Aula esôfago
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Transcript of Aula esôfago
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PATOLOGIA ESOFÁGICA
Ana Cristina Araújo Lemos da Silva
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Anomalias Congênitas• Restos ectópicos
– Mucosa gástrica
• Atresia e fístulas
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1:1500 – 1:5000 nativivos
90% com fístula tráqueo-esofágica
Sufocação desde a primeira ingestão de alimento
Evolução
Outras anomalias (50% dos casos)
Cardiopatia congênita
Anus imperfurado
Displasia renal
Anomalias vertebrais
Esôfago - atresia
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Lesões associadas à disfunção motora
ACALÁSIA
Dificuldade de relaxamento
primária
congênita
Disfagia progressiva
Câncer esofagiano
Divertículos
Aspiração ( broncoaspiração – pneumonia)
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HÉRNIA HIATAL Hérnia por deslizamentoHérnia para-esofágica
Etiologia desconhecida
Complicações ulceraçãoperfuraçãoesofagite por refluxoestrangulamentoobstrução
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A mais freqüente (90%)Hiato esofágico amplo e defeito na fixação do esôfagoSeparação dos pilares diafragmáticos com alargamento do espaçoPresente em 10% ou mais dos exames radiológicosSó 50% dos casos sintomáticos
aziaregurgitaçãodisfagia e sangramento (raros)
Tratamento clínicocirúrgico (raro)
Esôfago, Hérnia por deslizamento
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Geralmente assintomática
Mecanismos: “precariedade do tecido
conjuntivo de sustentação”
Risco de infarto gástrico
Tratamento cirúrgico
Esôfago, Hérnia para-esofágica
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DIVERTÍCULOS
Falsos
Divertículo de Zenker(imediatamente
acima do EES)
Verdadeiros
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Faringo-esofágico (Zenker)
Esôfago, divertículos.
Terço superior Patogênese: músculo crico-faríngeo) Regurgitação de alimentos Rara associação com carcinoma
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Para-traqueal
Esôfago, divertículos.
Terço médio
Bifurcação traqueal
Aderências/disfunção motora
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LACERAÇÃO DE MALLORY WEISS
vômitos excessivos
relaxamento reflexo da musculatura ausente
10% dos casos de HDA
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Esôfago
Laceração
(síndrome de Mallory-Weiss)
Ruptura/perfuração
(síndrome de Boerhaave)
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VARIZES ESOFAGIANAS
hipertensão portal
esquistossomose
cirrose (50%)
HDA maciça
mortalidade de 45%
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Refluxo
Esofagite
Infecções
Cáusticos
Agentes físicos
Causas diversas
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• Redução do tônus do EEI
• Hérnia hiatal por deslizamento
• Eliminação lenta do bolo alimentar
• Eliminação lenta do material refluído
• Reparo da mucosa lento
Esofagite por refluxo
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• Adultos• Crianças ( alergia)• Disfagia e azia• Dor retroesternal• Regurgitação• Aspiração pulmonar da secreção gástrica• Sangramento• Úlceração• Esôfago de Barret (metaplasia)- 10%
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Esôfago de Barret
Refluxo GE recorrente e prolongado
Inflamação
Ulceração
Cura por reepitelização e crescimentode células pluripotentes imaturas
ph no lúmem do esôfago distal causa diferenciaçãoDa mucosa para epitélio intestinal
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Fatores predisponentes
Esofagite infecciosa
Doenças mieloproliferativas Quimioterapia antineoplásica Radioterapia Antibióticos Corticosteróides Imunodepressão para transplantes de órgãos AIDS Cirurgia abdominal Diabete melito Debilidade física
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CANDIDÍASE ESOFÁGICA
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Herpes vírus
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CITOMEGALOVÍRUS
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Esofagite infecciosa
Clínica Odinofagia Dor torácica Febre
Complicações Sangramento Perfuração do esôfago
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Esofagite cáustica Ácidos Álcalis Outras substâncias corrosivas
Evolução Necrose e dissolução Inflamação Estenose
(radioterapia)
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NEOPLASIAS BENIGNAS
• Pólipos escamosos /condiloma
• Mesenquimais– Leiomiomas
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Neoplasias malignas
• 6% dos cânceres do TGI
• Assintomáticos
• Células escamosas
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Carcinoma epidermóide
• > 50 anos• 100:100000 hab no BR• 20% dos óbitos por ca• Álcool• Tabagismo• Nitrosamina• HPV• 20% - TS• 50% - TM• 30% - TI
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• Ausência de serosa
• Rica rede linfática
• Disseminação linfática a distância
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Padrão de crescimento
Esôfago, carcinoma epidermóide
Polipóide 60%
Ulcerante 25%
Infiltrante 15%
(misto)
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Clínica
Esôfago, carcinoma epidermóide
Disfagia (após diminuição 70% da luz) Odinofagia Halitose Perda de peso Aspiração de alimentos Fístula Rouquidão
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Prognóstico do carcinoma epidermóide
Sobrevida 5 anos: < 10%
[diagnóstico precoce]