https://drdhavalmangukiya.com/ http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat https://gastrosurgerysurat.blogspot.com/

1. SURGICAL GASTROENTEROLOGY
INTRODUCTORY
Dr. DHAVAL O. MANGUKIYA

2. SPECTRUM
• Oesophageal
• Gastrointestinal
• Colorectal
• Perianal
• Hepatobiliary
• Pancreatic

3. MULTIDISCIPLINARY APPROACH
• Surgeon
• Physician
• Radiologist
• Pathologist
• Anaesthetist
• Intensivist
• Physiotherapist
• Dietician
• Nursing

4. Why?.....
• Rising incidence
• Vigilant diagnostics
• Developing expertise
• Available gadgets
• Fast track surgery (ERAS)
• Decreasing complications
• Evidence based treatment
• Converting untreatable to cure

5. Oesophageal
Symptoms
• Retrosternal discomfort
• Dysphagia
• Dyspnoea
• haematemesis
Differentials
• Motility disorders
• Achalasia cardia
• Reflux
• Corrosive injury
• Hiatal hernia
• Perforation
• Vaiceal bleeding
Investigations
X-ray, Ba Meal, CT scan, UGI scopy, Manomatry, pH monitoring

6. Stomach
Symptoms
• Dyspepsia
• Burning
• Fullness
• Vomiting
Differentials
• Acid peptic ds.
• Ulcers
• Varices
• Tumors
• Perforation
Investigations
X-ray, Ba Meal, USG, CT scan, UGI scopy, pH monitoring

7. Intestinal
Symptoms
• Pain (central)
• Vomiting
• Distension
• Malaena
• Fever
Differentials
• Infection
• Obstruction
• Tumors
• Perforation
Investigations
X-ray, Ba Meal follow through, USG, CT scan

8. Colorectal
Symptoms
• Pain (flanks)
• Altered bowel habit
• Bleading PR
• Fever
Differentials
• Infection
• Obstruction
• Tumors
• Perforation
Investigations
X-ray, USG, CT scan

9. Perianal
Symptoms
• Pain
• constipation
• Bleading PR
• Something coming out
• Fever
Differentials
• Heamrrhoid
• Fissure
• Fistula
• Perianal abscess
• Tumors
Investigations
Ba Enema, Fistulogram, USG, MRI pelvis

10. Hepatobiliary
Symptoms
• Pain (RHC - referring)
• Fever
• Haematemesis
• Jaundice
• “Incidental”
Differentials
• Infections
• Stones
• Tumors
• Trauma
• Liver failure
Investigations
LFTs, USG, CT scan (triphasic), MRI-MRCP, ERCP

11. Pancreatic
Symptoms
• Pain (EG - referring)
• Diabetes (recent)
• Failure to thrive
• Jaundice
• “Incidental”
Differentials
• Pancreatitis
• Necrosis
• Pseudocyst
• Stones
• Tumors
Investigations
Blood Inv., USG, CT scan, MRI-MRCP

12. Multiorgan involving diseases
• Inflammatory bowel disease
• Polyposis syndrome
• Neuroendocrine tumor
• GIST
• Lymphoma
• Cirrhosis of liver
• Malignancy

13. Breaking the myths!!!!!
• Pre op NBM
• Antibiotic policies
• Use of nasogastric tube & catheters
• Hydration
• Operative time
• Wound dressing
• Post op NBM
• Mobilization

14. CA Rectum

15. Low Anterior resection

16. Duodenal Tumor with intususseption

17. Pancreas preserving duodenectomy

18. Hepatocellular carcinoma

19. Right Hepatectomy

20. Tumor with clear margin

21. Lets take initiative………