Podcast
Questions and Answers
In a normal anatomical setup, where is the duodenojejunal junction located in relation to the spine?
In a normal anatomical setup, where is the duodenojejunal junction located in relation to the spine?
To the left of the spine
What is the typical order of symptoms in acute appendicitis?
What is the typical order of symptoms in acute appendicitis?
Pain (referred to periumbilical area) >> Nausea and vomiting >> Anorexia >> Pain migrates to the RLQ
What is the definitive diagnostic test for achalasia?
What is the definitive diagnostic test for achalasia?
Manometry
What is the typical radiographic finding on a barium swallow in achalasia?
What is the typical radiographic finding on a barium swallow in achalasia?
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What is the main difference between diffuse esophageal spasm and nutcracker esophagus on manometry?
What is the main difference between diffuse esophageal spasm and nutcracker esophagus on manometry?
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What is the typical location of a Schatzki ring?
What is the typical location of a Schatzki ring?
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What is the primary symptom of a Schatzki ring?
What is the primary symptom of a Schatzki ring?
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What is the treatment for a Schatzki ring?
What is the treatment for a Schatzki ring?
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What is the primary diagnosis method for esophageal webs?
What is the primary diagnosis method for esophageal webs?
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What is the common symptom of Plummer-Vinson syndrome?
What is the common symptom of Plummer-Vinson syndrome?
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What is the cause of esophageal stricture?
What is the cause of esophageal stricture?
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What is the characteristic of Zenker's diverticulum?
What is the characteristic of Zenker's diverticulum?
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What is the primary symptom of Mallory Weiss tear syndrome?
What is the primary symptom of Mallory Weiss tear syndrome?
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What is the cause of Barrett's esophagus?
What is the cause of Barrett's esophagus?
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What is the complication of Barrett's esophagus?
What is the complication of Barrett's esophagus?
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What is the treatment for esophageal webs?
What is the treatment for esophageal webs?
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Study Notes
Gastrointestinal Surgery
- Malrotation: duodenojejunal junction is to the right of the spine instead of the left.
- Gross appendicitis: enlarged appendix and engorged blood vessels on it.
Acute Appendicitis
- Symptoms: pain (referred to periumbilical area) followed by nausea and vomiting, anorexia, and then pain migrates to the RLQ (constant and intense).
- Characteristics: high WBC, rebound tenderness, and periappendiceal fluid collection on ultrasound.
- Treatment: even if normal appendix is found upon exploration, it should be removed.
Appendiceal Abscess
- Treatment: percutaneous drainage, antibiotics, and elective surgery 6 weeks later.
Achalasia
- Manometry: failure of the LES to relax during swallowing, aperistalsis of the esophageal body.
- Symptoms: progressive dysphagia for both solids and liquids (worse for liquids), regurgitation.
- Treatment: upper endoscopy and balloon dilation of the LES, laparoscopic Heller's myotomy.
- Complications: aspiration pneumonia, weight loss, esophageal CA secondary to Barrett's esophagus from food stasis.
Barium Swallow
- Bird's beak sign and dilation of the proximal esophagus.
Diffuse Esophageal Spasm (DES) and Nut-Cracker Esophagus
- Manometry: intermittent contractions with high amplitudes.
- Symptoms: intermittent dysphagia for both solids and liquids, atypical chest pain that may mimic MI.
- Treatment: calcium channel blockers (diltiazem or nifidipine) and nitrates.
- Barium swallow: corkscrew appearance.
- DES: non-peristaltic contractions.
- Nut-Cracker: peristaltic contractions.
Schatzki Ring
- Location: usually at the squamo-columnar junction.
- Symptoms: intermittent dysphagia for solids only, no pain.
- Associated with: hiatal hernia.
- Diagnosis: barium swallow and endoscopy.
- Treatment: dilation by bougie tube or through scope hydrostatic balloon.
- Patients are placed on PPI after dilation.
Esophageal Webs
- Location: more proximal, usually in the hypopharynx.
- Symptoms: same as Schatzki ring.
- Example: Plummer-Vinson syndrome.
- Diagnosis: barium swallow and endoscopy.
- Treatment: dilation.
Plummer-Vinson Syndrome
- Characteristics: esophageal web, iron-deficiency anemia, dysphagia, spoon-shaped nails, and atrophic oral and tongue mucosa.
- Especially occurs in elderly women, 10% develop squamous cell carcinoma.
- May respond to treatment of IDA.
Esophageal Stricture
- Symptoms: constant and slowly progressive dysphagia for solids then liquids.
- Causes: long history of incomplete treated reflux, prolonged NG tube placement, lye ingestion.
- Diagnosis: barium swallow.
- Treatment: dilation.
Zenker's Diverticulum
- Location: outpouching of the upper esophagus (between the thyropharyngeus and cricopharyngeus muscles).
- Symptoms: halitosis, food regurgitation, dysphagia for solids only, posterior neck mass.
- Especially occurs in elderly.
- Diagnosis: barium swallow.
- Endoscopy and NG tube are contraindicated (risk of perforation).
- Treatment: surgical resection.
Mallory Weiss Tear Syndrome
- Characteristics: partial thickness lacerations at gastroesophageal junction.
- Symptoms: painful hematemesis preceded by vomiting, no dysphagia.
- Diagnosis: history and upper endoscopy.
- Treatment: resolves spontaneously.
Barrett's Esophagus
- Characteristic: change of cell type from esophageal squamous to specialized intestinal columnar (metaplasia).
- Causes: chronic GERD (most common), achalasia.
- Diagnosis: endoscopy.
- Treatment: PPI and follow up (if high grade dysplasia, do radiofrequency ablation or esophagectomy).
- Complication: increases the risk of adenocarcinoma.
Esophageal Varices
- Characteristics: dilated veins in the esophagus.
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Description
This quiz covers the key features of malrotation and gross appendicitis, including their symptoms and diagnosis. It's ideal for medical students and professionals looking to brush up on their knowledge of gastrointestinal surgery.
