Most common site of duodenal atresia?
Duodenal obstruction is distal to the ampulla of Vater, and infants present with bilious emesis in the neonatal periodQ.
Treatment of duodenal atresia?
Diamond-shaped duodenoduodenostomy is the treatment of choiceQ.
Bubble signs in GI radiology?
- Single bubble sign - Congenital Hypertrophic Pyloric StenosisQ
- Double bubble sign - Duodenal atresiaQ, Annular pancreas
- Triple bubble sign - Jejunal atresiaQ
Palpation finding in CHPS?
- • Palpation of the pyloric tumor or olive in the epigastrium or right upper quadrant by a skilled examiner is pathognomonic for the diagnosis of HPSQ.
- • If the olive is palpated, no additional diagnostic testing is necessaryQ.
USG measurements for CHPS?
- Pyloric wall thickness of at least 4 mmQ
- Channel length of at least 17 mmQ
Barium Meal finding in CHPS?
- −−String signQ: indicating a narrowed elongated pyloric canal that does not relax is seen
- −−Shoulder signQ: caused by the hypertrophied muscle indenting the antrum
- −−Double-track signQ: caused by the redundant mucosa
Treatment for CHPS?
- Never a surgical emergency, although dehydration and electrolyte abnormalities may present a medical emergencyQ
- Ramstedt-Fredet pyloromyotomy (cutting across the abnormal pyloric musculatureQ while preserving the underlying mucosa). If the mucosa is inadvertently opened then feeding is delayed for 48 hoursQ
MC cause of gastric outlet obstruction?
Site of stenosis or obstruction in peptic ulcer disease?
1st part of the duodenumQ
What is saline load test?
- Emptying the stomach with a nasogastric tube - instill 750 mL of saline, the patient is placed in sitting position, and 30 minutes later the nasogastric tube is aspirated, normally < 400 mL should remain in the stomach, and 90% of subjects have a residue of less than 200 mL.
- The finding of > 400 mL residual saline is consistent with a diagnosis of gastric outlet obstruction
Surgical procedure for GOO?
- Truncal vagotomy and antrectomyQ is the ideal procedure
- The inflammation and scarring at duodenal bulb or previous proximal duodenal surgeries prevents safe performance of an antrectomy, in this setting truncal vagotomy with drainage (Gastrojejunostomy) is the preferred approachQ
Why is there alkalosis in GOO and other conditions?
- • Gastric alkalosis is most marked with vomiting due to pyloric stenosis or obstruction because the vomitus is acidic gastric juice onlyQ.
- • Vomiting in other conditions may involve a mixture of acid gastric loss and alkaline duodenal contentsQ and the acid-base situation that results is more variable
Types of Bezoars?
- Bezoars are collections of nondigestible materials.
- Four types of Bezoar: Phytobezoars (MC), Trichobezoars, Pharmacobezoar and Lactobezoar
What is Stress Gastritis?
Characterized by multiple, superficial (nonulcerating) erosions that begin in the proximal or acid-secreting portion of the stomach and progress distallyQ
What is Cushing’s ulcer?
Occur in the setting of central nervous system disease (Head trauma)Q
What is Curling’s ulcer?
- Occurs as a result of thermal burn injury involving > 35% of BSAQ
- Increased acid secretion in Cushing’s ulcer but not in Curling’s ulcerQ
What are cameron ulcers?
Linear gastric erosions in hiatal herniasQ
Pathophysiology of stress gastritis?
In stress (hypoxia, sepsis, or organ failure), mucosal ischemia is the main factor responsible for the breakdown of these normal defense mechanismsQ
Types of gastric volvulus?
- Organoaxial (two thirds): Torsion occurs along the stomach’s longitudinal axisQ
- Mesenteroaxial (one third): Torsion occurs along the vertical axisQ
What is primary gastric volvulus?
- Seen in association with congenital asplenia and wandering spleenQ
- Usually mesenteroaxialQ
What is secondary gastric volvulus?
- Occur secondary to some anatomic abnormality, (Most commonly diaphragmatic hernia)Q
- Usually organoaxialQ
What is Borchardt’s triad?
Epigastric pain + Inability to vomit + Inability to pass a nasogastric tube - characteristic feature of gastric volvulusQ
What are types of vagotomy?
- Truncal vagotomy - Performed above the celiac and hepatic branches of the vagiQ
- Selective vagotomy - Performed below the celiac and hepatic branches of the vagiQ
- Highly selective vagotomy - Performed by dividing the crow’s feet to the proximal stomach while preserving the innervation of the antral and pyloric parts of stomachQ.
What is the pacemaker of stomach?
- Interstitial cells of Cajal (ICCs)Q
- Location: In bodyQ along the greater curvature
Cells of stomach?
CMPE: Chief cells (44%) > Mucous cells (40%) > Parietal cells (13%) > Endocrine cells (3%)Q
Secretions from Parietal cells and Chief cells?
- Parietal cells secrete Ghrelin, Intrinsic factor, Leptin and Acid. (GILA)Q
- Chief cells secrete pepsin and leptinQ
Which layer of stomach is responsible for rugae?
Muscularis mucosa is responsible for the rugaeQ
Strongest layer of GI tract?
Embryology of stomach?
- Assumes normal asymmetric shape and position by the end of the 7th weekQ.
- During the 6th to 10th week as the stomach enlarges it also rotates 90 degrees in a clockwise direction
Where is Brunner’s Gland located?
Submucosal gland found in the duodenumQ
What is Ghrelin?
Gherlin is secreted by oxyntic cells in the fundus of the stomachQ – it has orexigenic (appetite stimulating) propertiesQ
What are primary effects of Ghrelin?
- • Motilin like effects on gastric motilityQ
- • Stimulates release of somatostatin and PPQ
Location of gastric cardia?
Gastric cardia occurs in posterior cardia or fundusQ
What are features of Prune belly syndrome?
- Extremely lax lower abdominal musculatureQ
- Dilated urinary tract including the bladderQ
- Bilateral undescended testesQ
What is Hour-Glass Stomach?
Caused by cicatricial contraction of a saddle shaped ulcer at the lesser curvatureQ
What is Tea-Pot Stomach (Hand-bag Stomach)?
Tea-pot stomach is caused by longitudinal shortening of gastric ulcer at the lesser curvature of stomach (stomach looks like tea-pot)Q
Treatment of duodenal adenocarcinoma?
- For 1st or 2nd portion: Whipple procedureQ
- For 3rd or 4th portion: Segmental duodenal resectionQ
Length of stricture for Finney and Henneke Mikulicz procedure?
- Finney stricturoplasty is used for strictures > 10–15 cmQ.
- Heineke-Mikulicz stricturoplasty is appropriate strictures < 10 cmQ in length
- Antrectomy or distal gastrectomy • Removal of distal 1/3rd of stomachQ
- Hemigastrectmy • Removal of half of stomachQ
- Subtotal gastrectomy • Removal of 2/3rd of stomachQ
- Total gastrectomy • Removal of whole stomachQ