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Types of congenital diaphragmatic hernia?
- Bochdalek herniaQ - Posterolateral location
- Morgagni herniaQ - anteromedial, retrosternal
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Pathogenesis of diaphragmatic hernia?
failure of normal closure of the pleuroperitoneal canalQ
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Clinical triad of diaphragmatic hernia?
Respiratory distress + Dextrocardia + Scaphoid abdomenQ•
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How is dipahgragmatic hernia repaired?
Interrupted, nonabsorbable suturesQ
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Prognostic factors for congenital diaphragmatic hernia?
- Pulmonary hypoplasia (Most important)
- Pulmonary hypertension
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Which side of congenital diaphragmatic hernia has poor prognosis?
Right sided defects have poor prognosisQ
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What is Larrey’s herniaQ?
Morgagni hernias or Retrosternal hernias
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Which vessel may pass through Morgagni hernia?
Superior epigastric vessels may pass through Morgagni spaceQ
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Most commonly involved viscus in Morgagni hernia?
Transverse colonQ
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Treatment of Morgagni hernia?
- Transabdominal routeQ is preferred choice.
- Prosthetic mesh is generally required to repair the defectQ.
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Types of Hiatal hernia?
- Type I - Sliding hiatal hernia (MC)Q
- Type II - True paraesophageal herniaQ
- Type III - Mixed paraesophageal hernia (I and II)Q
- Type IV - Paraesophageal hernia containing other intraabdominal organsQ
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What is type I Hernia or sliding HH?
- Upward displacement of the GE junction into the posterior mediastinumQ.
- The stomach remains in its usual longitudinal alignmentQ
- 95% of HHs is type I
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What is Type II Hernia?
Normally positioned intraabdominal GE junction with upward herniation of the stomachQ alongside it.
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What is Type III Hernia?
- Displacement of both the GE junction and a large portion of the stomach cephalad into the posterior mediastinumQ.
- Of all PEHs, type III is the most commonQ•
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What is type IV Hernia?
Esophageal hiatus has dilated to such an extent that the hernia sac also contains other organs such as the spleen, colon, or small bowelQ
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Degree of wrap in fundoplication?
- Watson - 90-degree anterior fundoplicationQ
- Dor - 180-degree anterior fundoplicationQ
- Toupet - 180-degree posterior fundoplication subsequently modified to a 270-degree wrapQ
- Belsey Mark IV - 270-degree anterior fundoplicationQ
- Nissen - 360-degree fundoplicationQ
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What is Nissen’s fundoplication?
- Left crus approach to a 360-degree wrap (Nissen fundoplication), which is the procedure of choice for GERD.
- Left crus approach: Direct and early view of the short gastric vessels and spleenQ
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Classical triad of symptoms in GERD?
- Retrosternal burning pain
- Epigastric pain and
- RegurgitationQ
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Factors Contributing to the High-pressure Zone in the Lower Esophagus?
- • Intrinsic musculatureQ of the distal esophagus which are in a state of tonic contraction
- • Sling fibers of the cardiaQ which are at the same anatomic depth of the circular muscle fibers of the esophagus but are oriented in a different direction
- • DiaphragmQ: during inspiration the anteroposterior diameter of the crural opening is decreased, compressing the esophagus and increasing the measured pressure at the LES
- • Transmitted pressureQ of the abdominal cavity
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Gold standard for diagnosing and quantifying GERD?
24-hour pH testQ
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What is Demeester score?
DeMeester Score is a global measure of esophageal acid exposure. A Demeester score > 14.72 indicates reflux.
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Gold standard Antireflux surgery for GERD?
Laparoscopic Nissen’s fundoplication
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Principles of Nissen fundoplication?
Secure crural closure and creation of a short (≤2 cm), 360-degree “floppy” fundoplication designed to most closely replicate the normal physiology of the gastroesophageal flap valveQ
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IOC for anatomical disorders of esophagus?
Barium swallowQ
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IOC for motility disorders of esophagus?
ManometryQ
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Most frequent complication of Nissen fundoplication?
Pneumothorax
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What is Pathophysiology of achalasia cardia?
Destruction of the nerves to LES is primary pathology and degeneration of neuromuscular function of the body of esophagus is secondaryQ
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