary widely, ranging from anatomical malformations to motility disorders.

Adult Diaphragmatic Hernias

Hernias can be classified into two types:
- Rolling Hernias (Para-oesophageal Hernias): Occur when a portion of the stomach bulges through the diaphragm beside the oesophagus.
- Sliding Hernia: When a part of the stomach and the gastroesophageal junction slip through the diaphragm.

Oesophageal Motility Disorders

Includes various conditions such as:
- Achalasia: Failure of the lower oesophageal sphincter to relax.
- Diffuse Oesophageal Spasm: Erratic contractions in the oesophagus.
- Nutcracker Oesophagus: Hypercontraction of the oesophagus leading to intense chest pain.

Oesophageal Strictures

Abnormal narrowing of the oesophagus categorized based on underlying cause, leading to various clinical presentations and management options.

Oesophageal Perforation

Classified by the cause, may present with severe symptoms and requires prompt special investigations for diagnosis and management.

Corrosive Injury to the Oesophagus

Graded based on severity and extent of damage caused by caustic substances, with specific diagnostic and treatment protocols.

Oesophageal Carcinoma

Epidemiology reflects a growing concern with various risk factors such as smoking and diet.
Histological types include squamous cell carcinoma and adenocarcinoma, each with unique tumor biology characteristics and clinical staging systems.

Diverticulae of the Oesophagus

Classification includes conditions like Zenker's diverticulum, marked by pharyngeal pouch formation, with unique etiopathogenesis and management strategies.

Special Investigations

Critical for diagnosing and assessing oesophageal conditions, offering vital information for targeted treatments.

Description

Explore Chapter 22 focused on the diseases of the oesophagus, covering key aspects such as anatomy, physiology, clinical presentations, and treatment options. This quiz also delves into adult diaphragmatic hernias and various diverticulae associated with the oesophagus.