Diseases of the esophagus Department of faculty and hospital surgery Tashkent Medical Academy

Diseases of Diseases of the esophagusthe esophagus

Department of faculty and hospital surgery Department of faculty and hospital surgery Tashkent Medical AcademyTashkent Medical Academy

Diseases of the esophagus

Occupies the 6th place In the structure of

human diseasesOn the 3rd place

Among diseases of gastro - intestinal

tract (after disease Of stomach and rectum)

The incidence rates of esophageal population in 2010 year

(100 thousand)

Incidence of malignant tumors In 2010 year in the Republic of Uzbekistan

History of surgical treatment of esophageal-

is starting with 1877., When Vincenz Cherny

conducted the first successful resection of the cervical esophagus

Vincenz Czerny (1842 − 1916)

Only in 1913, Franz Torek first successfully

performed transtorakaling resection of the

esophagus (through the left torakotomtion

access) cancer middle chest

Franz J. A. Torek (1861-1938)

Transthoracic access to the clinic tried to apply Johannes

von Mikulicz (1904), Ernst Sauerbruch (1905), but these attempts were unsuccessful

Johannes von Mikulicz-Radecki 1850 - 1905

Peter A. Herzen (1871-1947)

Sergey Yudin (1891-1954)

Mikhail Davydov

Ivan Greeks (1867-1934)

Vasit Vakhidovich Vahidov

Shavkat Ibrahimovic Karimov

Nikolai Fedorovich Krotov

Sadik Aliyevich Masumov

Duties of the general practitioner in diseases Duties of the general practitioner in diseases of the esophagusof the esophagus

- Provision of primary health and social care; - Provision of primary health and social care; - Health education (promoting healthy lifestyles); - Health education (promoting healthy lifestyles); - Preventive work (timely detection of early and latent forms of the - Preventive work (timely detection of early and latent forms of the

disease, risk groups); disease, risk groups); - Dynamic monitoring; - Dynamic monitoring; - Emergency assistance in case of emergency and acute conditions; - Emergency assistance in case of emergency and acute conditions; - Timely consultation and hospitalization in the prescribed manner; - Timely consultation and hospitalization in the prescribed manner; - Medical and rehabilitation work in accordance with the qualifying - Medical and rehabilitation work in accordance with the qualifying

characteristic; characteristic; - An examination of temporary disability; - An examination of temporary disability; - The organization of medical and social care and household - The organization of medical and social care and household

together with the bodies of social protection and services of mercy together with the bodies of social protection and services of mercy alone, the elderly, the disabled, the chronically ill; alone, the elderly, the disabled, the chronically ill;

- Maintaining the approved forms of records and reports.- Maintaining the approved forms of records and reports.

Anatomy of the esophagus

Tracheal Tracheal Aortic Aortic Bronchial Bronchial Aorto-bronchial Aorto-bronchial EpibronhialEpibronhial Retropericardial Retropericardial Supradiaphragmatic Supradiaphragmatic Intradiafragmal Intradiafragmal AbdominalAbdominal

Anatomical region and part of the esophagus

1. The cervical 2. Hilar department a. The upper part of the

chest b. The average breast

part. c. The lower part of the

chest (including abdominal esophagus).

Blood circulation and the lymphatic system of the esophagus

branches of the lower thyroid artery

branches of the thoracic aortic

bronchial artery

ascending branch left gastric artery

Metastasis

Methods of study of the Methods of study of the esophagusesophagus

Methods of study of the Methods of study of the esophagusesophagus

1.1. Radiographs Radiographs

2.2. Endoscopic examination Endoscopic examination

3.3. Radioisotope study (external and Radioisotope study (external and intraluminal) intraluminal)

4.4. Ultrasound examinationUltrasound examination

5.5. Intraesophageal pH-meters Intraesophageal pH-meters

6.6. The study of motorThe study of motor

Endoscopic method of Endoscopic method of investigation of the investigation of the

esophagusesophagus

Endoscopic method of Endoscopic method of investigation of the investigation of the

esophagusesophagus

X-ray method for studying X-ray method for studying the esophagusthe esophagus

X-ray method for studying X-ray method for studying the esophagusthe esophagus

Classification of diseases of the Classification of diseases of the esophagusesophagus

Classification of diseases of the Classification of diseases of the esophagusesophagus

I. Malformations I. Malformations                 1 Congenital esophageal atresia and esophageal-tracheal 1 Congenital esophageal atresia and esophageal-tracheal

fistulafistula                  2 Congenital stenosis of the esophagus 2 Congenital stenosis of the esophagus                   3 Congenital diaphragm membrane of the esophagus 3 Congenital diaphragm membrane of the esophagus                   4 Congenital short esophagus 4 Congenital short esophagus                   5 Congenital esophageal cyst 5 Congenital esophageal cyst                   6 Anomalies vessels 6 Anomalies vessels II. damage II. damage                     1 Traumatic injuries - interior and exterior 1 Traumatic injuries - interior and exterior                     2 Burns of the esophagus and their consequences 2 Burns of the esophagus and their consequences III. diseases of the esophagus III. diseases of the esophagus                     1 diverticula - pulse and traction 1 diverticula - pulse and traction                     2 Inflammatory diseases - esophagitis 2 Inflammatory diseases - esophagitis IV. Tumors of the esophagus IV. Tumors of the esophagus                     1 Benign tumors 1 Benign tumors                     2 Cancers 2 Cancers V. Violation of esophageal motility (cardiospasm) V. Violation of esophageal motility (cardiospasm)                       1 Achalasia 1 Achalasia                       2 esophagism2 esophagism

The frequency of lesions of the The frequency of lesions of the esophagusesophagus

The frequency of lesions of the The frequency of lesions of the esophagusesophagus

Cancer Cancer Sarcoma Sarcoma Polyps Polyps Cardiospasm Cardiospasm Cicatricial stricture Cicatricial stricture Diverticula Diverticula Esophagitis Esophagitis Tuberculosis Tuberculosis SyphilisSyphilis

60-80

0,04

0,04

5,1

0,7

0,6

0,2

0,02

0,08

Esophageal cancer is 3.4% of all malignant neoplasms

DysphagiaDysphagiaDysphagiaDysphagia

Grade IGrade I - pass any food, but swallowing solid - pass any food, but swallowing solid food there are unpleasant sensations (burning, food there are unpleasant sensations (burning, scratching, sometimes pain) scratching, sometimes pain)

Grade IIGrade II - solid food stays in the esophagus and - solid food stays in the esophagus and passes with difficulty, it is necessary to wash passes with difficulty, it is necessary to wash down solid food with water down solid food with water

Grade IIIGrade III - solid food does not pass. When you - solid food does not pass. When you try to swallow it arises regurgitation. Patients try to swallow it arises regurgitation. Patients are fed liquid and semi-liquid food are fed liquid and semi-liquid food

Grade IV Grade IV - the esophagus to pass only liquid - the esophagus to pass only liquid Grade VGrade V - complete obstruction of the - complete obstruction of the

esophagus. Patients are unable to swallow a esophagus. Patients are unable to swallow a sip of water, does not pass even the salivasip of water, does not pass even the saliva

Types of congenital esophageal Types of congenital esophageal atresiaatresia

Types of congenital esophageal Types of congenital esophageal atresiaatresia

Esophageal corpus alienum

Esophageal corpus alienum

Esophageal-bronchial

fistula

Esophageal-bronchial

fistula

Excision of the esophageal-Excision of the esophageal-bronchial fistulabronchial fistula

Excision of the esophageal-Excision of the esophageal-bronchial fistulabronchial fistula

Degree of burns of the Degree of burns of the esophagusesophagus

Degree of burns of the Degree of burns of the esophagusesophagus

Grade IGrade I - redness and swelling - redness and swelling of the mucous membrane of the mucous membrane

Grade IIGrade II - the defeat of the - the defeat of the mucosa and submucosa mucosa and submucosa

Grade IIIGrade III - the defeat of all the - the defeat of all the shells of the esophagusshells of the esophagus

Factors determining the Factors determining the degree of damage to the degree of damage to the

esophagus a burnesophagus a burn

1 The nature of the received 1 The nature of the received material material

2 Number of received material 2 Number of received material 3 Concentration of the solution 3 Concentration of the solution 4 Consistency received 4 Consistency received

substance substance 5 Individual sensitivity to the 5 Individual sensitivity to the

received substancereceived substance

The clinical picture of burns of the The clinical picture of burns of the esophagusesophagus

The clinical picture of burns of the The clinical picture of burns of the esophagusesophagus

Acute stage (5-10 days),Acute stage (5-10 days), pain in the mouth, pharynx, pain in the mouth, pharynx, behind the breastbone, in the epigastric region. behind the breastbone, in the epigastric region. Hypersalivation. dysphagia, shock in the next few hours Hypersalivation. dysphagia, shock in the next few hours after the injury. Burn toxemia after a few hours begins to after the injury. Burn toxemia after a few hours begins to prevail prevail

Step imaginary well-being (7-30 days)Step imaginary well-being (7-30 days) as a result of as a result of rejection of the necrotized esophageal webs around the rejection of the necrotized esophageal webs around the end of the 1st week is somewhat looser. Complications: end of the 1st week is somewhat looser. Complications: esophageal bleeding, perforation of the wall of the esophageal bleeding, perforation of the wall of the esophagus, in the presence of extensive wound surfaces esophagus, in the presence of extensive wound surfaces develops sepsis develops sepsis

Stage of formation of the stricture (from 2 to 6 Stage of formation of the stricture (from 2 to 6 months, sometimes years)months, sometimes years) on the wall of the esophagus on the wall of the esophagus ulcers of different sizes. Wound surface covered with a ulcers of different sizes. Wound surface covered with a scab, bleed easily. Dysphagia can reach the degree of scab, bleed easily. Dysphagia can reach the degree of complete obstruction of the esophagus. When top complete obstruction of the esophagus. When top strictures: laryngospasm, coughing, choking due to spillage strictures: laryngospasm, coughing, choking due to spillage of food into the airwayof food into the airway

Burns and scar strictures of Burns and scar strictures of the esophagusthe esophagus

Burns and scar strictures of Burns and scar strictures of the esophagusthe esophagus

Short burn stricture at pharyngeoesophageal

transition

Short burn stricture of the middle third of the esophagus

Extended burn stricture of the

esophagus

Burns and scar strictures of Burns and scar strictures of the esophagusthe esophagus

Burns and scar strictures of Burns and scar strictures of the esophagusthe esophagus

Complications caused by chemical burns of Complications caused by chemical burns of the esophagusthe esophagus

Complications caused by chemical burns of Complications caused by chemical burns of the esophagusthe esophagus

Early shock laryngeal edema hemolysis

Older stricture depletion

pulmonaryEarly acute tracheobronchitis pneumonia Esophageal-bronchial fistula

Older pneumonia lung abscess bronchiectasis Esophageal-bronchial fistula

Perforation mediastinitis pericarditis empyema bleeding

Other foreign bodies diverticula Hiatal hernia Cancer of the esophagus Complications of dilatation

anemia

sepsis

Treatment of burns of the Treatment of burns of the esophagus in the acute periodesophagus in the acute period

Treatment of burns of the Treatment of burns of the esophagus in the acute periodesophagus in the acute period

1.1. Neutralize poison Neutralize poison

2.2. Removal of intoxication and pain Removal of intoxication and pain

3.3. Normalization of water-salt metabolism Normalization of water-salt metabolism

4.4. Anti-inflammatory therapy Anti-inflammatory therapy

5.5. Parenteral nutrition Parenteral nutrition

6.6. Normalization function of the Normalization function of the cardiovascular system cardiovascular system

7.7. Normalization of renal function Normalization of renal function

8.8. Prevention of respiratory disorders Prevention of respiratory disorders

9.9. Oral CareOral Care

Probing of the esophagusProbing of the esophagusProbing of the esophagusProbing of the esophagus

Segmental esophagoplasty Segmental esophagoplasty coloncolon

Segmental esophagoplasty Segmental esophagoplasty coloncolon

Esophagoplasty stomachEsophagoplasty stomach

Esophagoplasty with stomachEsophagoplasty with stomach

Esophageal diverticulaEsophageal diverticulaEsophageal diverticulaEsophageal diverticula

Esophageal diverticulaEsophageal diverticulaEsophageal diverticulaEsophageal diverticula

Esophageal diverticulaEsophageal diverticulaEsophageal diverticulaEsophageal diverticula

Esophageal diverticulaEsophageal diverticulaEsophageal diverticulaEsophageal diverticula

Complications of Complications of esophageal diverticulaesophageal diverticula

1 Diverticulitis - 85.2% 1 Diverticulitis - 85.2% 2 Intestinal obstruction - 6.5% 2 Intestinal obstruction - 6.5% 3 Bleeding - 4.3% 3 Bleeding - 4.3% 4 Perforation or penetration - 3.2% 4 Perforation or penetration - 3.2% 5 Tumor development - 0.8%5 Tumor development - 0.8%

Removal of esophageal Removal of esophageal diverticulumdiverticulum

Classification of reflux Classification of reflux esophagitisesophagitis

Classification of reflux Classification of reflux esophagitisesophagitis

I. Primary I. Primary          Primary disorders of the nervous and peptide Primary disorders of the nervous and peptide

(gastrin, histamine, motilin, etc..) Regulation (gastrin, histamine, motilin, etc..) Regulation of motility of the esophagus and the stomach of motility of the esophagus and the stomach

II. Secondary II. Secondary       When hiatal hernia, pyloric stenosis, peptic When hiatal hernia, pyloric stenosis, peptic

ulcer, cholecystitis, large tumors in the ulcer, cholecystitis, large tumors in the abdomen, ascites, pregnancy, after abdomen, ascites, pregnancy, after gastrectomy, scleroderma, and other gastrectomy, scleroderma, and other diseases diseases

III. Severity (endoscopic classification of III. Severity (endoscopic classification of Savary and Miller, 1978)Savary and Miller, 1978)

Stages of cardiospasmStages of cardiospasm(B.V. Petrovsky)(B.V. Petrovsky)

Stages of cardiospasmStages of cardiospasm(B.V. Petrovsky)(B.V. Petrovsky)

Stage IStage I - unstable functional spasm of - unstable functional spasm of the cardia, the expansion of the the cardia, the expansion of the esophagus is not observed esophagus is not observed

Stage IIStage II - stable spasm of the cardia with - stable spasm of the cardia with soft extension of the esophagus soft extension of the esophagus

Stage IIIStage III - scarring the muscle layers of - scarring the muscle layers of the cardia with a pronounced expansion the cardia with a pronounced expansion of the esophagus of the esophagus

Stage IVStage IV - pronounced stenosis of the - pronounced stenosis of the cardia with dilation of the esophagus, cardia with dilation of the esophagus, often S-shaped with esophagitisoften S-shaped with esophagitis

CardiospasmCardiospasmCardiospasmCardiospasm

stage II stage III

stage IV

Treatment of the Treatment of the cardiospasmcardiospasm

Treatment of the cardiospasmcardiospasm

operation of Nissen

Achalasia of the Achalasia of the esophagusesophagus

The most characteristic The most characteristic symptoms of achalasia of the symptoms of achalasia of the

esophagusesophagus

The most characteristic The most characteristic symptoms of achalasia of the symptoms of achalasia of the

esophagusesophagus1.1. Dysphagia Dysphagia 2.2. After the passage of food techniques After the passage of food techniques

that increase the intraluminal pressure that increase the intraluminal pressure 3.3. Regurgitation (a few hours after a meal Regurgitation (a few hours after a meal

the night immediately after a meal) the night immediately after a meal) 4.4. Pain (pain crises, non-food, pain on Pain (pain crises, non-food, pain on

swallowing, paresthesias, itching, etc.) swallowing, paresthesias, itching, etc.) 5.5. Nausea, vomiting, weight loss Nausea, vomiting, weight loss 6.6. Complications (esophagitis, the Complications (esophagitis, the

transition to cancer, respiratory transition to cancer, respiratory disorders)disorders)

A benign tumor of the A benign tumor of the esophagusesophagus

A benign tumor of the A benign tumor of the esophagusesophagus

Removal of a benign tumor of Removal of a benign tumor of the esophagusthe esophagus

Removal of a benign tumor of Removal of a benign tumor of the esophagusthe esophagus

Cancer of the esophagusCancer of the esophagusCancer of the esophagusCancer of the esophagus

The share of esophageal cancer:

structure bowel diseases - 5-7%;

in the structure of all neoplasms of the body - 1.5-2%.

Mortality from cancer of the esophagus, in a number of other malignancies,

up - 5-6%.

Factors contributing to the development of cancer of the esophagus

Alcohol and tobacco; Deficiency of vitamin A, riboflavin, zinc, molybdenum; Dietary carcinogens; Chemical burns or stricture of the esophagus; Tyloses (a disease characterized by hyperkeratosis of the

palms and soles); Plummer-Vinson syndrome (iron deficiency anemia + +

achlorhydria stricture of the upper esophagus; A long-term untreated achalasia; Prior exposure of the mediastinum; Celiac disease and chronic non refluks esophagitis.

Cancer of the middle third of Cancer of the middle third of the esophagusthe esophagus

Cancer of the middle third of Cancer of the middle third of the esophagusthe esophagus

Cancer lower third of the Cancer lower third of the esophagusesophagus

Cancer lower third of the Cancer lower third of the esophagusesophagus

Growth form of esophageal Growth form of esophageal cancercancer

Growth form of esophageal Growth form of esophageal cancercancer

Symptoms of esophageal Symptoms of esophageal cancercancer

Symptoms of esophageal Symptoms of esophageal cancercancer

General General adynamy, weight loss, fatigue, low-grade fever, adynamy, weight loss, fatigue, low-grade fever,

hypoproteinemia hypoproteinemia

Characteristic of diseases of the chest Characteristic of diseases of the chest cavity cavity

blunt chest pain, tachycardia after eating, blunt chest pain, tachycardia after eating, changing the tone of voice, coughing changing the tone of voice, coughing

Characteristic of esophageal Characteristic of esophageal Dysphagia - reflex, mechanical or mixed, Dysphagia - reflex, mechanical or mixed,

increased salivation, pain, bad breath, bad increased salivation, pain, bad breath, bad taste, regurgitationtaste, regurgitation

Clinical manifestations of esophageal cancer

Dysphagia; Weight loss; Odynophagia; Constant chest pain, epigastric and back; Hiccups; Hypersalivation; Hoarseness; Symptoms of damage to the nervous system and

muscles; Vomiting blood.

Diagnosis primary binding studies

Chest X-ray in 2 projections; Polypositional contrast study of the esophagus and

stomach; Esophagoscopy with multiple biopsies from both the

tumor and from the mucosal sites are not altered by the expected resection line;

Morphological examination of the biopsy specimen; Ultrasound imaging of the mediastinum, supraclavicular

areas, abdominal, retroperitoneal, pelvic organs; ECG; bronchoscopy; General analysis of blood and urine tests, biochemical

blood tests, coagulation, immunoassay, blood group and Rh factor.

Diagnosis additional studies

Computed tomography of the chest and abdomen with contrast;

Diagnostic thoracoscopy; Diagnostic laparoscopy -with suspect

the presence of metastases in the abdominal cavity.

Radiographs of patients with Radiographs of patients with esophageal canceresophageal cancer

At the level of Th6 determined by restriction esophagus. Patency of barium significantly impeded. CONCLUSION: Cancer middle third of the esophagus.

There is a circular narrowing of the esophagus at the level of TH7, for 3.0-3.5 cm. Above which the esophagus suprastenoticheski expanded. CONCLUSION: Cancer between the middle and lower third of the esophagus (endophytic growth).

Radiographs of patients with Radiographs of patients with esophageal canceresophageal cancer

Esophagus pass all over. At the level of VTh6-Th7 determined luminal narrowing, tuberosity contours. The length of the process = 7.0-8.0 cm. CONCLUSION: Cancer middle third of the esophagus.

From the level of VTh V-VII, for 7.0-8.0 cm. Celebrated circular narrowing of the esophagus with irregular contours, the destruction of the mucous relief. CONCLUSION: Cancer middle third of the esophagus.

The differential diagnosis

Cardiospasm. Cicatricial narrowing of the esophagus. Esophageal ulcers and ulcerative esophagitis. Benign tumors of the esophagus. Esophageal varices. Diverticula of the esophagus. Compression of the esophagus from the outside tumors of the

mediastinum. Scars after suffering mediastinitis. Abnormally positioned vessels in the mediastinum.

Leading in the differential diagnosis of esophageal cancer is morphologically !!!

Only multiple negative answer, along with watchful waiting may make relatively favorable judgment.

Methods of treatment of esophageal cancer

radiation Herbal Surgical Combined Complex

Subtotal esophagectomy with intrapleural

     simultaneous plasticity with stomach by Lewis.

Operation - one-step, two available.

Access - wide upper midline laparotomy bypassing the navel to the left, then anterolateral thoracotomy in the IV-V intercostal space on

the right.

Esophagogastroanastomosis in the right pleural cavity.