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MALLORY-WEISS SYNDROMEMALLORY-WEISS SYNDROME
 Vigorous vomiting-vert split in the gastricVigorous vomiting-vert split in ...
CORROSIVE INJURYCORROSIVE INJURY
 Corrosive-sod hydroxide,sulphuric acidCorrosive-sod hydroxide,sulphuric acid
 Accident...
Investigaion- endoscopy
-deep ulcers n black eschars-greatest
risk of perforation
Managemnt-minor injury- pt safely fed
...
GORDGORD
 Loss of competence of LOSLoss of competence of LOS
 Competence affected-obesity,smoking nCompetence affected-o...
PRECIPITATING FACTORS-
 1.structurally defective LOS
 2.short length of oesophagus
 3.ineffective oesophageal
pump(inf...
overeating/ingestion of irritants
gasrtic distension
unfolding of sphincter
terminal s epi of oeso exposed to acid
erosion...
AetiopathogenesisAetiopathogenesis
 Acid reflux to LOS – diffuse inflmn withAcid reflux to LOS – diffuse inflmn with
mult...
CLINICAL FEATURESCLINICAL FEATURES
 Retrosternal painRetrosternal pain
 Epigastric painEpigastric pain
 RegurgitationRe...
DIAGNOSISDIAGNOSIS
 Assume rather than prevent – Rx isAssume rather than prevent – Rx is
empericalemperical
 Investigati...
MEDICAL MANAGEMENTMEDICAL MANAGEMENT
 Alcohol minimisedAlcohol minimised
 Loose weightLoose weight
 Coffee & tea minimi...
SURGERYSURGERY
 Endoscopic treatmentsEndoscopic treatments
 Surgical treatments –Surgical treatments –
uncomplicated gor...
COMPLICATIONSCOMPLICATIONS
 Barret”s oesophagusBarret”s oesophagus
 StrictureStricture
 Oesophageal shorteningOesophage...
HIATUS HERNIAHIATUS HERNIA
 Abnormal protrusion of abdominal viscusAbnormal protrusion of abdominal viscus
through oesoph...
Common symptomsCommon symptoms
 1.Symptoms due to reflux(reflux &heart1.Symptoms due to reflux(reflux &heart
burn)burn)
...
SLIDING HERNIASLIDING HERNIA
 Anatomical factors which prevent slidingAnatomical factors which prevent sliding
herniahern...
CausesCauses
 1.The position of fatty tissue in the hiatus1.The position of fatty tissue in the hiatus
 2.Advancing age ...
CF
like reflux oesophagitis
commom in women,obese
INVESTIATIONS
Oesophagoscopy- reflux of the gastric acd –
most valuabl...
TREATMENT
 1.Conservative treatment
Principles:
1.Lifestyle changes
-decrease in wt
-Diet cntrol
-decreasd alcohol n tobe...
SurgerySurgery
 IndicationsIndications
-Intractable pain-Intractable pain
-Complication –hge or stricture-Complication –h...
ROLLING HERNIAROLLING HERNIA
 Cardio –oeso jn is normal.Cardio –oeso jn is normal.
 Greater curvature of stomach ascends...
Clinical FeaturesClinical Features
 No retrosternal burning painNo retrosternal burning pain
 Discomfort after a small m...
InvestigationInvestigation
Ba mealBa meal
RxRx
 Reduction of sac &repair of hiatusReduction of sac &repair of hiatus
MIXE...
BARRET”S OESOPHAGUSBARRET”S OESOPHAGUS
 When columnar mucosa extends at least 3When columnar mucosa extends at least 3
cm...
PATHOLOGICAL TYPESPATHOLOGICAL TYPES
 1.Gastric type – Chief & parietal cells1.Gastric type – Chief & parietal cells
 2....
Incidence of malignancyIncidence of malignancy
 Lower &Midle oeso more prone to developLower &Midle oeso more prone to de...
RxRx
 Laser photodynamic therapyLaser photodynamic therapy
 Argon beam plasma coaulationArgon beam plasma coaulation
 L...
Mallory weiss syndrome
Mallory weiss syndrome
Mallory weiss syndrome
Mallory weiss syndrome
Mallory weiss syndrome
Mallory weiss syndrome
Mallory weiss syndrome
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Mallory weiss syndrome

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Mallory weiss syndrome

  1. 1. MALLORY-WEISS SYNDROMEMALLORY-WEISS SYNDROME  Vigorous vomiting-vert split in the gastricVigorous vomiting-vert split in the gastric mucosa (below sc jn at the cardia)- 90%mucosa (below sc jn at the cardia)- 90%  Tear in the oesophagus-10%Tear in the oesophagus-10%  Presents with hematemesisPresents with hematemesis  endoscopic injection therapy requird 4 severeendoscopic injection therapy requird 4 severe casescases
  2. 2. CORROSIVE INJURYCORROSIVE INJURY  Corrosive-sod hydroxide,sulphuric acidCorrosive-sod hydroxide,sulphuric acid  Accidental ingestion-damageAccidental ingestion-damage 2nouth,pharynx,larynx,oeso,stomach2nouth,pharynx,larynx,oeso,stomach  Alkalies causeliquifaction,saponification ofAlkalies causeliquifaction,saponification of fat,dehydration and thrombosis of bv- fibrousfat,dehydration and thrombosis of bv- fibrous scarringscarring  Acids-coagulative necrosis with eschar formationAcids-coagulative necrosis with eschar formation -causes intense pylorospasm with pooling-causes intense pylorospasm with pooling in the antrum(more gastric damage)in the antrum(more gastric damage)
  3. 3. Investigaion- endoscopy -deep ulcers n black eschars-greatest risk of perforation Managemnt-minor injury- pt safely fed sev injury-feeding jejunostomy Complication-stricture formation-50% (oeso resection)
  4. 4. GORDGORD  Loss of competence of LOSLoss of competence of LOS  Competence affected-obesity,smoking nCompetence affected-obesity,smoking n excissive eatingexcissive eating  Gastric acid reflux- extensive inflammmation ofGastric acid reflux- extensive inflammmation of lower oeso- oesophagitislower oeso- oesophagitis  Types-a/c – alcohol,burns,stressTypes-a/c – alcohol,burns,stress c/c – hitus hernia,oesophagojejunostomyc/c – hitus hernia,oesophagojejunostomy
  5. 5. PRECIPITATING FACTORS-  1.structurally defective LOS  2.short length of oesophagus  3.ineffective oesophageal pump(influenced by gravity,oeso motility,salivation)  4.increased gastric pressure
  6. 6. overeating/ingestion of irritants gasrtic distension unfolding of sphincter terminal s epi of oeso exposed to acid erosion,ulceration,fibrosis,metaplasia barret”s oeso AdenoCa
  7. 7. AetiopathogenesisAetiopathogenesis  Acid reflux to LOS – diffuse inflmn withAcid reflux to LOS – diffuse inflmn with multiple ulcersmultiple ulcers  Symptoms worse when patient lies downSymptoms worse when patient lies down  Vicious cycleVicious cycle  vagal hypersensitivity – oesophagitis –vagal hypersensitivity – oesophagitis – long muscle spasm – displacement oflong muscle spasm – displacement of oesophagus – increased regurgitationoesophagus – increased regurgitation
  8. 8. CLINICAL FEATURESCLINICAL FEATURES  Retrosternal painRetrosternal pain  Epigastric painEpigastric pain  RegurgitationRegurgitation  Occult blood in stoolsOccult blood in stools  Anaemia & weaknessAnaemia & weakness  Dysphagia(sricture)Dysphagia(sricture)  Atypical symp – Angina like chest pain , pulm orAtypical symp – Angina like chest pain , pulm or laryngeal symplaryngeal symp
  9. 9. DIAGNOSISDIAGNOSIS  Assume rather than prevent – Rx isAssume rather than prevent – Rx is empericalemperical  Investigations – when patient does notInvestigations – when patient does not respond to ppirespond to ppi  24 hr ph recording – gold std24 hr ph recording – gold std  TLOSR – manometric findingTLOSR – manometric finding  Ba swallow( in trendelenburg position)Ba swallow( in trendelenburg position)  OesophagoscopyOesophagoscopy
  10. 10. MEDICAL MANAGEMENTMEDICAL MANAGEMENT  Alcohol minimisedAlcohol minimised  Loose weightLoose weight  Coffee & tea minimisedCoffee & tea minimised  Oeso mucosal protecters(Antacids,H2 blockers)Oeso mucosal protecters(Antacids,H2 blockers)  Head up tiltHead up tilt  Oily& spicy food avoidedOily& spicy food avoided  Large meal avoided at nightLarge meal avoided at night  PPI most effective drug Rx (8 wks)PPI most effective drug Rx (8 wks)
  11. 11. SURGERYSURGERY  Endoscopic treatmentsEndoscopic treatments  Surgical treatments –Surgical treatments – uncomplicated gord –pt”s choiceuncomplicated gord –pt”s choice Symptomatic on PPI(volume reflux ,Symptomatic on PPI(volume reflux , hermit lifestyle , poor compliance)hermit lifestyle , poor compliance) Laproscopic fundoplicationLaproscopic fundoplication
  12. 12. COMPLICATIONSCOMPLICATIONS  Barret”s oesophagusBarret”s oesophagus  StrictureStricture  Oesophageal shorteningOesophageal shortening
  13. 13. HIATUS HERNIAHIATUS HERNIA  Abnormal protrusion of abdominal viscusAbnormal protrusion of abdominal viscus through oesophageal hiatus into chest.through oesophageal hiatus into chest.  TYPESTYPES  1.Sliding hernia(oesophageo gastric1.Sliding hernia(oesophageo gastric hernia) – 80%hernia) – 80%  2.Rolling or paraoesophageal hernia2.Rolling or paraoesophageal hernia  3.Mixed hernia3.Mixed hernia  4.Massive herniation4.Massive herniation
  14. 14. Common symptomsCommon symptoms  1.Symptoms due to reflux(reflux &heart1.Symptoms due to reflux(reflux &heart burn)burn)  2.Symptoms due to2.Symptoms due to complications(dysphagia,complications(dysphagia, odynophagia,hematemesis, melaena)odynophagia,hematemesis, melaena)  3.Nonoesophageal synp(asthma & chest3.Nonoesophageal synp(asthma & chest pain )pain )
  15. 15. SLIDING HERNIASLIDING HERNIA  Anatomical factors which prevent slidingAnatomical factors which prevent sliding herniahernia  1.Presence of 2 cm of intraabd1.Presence of 2 cm of intraabd oesophagusoesophagus  2.The angle of His2.The angle of His  3.Mucosal folds at oesophageocardial jn3.Mucosal folds at oesophageocardial jn  4.+ intraabd pressure4.+ intraabd pressure  5.LOS5.LOS
  16. 16. CausesCauses  1.The position of fatty tissue in the hiatus1.The position of fatty tissue in the hiatus  2.Advancing age – mus degeneration2.Advancing age – mus degeneration  3.Lower abd trs , preg – raised intraabd3.Lower abd trs , preg – raised intraabd pressurepressure  4.Saint”s triad- Gallstone , diverticulosis,4.Saint”s triad- Gallstone , diverticulosis, hiatus herniahiatus hernia
  17. 17. CF like reflux oesophagitis commom in women,obese INVESTIATIONS Oesophagoscopy- reflux of the gastric acd – most valuable sign. Ba meal- gord in trendelemburg
  18. 18. TREATMENT  1.Conservative treatment Principles: 1.Lifestyle changes -decrease in wt -Diet cntrol -decreasd alcohol n tobecco consumption 2.Oesophageal mucosa protection -Antacids -H2 blockers -PPI
  19. 19. SurgerySurgery  IndicationsIndications -Intractable pain-Intractable pain -Complication –hge or stricture-Complication –hge or stricture Types of surgeryTypes of surgery 1.Nissen”s total fundoplication1.Nissen”s total fundoplication 2.Partial fundplication(Tupet)2.Partial fundplication(Tupet) 3.Belsey mark IV operation3.Belsey mark IV operation 4.Hill”s repair4.Hill”s repair
  20. 20. ROLLING HERNIAROLLING HERNIA  Cardio –oeso jn is normal.Cardio –oeso jn is normal.  Greater curvature of stomach ascends intoGreater curvature of stomach ascends into a preformed sac in mediastinum.a preformed sac in mediastinum.  Compression of heart & lung.Compression of heart & lung.
  21. 21. Clinical FeaturesClinical Features  No retrosternal burning painNo retrosternal burning pain  Discomfort after a small mealDiscomfort after a small meal  Feeling of fullness after meal or dysphagiaFeeling of fullness after meal or dysphagia  PalpitationsPalpitations  RTI or hiccough (phrenic nerve irritation)RTI or hiccough (phrenic nerve irritation)
  22. 22. InvestigationInvestigation Ba mealBa meal RxRx  Reduction of sac &repair of hiatusReduction of sac &repair of hiatus MIXED HERNIAMIXED HERNIA Both rolling & sliding hernia +Both rolling & sliding hernia + Symptoms & Rx - mixedSymptoms & Rx - mixed
  23. 23. BARRET”S OESOPHAGUSBARRET”S OESOPHAGUS  When columnar mucosa extends at least 3When columnar mucosa extends at least 3 cm into oesophaguscm into oesophagus  Intestinal metaplasiaIntestinal metaplasia PathogenesisPathogenesis  Rptd reflux –Shifting of oesogastric jnRptd reflux –Shifting of oesogastric jn upwards – Further increase in reflux –upwards – Further increase in reflux – Intestinal metaplasia of middle & lowerIntestinal metaplasia of middle & lower oesooeso
  24. 24. PATHOLOGICAL TYPESPATHOLOGICAL TYPES  1.Gastric type – Chief & parietal cells1.Gastric type – Chief & parietal cells  2.Intestinal type – Goblet cells2.Intestinal type – Goblet cells  3. junctional type – Mucous glands3. junctional type – Mucous glands CLINICAL TYPESCLINICAL TYPES -Long segment : Metaplastic changes more-Long segment : Metaplastic changes more than 3cmthan 3cm -Short segment:Changes less than 3 cm-Short segment:Changes less than 3 cm
  25. 25. Incidence of malignancyIncidence of malignancy  Lower &Midle oeso more prone to developLower &Midle oeso more prone to develop CACA  CA will be invasive & more proximalCA will be invasive & more proximal TYPES OF DYSPLASIATYPES OF DYSPLASIA -Low grade : negligible risk for ca-Low grade : negligible risk for ca -High grade :very high risk for ca-High grade :very high risk for ca
  26. 26. RxRx  Laser photodynamic therapyLaser photodynamic therapy  Argon beam plasma coaulationArgon beam plasma coaulation  Lap antireflux surgeryLap antireflux surgery  High dose PPIHigh dose PPI  Oesophagectomy(High grade dysplasia)Oesophagectomy(High grade dysplasia) ComplicationsComplications  1. Oesophageal ulcers1. Oesophageal ulcers  2.Oesophageal strictures2.Oesophageal strictures  3.Dysplasia & adenoca3.Dysplasia & adenoca

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