This document contains summaries of three gastrointestinal pathology cases and additional information about achalasia, oesophageal carcinoma, small bowel malrotation, and midgut volvulus. Case 1 describes dilatation and narrowing of the esophagus resembling a rat tail or bird beak. Case 2 describes abnormal positioning of the duodenum and small bowel. Case 3 shows irregular narrowing and lack of peristalsis in the colon. Additional sections provide details on the causes, presentations, investigations and treatments of these conditions.
1. The document provides an overview of common pediatric surgical conditions, including congenital diaphragmatic hernia, esophageal atresia with tracheoesophageal fistula, congenital hypertrophic pyloric stenosis, intussusception, Meckel's diverticulum, Hirschsprung disease, and anorectal malformations.
2. It describes the definition, etiology, pathophysiology, clinical presentation, diagnostic workup, and management of each condition. Diagrams and images are provided to illustrate key aspects.
3. The review is intended for 6th year medical students to familiarize them with important pediatric surgical topics.
1) The document describes a case of a 9-day old baby boy presenting with abdominal distention, vomiting of fecal matter, and constipation for 6 days. Examination found the baby to be ill and dehydrated.
2) Operative findings revealed ileal atresia type 3 at the distal ileum. Excision of the blind ends and primary anastomosis was performed.
3) The baby passed stool on the 3rd post-op day and was discharged in good condition on the 30th post-op day with increased weight.
The document discusses various pediatric gastrointestinal disorders including:
1. Duodenal atresia, malrotation with midgut volvulus, jejunal/ileal atresia as causes of intestinal obstruction.
2. Hirschsprung's disease, anorectal malformations, meconium ileus as other causes.
3. Signs, investigations, and management are described for different conditions like biliary atresia.
This document summarizes several common surgical problems in children. It discusses conditions like cleft lip and palate, gastroesophageal reflux disease, infantile hypertrophic pyloric stenosis, and Hirschsprung disease. For each condition, it provides information on incidence, clinical features, investigations, and management. The goal is to provide pediatricians with sound knowledge of these common pediatric surgical issues.
This document discusses acute abdomen in pediatric patients. It defines acute abdomen and provides the main etiologies as inflammatory, traumatic, obstructive, and vascular conditions. It then discusses specific acute abdominal conditions that present at different ages, including neonatal causes like necrotizing enterocolitis, meconium plugs and atresia. Other causes mentioned include gastroenteritis, intussusceptions, malrotation and tumors. Signs and symptoms as well as approaches to specific conditions like appendicitis, meconium ileus and hypertrophic pyloric stenosis are summarized. Radiological images are also included to illustrate various pathologies.
Gastric volvulus is a twisting of the stomach by at least 180 degrees that causes an obstruction. It is rare in children but can be life-threatening if acute. Chronic volvulus may be more difficult to recognize. Causes include ligament abnormalities or issues with adjacent organs like the diaphragm or transverse colon. The most common pediatric presentation is in a child under 5 with non-bilious vomiting, epigastric distention, and abdominal pain. Diagnosis is made via upper GI imaging and treatment involves surgical repair of defects and fixing the stomach to the abdominal wall, with a mortality rate of around 5% for surgery.
1. The document provides an overview of common pediatric surgical conditions, including congenital diaphragmatic hernia, esophageal atresia with tracheoesophageal fistula, congenital hypertrophic pyloric stenosis, intussusception, Meckel's diverticulum, Hirschsprung disease, and anorectal malformations.
2. It describes the definition, etiology, pathophysiology, clinical presentation, diagnostic workup, and management of each condition. Diagrams and images are provided to illustrate key aspects.
3. The review is intended for 6th year medical students to familiarize them with important pediatric surgical topics.
1) The document describes a case of a 9-day old baby boy presenting with abdominal distention, vomiting of fecal matter, and constipation for 6 days. Examination found the baby to be ill and dehydrated.
2) Operative findings revealed ileal atresia type 3 at the distal ileum. Excision of the blind ends and primary anastomosis was performed.
3) The baby passed stool on the 3rd post-op day and was discharged in good condition on the 30th post-op day with increased weight.
The document discusses various pediatric gastrointestinal disorders including:
1. Duodenal atresia, malrotation with midgut volvulus, jejunal/ileal atresia as causes of intestinal obstruction.
2. Hirschsprung's disease, anorectal malformations, meconium ileus as other causes.
3. Signs, investigations, and management are described for different conditions like biliary atresia.
This document summarizes several common surgical problems in children. It discusses conditions like cleft lip and palate, gastroesophageal reflux disease, infantile hypertrophic pyloric stenosis, and Hirschsprung disease. For each condition, it provides information on incidence, clinical features, investigations, and management. The goal is to provide pediatricians with sound knowledge of these common pediatric surgical issues.
This document discusses acute abdomen in pediatric patients. It defines acute abdomen and provides the main etiologies as inflammatory, traumatic, obstructive, and vascular conditions. It then discusses specific acute abdominal conditions that present at different ages, including neonatal causes like necrotizing enterocolitis, meconium plugs and atresia. Other causes mentioned include gastroenteritis, intussusceptions, malrotation and tumors. Signs and symptoms as well as approaches to specific conditions like appendicitis, meconium ileus and hypertrophic pyloric stenosis are summarized. Radiological images are also included to illustrate various pathologies.
Gastric volvulus is a twisting of the stomach by at least 180 degrees that causes an obstruction. It is rare in children but can be life-threatening if acute. Chronic volvulus may be more difficult to recognize. Causes include ligament abnormalities or issues with adjacent organs like the diaphragm or transverse colon. The most common pediatric presentation is in a child under 5 with non-bilious vomiting, epigastric distention, and abdominal pain. Diagnosis is made via upper GI imaging and treatment involves surgical repair of defects and fixing the stomach to the abdominal wall, with a mortality rate of around 5% for surgery.
This document discusses Hirschsprung's disease, which occurs when ganglion cells are missing from parts of the colon. It has a prevalence of 1 in 5000 live births and is more common in males. The main symptoms are constipation and abdominal distension. Diagnosis involves contrast enema, anorectal manometry, and biopsy/histology of rectal tissue. Treatment is surgical removal of the aganglionic segment and reconnection of the bowel. The document describes various surgical techniques like Swenson and Soave procedures. Overall it provides an overview of the embryology, clinical presentation, diagnostic workup and management of Hirschsprung's disease.
Hirschsprung's disease is a congenital condition caused by the lack of nerve cells in parts of the colon, preventing normal contraction. It is most commonly due to mutations in RET, EDNRB or EDN3 genes. Symptoms include constipation, abdominal distension and vomiting in newborns. Diagnosis involves biopsy and imaging showing dilated bowel above a narrowed transition zone. Treatment is initially with colostomy, then definitive surgery like pull-through procedures to remove the affected bowel segment. Complications can include infection and incontinence.
This document provides an overview of common referrals to pediatric surgery at Kentucky Children's Hospital. It discusses the top 10 most common referrals which include skin and soft tissue infections, hernias, head and neck masses, abdominal pain, pyloric stenosis, and undescended testicles. For each topic, it describes the scope of the problem, presentation, diagnosis, and treatment approaches used by the pediatric surgery specialists at the hospital. The goal is to help identify when a referral to pediatric surgery is appropriate.
Pyloric stenosis is a narrowing of the opening from the stomach to the small intestine caused by thickening of the pyloric muscle. It typically presents in infants as projectile vomiting after feeding. Diagnosis is usually made clinically based on symptoms and feeling an olive-sized mass in the abdomen. Treatment involves initially stabilizing the infant followed by surgery to cut the thickened pyloric muscle. With timely diagnosis and treatment, prognosis is excellent with complete relief of symptoms and normal development. Nurses play an important role in pre and post-operative care including monitoring temperature, IV fluids, pain, and for any surgical complications.
The document provides guidance on evaluating pediatric abdominal pain. It discusses taking a thorough history, including details of the pain and associated symptoms, as well as performing a physical exam. The history should explore timing, location, quality of pain, relieving/aggravating factors, bowel habits, past medical history, and more. The physical exam involves inspection, palpation, percussion, and auscultation of the abdomen as well as a digital rectal exam. Key points are determining if the pain is acute or chronic, whether the abdomen indicates something acute/surgical or benign, and looking for any red flag signs.
Common pediatric surgical conditions 3 Dr Hatem El GoharyHatem Elgohary
Hirschsprung disease is a developmental disorder of the enteric nervous system characterized by the absence of ganglion cells in the distal colon, resulting in functional obstruction. It is caused by congenital aganglionosis of the distal bowel. Diagnosis involves symptoms of delayed meconium passage and chronic constipation, as well as barium enema and rectal biopsy showing aganglionosis. Treatment involves rehydration, colostomy, and resection of the aganglionic segment via procedures like Swenson or Duhamel. Imperforate anus is caused by defects in formation of the posterior urorectal septum. It can be low or high and is sometimes associated with VACTERL
Abdominal pain is a common complaint in pediatrics and can be caused by benign or life-threatening issues. A thorough history and physical exam is important to identify concerning red flags and determine if the pain is acute surgical, visceral, referred, or chronic/recurrent in nature. Based on the location and characteristics of the pain, appropriate lab tests, imaging, and procedures should be considered to arrive at an accurate diagnosis and guide management. Common etiologies include appendicitis, gastroenteritis, constipation, and functional abdominal pain.
This document discusses abdominal pain in pediatric patients. It separates causes into acute vs chronic and organic vs functional. Common acute organic causes include malrotation, intussusception, appendicitis, mesenteric lymphadenitis, and obstructive lesions. Chronic organic causes include IBD, hepatitis, pancreatitis, and urolithiasis. Functional abdominal pain is more common in older children and lacks clear pathology. A thorough history, examination, and testing is needed to identify potential organic causes of abdominal pain in pediatric patients.
1) Acute abdominal pain in children is commonly caused by non-specific abdominal pain, acute appendicitis, constipation, or urinary tract infections. Other potential causes include intestinal obstruction, gastroenteritis, or tropical diseases.
2) Acute appendicitis presents with anorexia, vomiting, central abdominal pain shifting to the right lower quadrant, fever, localized tenderness, and guarding. Ultrasound can show a thickened, edematous appendix. Treatment is resuscitation, antibiotics, and appendicectomy.
3) Intussusception is when one portion of the gut invaginates into an adjacent segment, most commonly the ileum into the colon. It typically affects
Hirschsprung's disease is a congenital disorder where there is an absence of ganglion cells in the distal colon, resulting in functional obstruction. It occurs in around 1 in 5000 live births and is more common in males. The classic presentation is constipation since birth. Diagnosis involves rectal biopsy and anorectal manometry. Treatment is surgical resection of the aganglionic segment and pull-through of the proximal ganglionic colon, with various procedures available. Complications can include infection, bleeding, stricture formation, and enterocolitis.
acute abdominal pain in pediatrics. include background and approach also there are three cases included, intussusception, Hirschsprung's disease and DKA.
This document discusses various gastrointestinal conditions seen in neonates and infants that may require imaging evaluation. It describes the clinical presentations and key radiographic findings of conditions such as esophageal atresia, pyloric stenosis, intestinal atresias and obstructions, malrotation, intussusception, and Meckel's diverticulum. Imaging modalities discussed include radiography, upper GI studies, ultrasound, CT, and nuclear medicine scans. The document provides an overview of the imaging approach and features that help characterize many common neonatal gastrointestinal pathologies.
Anorectal malformations refer to anomalies of the rectum and anus that have an incidence of approximately 1 in 5000 live births. They can range from a simple imperforate anus to more complex anomalies associated with genitourinary and pelvic organs. Anorectal malformations are frequently associated with other anomalies as well, such as VACTERL. Surgical treatment depends on the specific defect but may include procedures such as posterior sagittal anorectoplasty. Postoperative nursing care focuses on pain management, maintaining appropriate skin care and drainage, and educating parents on ostomy and wound care.
A young infant presented with persistent vomiting and failure to thrive. Imaging showed malrotation of the gut with the superior mesenteric vein lying superior and lateral to the superior mesenteric artery. Further imaging found gastric volvulus, which was corrected surgically. Gastric volvulus can be primary due to laxity of ligaments, or secondary to anatomical abnormalities, and presents as epigastric pain, vomiting, and inability to pass a tube into the stomach.
This document discusses the history, types, diagnosis and management of intussusception. It notes that intussusception occurs most often in children under 2 years old and presents with abdominal pain and vomiting. Ultrasound is the primary diagnostic tool, showing a target or doughnut-shaped mass. Management involves attempting non-operative reduction with hydrostatic or pneumatic enemas under radiologic guidance. Surgery is reserved for failed non-operative reduction or if signs of bowel ischemia are present. Recurrence rates after initial reduction are approximately 5-20%.
This document discusses two conditions that can cause bowel obstruction in children: Intussusception and Hirschsprung's disease. Intussusception occurs when the proximal bowel invaginates into the distal bowel, compressing and blocking it. It typically affects children from 2 months to 2 years and presents with severe abdominal pain, vomiting, and a palpable abdominal mass. Ultrasound can show the "target" or "doughnut sign". Treatment involves air or liquid enemas to try to reduce the intussusception or surgery if complications occur. Hirschsprung's disease is a congenital condition where the large bowel lacks ganglion cells, usually affecting the rectum. It presents in neonates
This document discusses various types of intestinal obstructions in neonates. It describes high intestinal obstructions, which occur proximal to the ileum such as gastric, duodenal or jejunal obstructions. It also describes low intestinal obstructions, which occur distal to the ileum and in the colon. Specific causes of obstruction discussed include duodenal atresia, intestinal malrotation, necrotizing enterocolitis, meconium ileus and Hirschsprung's disease. Diagnosis involves abdominal x-rays and contrast studies to identify the location and cause of obstruction.
This document discusses obstetrics and gynecology articles related to massive vaginal vault prolapse and enterocele. It provides definitions and descriptions of pelvic organ prolapse, including its causes, symptoms, diagnosis, and treatment. Pelvic organ prolapse is defined as the descent of the anterior vaginal wall, posterior vaginal wall, uterus, or vaginal vault. Causes can include childbirth injuries or surgery that damage pelvic floor muscles and nerves. Symptoms vary but may include a feeling of pressure or fullness in the pelvis. Diagnosis involves examination and sometimes tests like ultrasound or manometry. Treatment aims to regulate bowel movements and strengthen pelvic floor muscles through exercises or devices.
This document discusses congenital inguinal hernia and hydrocele. It notes that a congenital inguinal hernia occurs when the processus vaginalis fails to close after testicular descent in fetal development, allowing abdominal contents to enter the scrotum. It has a high rate in premature infants and is more common in males. A hydrocele occurs when the processus vaginalis remains fluid-filled but no abdominal contents enter. Both often resolve spontaneously in infants but may require surgery if persisting past 2 years. The hernia repair procedure involves high ligation of the hernia sac at the internal ring through an inguinal incision.
This document presents a case study on tracheoesophageal fistula (TEF). It begins with an introduction stating that TEF is a congenital abnormal connection between the trachea and esophagus. It is often diagnosed at birth and can cause life-threatening complications. The document then defines TEF and provides information on incidence, etiology, pathophysiology, signs and symptoms, diagnosis, management including pharmacologic and surgical approaches, nursing diagnoses, and complications. It aims to inform on the nature, causes, and treatment of TEF.
Oleh discusses imaging techniques for evaluating abdominal trauma in children. Key points include:
1. Computed tomography (CT) is the imaging method of choice for abdominal trauma due to its ability to detect injuries to solid organs and cavities. Sonography can also detect free fluid but has limitations.
2. Common injuries seen in children include liver lacerations and hematomas, splenic injuries like lacerations and fragmentation, and renal injuries such as contusions, lacerations, and hematomas.
3. Injuries are graded based on severity using standardized scales to determine need for intervention. Close monitoring is important as some injuries like smaller liver hematomas may resolve without surgery.
This document discusses Hirschsprung's disease, which occurs when ganglion cells are missing from parts of the colon. It has a prevalence of 1 in 5000 live births and is more common in males. The main symptoms are constipation and abdominal distension. Diagnosis involves contrast enema, anorectal manometry, and biopsy/histology of rectal tissue. Treatment is surgical removal of the aganglionic segment and reconnection of the bowel. The document describes various surgical techniques like Swenson and Soave procedures. Overall it provides an overview of the embryology, clinical presentation, diagnostic workup and management of Hirschsprung's disease.
Hirschsprung's disease is a congenital condition caused by the lack of nerve cells in parts of the colon, preventing normal contraction. It is most commonly due to mutations in RET, EDNRB or EDN3 genes. Symptoms include constipation, abdominal distension and vomiting in newborns. Diagnosis involves biopsy and imaging showing dilated bowel above a narrowed transition zone. Treatment is initially with colostomy, then definitive surgery like pull-through procedures to remove the affected bowel segment. Complications can include infection and incontinence.
This document provides an overview of common referrals to pediatric surgery at Kentucky Children's Hospital. It discusses the top 10 most common referrals which include skin and soft tissue infections, hernias, head and neck masses, abdominal pain, pyloric stenosis, and undescended testicles. For each topic, it describes the scope of the problem, presentation, diagnosis, and treatment approaches used by the pediatric surgery specialists at the hospital. The goal is to help identify when a referral to pediatric surgery is appropriate.
Pyloric stenosis is a narrowing of the opening from the stomach to the small intestine caused by thickening of the pyloric muscle. It typically presents in infants as projectile vomiting after feeding. Diagnosis is usually made clinically based on symptoms and feeling an olive-sized mass in the abdomen. Treatment involves initially stabilizing the infant followed by surgery to cut the thickened pyloric muscle. With timely diagnosis and treatment, prognosis is excellent with complete relief of symptoms and normal development. Nurses play an important role in pre and post-operative care including monitoring temperature, IV fluids, pain, and for any surgical complications.
The document provides guidance on evaluating pediatric abdominal pain. It discusses taking a thorough history, including details of the pain and associated symptoms, as well as performing a physical exam. The history should explore timing, location, quality of pain, relieving/aggravating factors, bowel habits, past medical history, and more. The physical exam involves inspection, palpation, percussion, and auscultation of the abdomen as well as a digital rectal exam. Key points are determining if the pain is acute or chronic, whether the abdomen indicates something acute/surgical or benign, and looking for any red flag signs.
Common pediatric surgical conditions 3 Dr Hatem El GoharyHatem Elgohary
Hirschsprung disease is a developmental disorder of the enteric nervous system characterized by the absence of ganglion cells in the distal colon, resulting in functional obstruction. It is caused by congenital aganglionosis of the distal bowel. Diagnosis involves symptoms of delayed meconium passage and chronic constipation, as well as barium enema and rectal biopsy showing aganglionosis. Treatment involves rehydration, colostomy, and resection of the aganglionic segment via procedures like Swenson or Duhamel. Imperforate anus is caused by defects in formation of the posterior urorectal septum. It can be low or high and is sometimes associated with VACTERL
Abdominal pain is a common complaint in pediatrics and can be caused by benign or life-threatening issues. A thorough history and physical exam is important to identify concerning red flags and determine if the pain is acute surgical, visceral, referred, or chronic/recurrent in nature. Based on the location and characteristics of the pain, appropriate lab tests, imaging, and procedures should be considered to arrive at an accurate diagnosis and guide management. Common etiologies include appendicitis, gastroenteritis, constipation, and functional abdominal pain.
This document discusses abdominal pain in pediatric patients. It separates causes into acute vs chronic and organic vs functional. Common acute organic causes include malrotation, intussusception, appendicitis, mesenteric lymphadenitis, and obstructive lesions. Chronic organic causes include IBD, hepatitis, pancreatitis, and urolithiasis. Functional abdominal pain is more common in older children and lacks clear pathology. A thorough history, examination, and testing is needed to identify potential organic causes of abdominal pain in pediatric patients.
1) Acute abdominal pain in children is commonly caused by non-specific abdominal pain, acute appendicitis, constipation, or urinary tract infections. Other potential causes include intestinal obstruction, gastroenteritis, or tropical diseases.
2) Acute appendicitis presents with anorexia, vomiting, central abdominal pain shifting to the right lower quadrant, fever, localized tenderness, and guarding. Ultrasound can show a thickened, edematous appendix. Treatment is resuscitation, antibiotics, and appendicectomy.
3) Intussusception is when one portion of the gut invaginates into an adjacent segment, most commonly the ileum into the colon. It typically affects
Hirschsprung's disease is a congenital disorder where there is an absence of ganglion cells in the distal colon, resulting in functional obstruction. It occurs in around 1 in 5000 live births and is more common in males. The classic presentation is constipation since birth. Diagnosis involves rectal biopsy and anorectal manometry. Treatment is surgical resection of the aganglionic segment and pull-through of the proximal ganglionic colon, with various procedures available. Complications can include infection, bleeding, stricture formation, and enterocolitis.
acute abdominal pain in pediatrics. include background and approach also there are three cases included, intussusception, Hirschsprung's disease and DKA.
This document discusses various gastrointestinal conditions seen in neonates and infants that may require imaging evaluation. It describes the clinical presentations and key radiographic findings of conditions such as esophageal atresia, pyloric stenosis, intestinal atresias and obstructions, malrotation, intussusception, and Meckel's diverticulum. Imaging modalities discussed include radiography, upper GI studies, ultrasound, CT, and nuclear medicine scans. The document provides an overview of the imaging approach and features that help characterize many common neonatal gastrointestinal pathologies.
Anorectal malformations refer to anomalies of the rectum and anus that have an incidence of approximately 1 in 5000 live births. They can range from a simple imperforate anus to more complex anomalies associated with genitourinary and pelvic organs. Anorectal malformations are frequently associated with other anomalies as well, such as VACTERL. Surgical treatment depends on the specific defect but may include procedures such as posterior sagittal anorectoplasty. Postoperative nursing care focuses on pain management, maintaining appropriate skin care and drainage, and educating parents on ostomy and wound care.
A young infant presented with persistent vomiting and failure to thrive. Imaging showed malrotation of the gut with the superior mesenteric vein lying superior and lateral to the superior mesenteric artery. Further imaging found gastric volvulus, which was corrected surgically. Gastric volvulus can be primary due to laxity of ligaments, or secondary to anatomical abnormalities, and presents as epigastric pain, vomiting, and inability to pass a tube into the stomach.
This document discusses the history, types, diagnosis and management of intussusception. It notes that intussusception occurs most often in children under 2 years old and presents with abdominal pain and vomiting. Ultrasound is the primary diagnostic tool, showing a target or doughnut-shaped mass. Management involves attempting non-operative reduction with hydrostatic or pneumatic enemas under radiologic guidance. Surgery is reserved for failed non-operative reduction or if signs of bowel ischemia are present. Recurrence rates after initial reduction are approximately 5-20%.
This document discusses two conditions that can cause bowel obstruction in children: Intussusception and Hirschsprung's disease. Intussusception occurs when the proximal bowel invaginates into the distal bowel, compressing and blocking it. It typically affects children from 2 months to 2 years and presents with severe abdominal pain, vomiting, and a palpable abdominal mass. Ultrasound can show the "target" or "doughnut sign". Treatment involves air or liquid enemas to try to reduce the intussusception or surgery if complications occur. Hirschsprung's disease is a congenital condition where the large bowel lacks ganglion cells, usually affecting the rectum. It presents in neonates
This document discusses various types of intestinal obstructions in neonates. It describes high intestinal obstructions, which occur proximal to the ileum such as gastric, duodenal or jejunal obstructions. It also describes low intestinal obstructions, which occur distal to the ileum and in the colon. Specific causes of obstruction discussed include duodenal atresia, intestinal malrotation, necrotizing enterocolitis, meconium ileus and Hirschsprung's disease. Diagnosis involves abdominal x-rays and contrast studies to identify the location and cause of obstruction.
This document discusses obstetrics and gynecology articles related to massive vaginal vault prolapse and enterocele. It provides definitions and descriptions of pelvic organ prolapse, including its causes, symptoms, diagnosis, and treatment. Pelvic organ prolapse is defined as the descent of the anterior vaginal wall, posterior vaginal wall, uterus, or vaginal vault. Causes can include childbirth injuries or surgery that damage pelvic floor muscles and nerves. Symptoms vary but may include a feeling of pressure or fullness in the pelvis. Diagnosis involves examination and sometimes tests like ultrasound or manometry. Treatment aims to regulate bowel movements and strengthen pelvic floor muscles through exercises or devices.
This document discusses congenital inguinal hernia and hydrocele. It notes that a congenital inguinal hernia occurs when the processus vaginalis fails to close after testicular descent in fetal development, allowing abdominal contents to enter the scrotum. It has a high rate in premature infants and is more common in males. A hydrocele occurs when the processus vaginalis remains fluid-filled but no abdominal contents enter. Both often resolve spontaneously in infants but may require surgery if persisting past 2 years. The hernia repair procedure involves high ligation of the hernia sac at the internal ring through an inguinal incision.
This document presents a case study on tracheoesophageal fistula (TEF). It begins with an introduction stating that TEF is a congenital abnormal connection between the trachea and esophagus. It is often diagnosed at birth and can cause life-threatening complications. The document then defines TEF and provides information on incidence, etiology, pathophysiology, signs and symptoms, diagnosis, management including pharmacologic and surgical approaches, nursing diagnoses, and complications. It aims to inform on the nature, causes, and treatment of TEF.
Oleh discusses imaging techniques for evaluating abdominal trauma in children. Key points include:
1. Computed tomography (CT) is the imaging method of choice for abdominal trauma due to its ability to detect injuries to solid organs and cavities. Sonography can also detect free fluid but has limitations.
2. Common injuries seen in children include liver lacerations and hematomas, splenic injuries like lacerations and fragmentation, and renal injuries such as contusions, lacerations, and hematomas.
3. Injuries are graded based on severity using standardized scales to determine need for intervention. Close monitoring is important as some injuries like smaller liver hematomas may resolve without surgery.
This document provides an overview of imaging for abdominal trauma. It summarizes that FAST has high sensitivity for detecting free fluid but lower sensitivity for organ injuries compared to CT. CT is nearly 100% accurate for detecting hemoperitoneum and organ injuries and can help guide management. The document recommends performing FAST first in hemodynamically unstable patients and CT in stable patients, with CT also indicated for penetrating injuries to the back/flank and potentially the anterior abdomen.
Role of mdct in blunt abdominal trauma Dr. Muhammad Bin Zulfiqar
Briefly Describes the role of Ct in Diagnosis of Blunt Abdominal trauma.
Major organs injuries are discussed
This document discusses imaging in abdominal trauma. It begins by outlining the mechanisms and types of abdominal injuries from blunt and penetrating trauma. It then describes the FAST (Focused Assessment with Sonography for Trauma) exam and its role in the initial assessment of hemodynamically unstable patients. For stable patients, CT is typically used to further evaluate injuries suggested on clinical exam or FAST. The document outlines key CT findings for various intra-abdominal injuries and hemorrhage.
1) Tumors of the central nervous system (CNS) can be classified based on the cell type they arise from, including glial cells, neurons, meninges, and other tissues.
2) The most common CNS tumors include gliomas such as astrocytomas, oligodendrogliomas, and ependymomas. Astrocytomas are further classified based on grade from pilocytic astrocytoma to glioblastoma.
3) CNS tumor characteristics vary based on histology, location in the brain or spine, patient age, and other factors. Malignant tumors tend to grow quickly and infiltrate surrounding brain tissue, while benign tumors are often slow
This document provides information on bone tumors, including their classification, locations, and radiographic features. It discusses benign bone forming tumors like bone islands and osteoblastomas. It also covers cartilage forming tumors such as enchondromas and osteochondromas, as well as fibrous lesions including fibrous dysplasia. Malignant tumors described include osteosarcoma, chondrosarcoma, and malignant fibrous histiocytoma. For each tumor type, the document provides details on incidence, anatomical distribution, and characteristic imaging appearance to aid in diagnosis.
The document provides information about FAST (Focused Assessment with Sonography in Trauma) scans. It begins with an overview of what a FAST scan is used for - to identify fluid in the abdomen or pelvis where it is not normally found, which can indicate injury. It then details the anatomy visualized in a standard FAST scan and describes the technique. Examples are provided of free fluid appearing in different locations like Morrison's pouch or the pelvis. The document discusses interpreting FAST scans and explores limitations and advantages of the procedure. In under 3 sentences, the document provides an overview of the FAST scan for trauma patients to quickly identify free fluid that could indicate internal injury.
The document discusses bone tumors. It begins by stating that the most common bone tumor is secondary tumors from other sites, while the most common primary bone tumor is multiple myeloma. It then covers the WHO classification of bone tumors including bone-forming, cartilage-forming, marrow, vascular, and other tumors. Diagnosis involves clinical examination, imaging like radiographs, CT, MRI and bone scans, as well as laboratory tests and biopsy. Staging is discussed including the Enneking system based on aggressiveness and spread. Management depends on staging and includes wide excision for low grade lesions and more radical resection or palliative treatment for high grade or metastatic tumors.
Gastro-oesophageal reflux disease is caused by abnormal reflux of gastric contents into the oesophagus, affecting approximately 30% of the population. It develops when the oesophageal mucosa is exposed to gastric contents for prolonged periods, resulting in symptoms like heartburn and regurgitation. Key factors include abnormalities of the lower oesophageal sphincter that permit reflux, such as reduced tone or inappropriate relaxation, as well as hiatus hernia. Complications may include oesophagitis, Barrett's oesophagus which is a pre-malignant condition, benign strictures, and iron-deficiency anaemia. Investigation involves endoscopy to diagnose and exclude complications, while management focuses
The document describes the normal anatomy and physiology of the esophagus. It discusses various esophageal disorders including dysphagia, heartburn, esophagitis, gastroesophageal reflux disease, achalasia, hiatal hernia, Barrett's esophagus, esophageal varices, and esophageal tumors. The esophagus is a muscular tube that connects the pharynx to the stomach. It has an upper and lower sphincter and consists of mucosa, submucosa, muscle and adventitia layers. Disorders can involve problems with motor function, luminal narrowing or inflammation.
This document provides information on performing a physical examination of the gastrointestinal (GI) system. It discusses collecting a history related to nutrition, swallowing, the upper GI tract, digestion, and elimination. The physical exam involves inspection, auscultation, percussion, and palpation of the abdomen to examine the liver, spleen, masses, tenderness and other structures and functions. Key steps and findings of the exam are outlined.
This document discusses intestinal obstruction, including its causes, classifications, symptoms, diagnosis and treatment. Some key points:
- Intestinal obstruction can be caused by adhesions, hernias, tumors, strictures and more. It is classified by the obstructed site and presence of blood flow issues.
- Symptoms include pain, vomiting, constipation and distension. Signs depend on obstruction location and duration. Strangulated obstructions require urgent surgery to prevent tissue death.
- Diagnosis involves medical history, physical exam, imaging like x-rays and CT scans. Treatment involves resuscitation, nasogastric drainage, and surgery to relieve the obstruction and address the underlying cause. S
1. Acute appendicitis is a common condition that usually presents with abdominal pain that starts around the navel and shifts to the lower right abdomen. Other common symptoms include anorexia, nausea, and vomiting.
2. A clinical examination often reveals tenderness at McBurney's point with guarding and rebound tenderness. Special tests like Rovsing's sign may also indicate appendicitis. Differential diagnoses include other abdominal conditions.
3. The diagnosis is usually made based on history and clinical exam findings. Laboratory tests are not usually required but may include a CBC and urinalysis. Imaging tests like ultrasound or CT scans can help in unclear cases. Prompt diagnosis and treatment is important to
Presented on 10th DANUBE SYMPOSIUM PEDIATRIC SURGERY November 26–28, 2010 VIENNA, AUSTRIA
Background
Acquired shortening of the esophagus may occurs in children with mistreated gastroesophageal reflux which results in a profound inflammatory reaction with subsequent fibrosis and significant cephalad displacement of the cardia. Our purpose is to discuss the pathogenesis of the short esophagus, to review the history of treatment and to present our own experience in open surgical procedures.
Methods
For a period of 20 years (1990 - 2009) 171 children were operated on: 138 for GERD, 12 for congenital hiatus hernia and 21 for secondary reflux following the prolonged dilatation treatment for lye stricture. In 27 children we diagnosed a secondary short esophagus.
According to K.Horvath we divide our cases as follow: 1.True, nonreducible short esophagus (3) 2. True but reducible short esophagus (mistreated GERD – 11, lye stricture – 7) 3.Apparent short esophagus (6).
Results
Standart Nissen fundoplication was performed in 21 cases. In order to ensure a longer intraabdominal esophageal portion we adapt the transthoracic procedure of Merendino. After deep mediastinal dissection of the esophagus we incise the hiatus arch about 3 cm and positioned the esophagus anteriorly.
In three cases the standard laparotomy was converted in a thoraco-laparotomy because of severe changes in the distal esophagus and an intrathoracic Nissen procedure was accomplished. In two cases we performed a transthoracic fundoplication. In one case the uncut Collis gastroplasty was applied.
There was no postoperative death. Additionally four children with lye stricture required a second stage colon replacement due to irreversible changes.
Conclusions
In our series the incidence of the short esophagus represent 15,8 % of patients undergoing antireflux surgery. Most of them can be appropriately managed with extensive mediastinal mobilization of the esophagus to achieve the required intraabdominal esophageal length to perform a wrap. The remaining require different aggressive surgical approaches to create an adequate antireflux valve mechanism at the gastro-esophageal junction.
This document discusses various esophageal disorders including structural disorders like hiatal hernia and rings, motility disorders like achalasia, and conditions caused by reflux like GERD and Barrett's esophagus. It provides details on the causes, symptoms, diagnoses and treatments of these common esophageal problems.
1. The document discusses the evaluation and management of various gastrointestinal disorders in children including abdominal pain, vomiting, diarrhea, constipation, and other issues.
2. Key points include recognizing signs and symptoms of conditions like appendicitis, intussusception, Hirschsprung's disease, gastroesophageal reflux, and infectious causes of diarrhea.
3. Management involves considering differential diagnoses, performing appropriate testing, and treating underlying causes or symptoms while monitoring for complications.
Presentation main surgery 123456nhnhnhnahkoHardikSiwach1
1. The document describes various abnormalities or anomalies of the oesophagus known as "bizarre oesophagus". These include conditions like esophageal webs, rings, diverticula, achalasia, and Barrett's esophagus.
2. Esophageal webs are thin membranes in the esophagus that cause narrowing and difficulty swallowing. Achalasia is a condition where the lower esophageal sphincter fails to relax properly, causing difficulty swallowing and food regurgitation.
3. The document provides details on the symptoms, diagnosis, and treatment of these different conditions of the bizarre oesophagus.
This document discusses esophageal motility disorders. It begins with the anatomy of the esophagus, including its three parts (cervical, thoracic, abdominal) and normal narrowings. It then covers the physiology of peristalsis and swallowing. The main types of esophageal motility disorders are described - achalasia (failure of LES to relax), spastic disorders like DES and nutcracker esophagus, and presbyoesophagus in elderly patients. Diagnostic tests like manometry and scintigraphy transit tests are also summarized.
This document discusses the anatomy, embryology, classification, pathophysiology, clinical features, diagnosis, and management of esophageal atresia with tracheo-esophageal fistula (TEF). It notes that TEF occurs due to incomplete separation of the foregut during embryological development. The classification system describes the different types of atresia and fistula presentations. Surgical repair aims to divide the fistula and perform an end-to-end anastomosis of the esophageal pouches. Long-term complications can include tracheomalacia, gastroesophageal reflux, and swallowing and motility issues.
This document discusses the anatomy, embryology, classification, clinical features, diagnosis, and management of esophageal atresia with tracheo-esophageal fistula (TEF). Key points include:
1) TEF results from incomplete separation of the foregut from the laryngotracheal groove during embryological development.
2) There are various classifications of TEF including the Vogt and Gross system. Type C, with upper pouch atresia and lower pouch fistula, accounts for 85% of cases.
3) Clinical features include frothing at the mouth, choking, and cyanosis with feeding. Diagnosis is made with chest x-rays and es
Mallory-Weiss syndrome and corrosive injury are caused by vomiting and corrosive ingestion respectively, leading to tears in the gastric mucosa or esophagus. GERD is caused by reflux of gastric acid into the esophagus due to incompetence of the lower esophageal sphincter, resulting in inflammation and ulcers. Hiatal hernia is a protrusion of the stomach through the esophageal hiatus that can cause reflux. Barret's esophagus is a complication of longstanding GERD where the esophageal mucosa is replaced by intestinal metaplasia, increasing the risk of esophageal adenocarcinoma.
This document defines peptic ulcer disease and provides information on its epidemiology, etiology, pathophysiology, clinical features, investigations, management, and H. pylori eradication. Peptic ulcer disease is defined as a disruption of the stomach or duodenal mucosa caused by an imbalance between defensive and aggressive luminal factors. Key points include that H. pylori infection is the primary cause in most cases, NSAIDs can also cause ulcers, and eradicating H. pylori is the cornerstone of long-term management to prevent relapse.
This document provides information about pancreatitis, including its definition, causes, symptoms, diagnosis, and treatment. It defines pancreatitis as an inflammatory disease of the pancreas that can be acute or chronic. Acute pancreatitis involves sudden inflammation while chronic pancreatitis is a long-lasting condition characterized by progressive fibrosis of the pancreas. Common causes include alcohol use, gallstones, trauma, and certain medications. Symptoms include abdominal pain, nausea, vomiting, and digestive issues. Diagnosis involves blood tests, imaging like ultrasound or CT, and other procedures. Treatment focuses on pain management, a low-fat diet, pancreatic enzyme supplements, and drugs to reduce secretion and inflammation.
1. The document discusses common mistakes that can occur during upper gastrointestinal endoscopy and how to avoid them. It describes mistakes like missing Cameron ulcers, Dieulafoy lesions, eosinophilic esophagitis, long segment Barrett's esophagus, and confusion between portal hypertensive gastropathy and gastric antral vascular ectasia.
2. Key recommendations include paying close attention to the cardia region in patients with large hiatal hernias, performing urgent endoscopy in cases of new bleeding, asking patients to cough to induce bleeding from possible Dieulafoy lesions, taking multiple biopsies to diagnose eosinophilic esophagitis, and actively searching for the Z-line in cases
Seminar presentation by 5th year Medical Student under the supervision of a pediatric surgery specialist from HRPZ II. Reference as mentioned in the slide.
This document discusses the use of abdominal x-rays in pediatrics. It notes that radiation exposure from medical imaging increases cancer risk in children. Common views used in abdominal x-rays are described along with how to interpret bowel gas patterns, signs of obstruction, pneumoperitoneum, constipation and foreign bodies. Examples of clinical cases are provided to demonstrate different pathologies seen on abdominal x-rays such as bowel obstruction, hernias, perforation and hypertrophic pyloric stenosis. The importance of accurate imaging for diagnosis is emphasized.
This document discusses the examination of a case of dysphagia. It covers taking a thorough history, including details on age, sex, symptoms, and past medical history. A physical examination focuses on the mouth, neck, chest, abdomen, and spine. Special investigations like barium swallow, endoscopy, and manometry help identify potential causes, which can include issues in the mouth, pharynx, or esophagus, such as tumors, strictures, or hiatal hernias. Differential diagnosis considers various conditions that may be causing the dysphagia.
all about behecets syndrome in detail elabortedBosan Khalid
X-RAY LEFT MASTOIDS
• Partial loss of left mastoid pneumatisation likely due to mastoiditis. . No evidence of sclerosis noted on left side.
• Visualized skull vault is normal with no evidence of any trauma or bone lesion.
SUGGESTS:
• Partial loss of left mastoid pneumatisation likely due to mastoiditis. . No evidence of sclerosis noted on left side.
all about online securtity and measures ppt.pptxBosan Khalid
Online safety refers to policies and practices that protect people from harm caused by technology and the internet. There are several types of dangers people face online like invasion of privacy, exposure to inappropriate content, identity theft, and viruses or spyware. To ensure online safety, people should take precautions with their personal information, use antivirus software, and be aware of what they access online.
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2. SLE most commonly affects women of childbearing age and has a variety of clinical manifestations involving the skin, joints, kidneys, and other organ systems.
3. Diagnosis involves assessing clinical signs and symptoms along with serological tests like ANA and anti-DNA antibodies. Disease activity and organ involvement help guide treatment approaches.
sle ins and outs elaborated in detail explainedBosan Khalid
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organ systems. It is characterized by periods of disease exacerbation and remission. Common symptoms include skin rashes, joint pain, fatigue, and kidney problems. SLE results from genetic and environmental factors that cause the immune system to produce antibodies that attack the body's own tissues and organs. Treatment involves managing symptoms with medications like corticosteroids, immunosuppressants, and biologic therapies to control disease activity and prevent organ damage. Nursing care focuses on education, symptom management, preventing exacerbations, and addressing the psychosocial issues patients often experience.
rheumatoid arthritis details ins and outsBosan Khalid
Rheumatoid arthritis is a chronic inflammatory joint disease that commonly causes pain, stiffness, swelling, and limitation of motion in the joints. It occurs when the immune system mistakenly attacks the joints, causing inflammation and damage over time. If not managed properly, it can lead to joint deformity and disability. Treatment aims to reduce inflammation and pain, prevent further joint damage, and improve quality of life through a combination of medications, surgery, exercise and assistive devices.
ALL ABOUT DETALED DESCRIPTION Parapharyngeal-spaces.pptxBosan Khalid
The document discusses the parapharyngeal space, which is the fat-filled triangular space lateral to the pharynx extending from the skull base to the oropharynx. It contains fat, arteries, veins and nerves. Imaging of the space involves CT and MRI using axial and coronal planes to evaluate for pathology. Common pathologies discussed include nasopharyngeal carcinoma, lymphomas, angiofibromas, glomus tumors and metastatic diseases.
research methodology all about deatails and descriptionBosan Khalid
This document provides an introduction to research methodology. It discusses what research is, including that it involves systematically investigating facts through defining problems, formulating hypotheses, collecting and analyzing data, making deductions, and testing conclusions. Reasons for doing research include desires for career advancement, intellectual challenge, and helping society. Key aspects of research design are outlined, such as specifying relevant information sources and determining data collection and analysis strategies. Characteristics of good research like being systematic, logical, empirical, objective, and replicable are also described. The document outlines steps in conducting research like choosing topics, literature reviews, defining objectives, experiments, analysis, and reporting. Different types of research are defined.
The document discusses the approach to mammogram interpretation. It covers breast anatomy, zonal anatomy, BI-RADS breast composition categories, and key mammographic findings including masses, calcifications, asymmetries, lymph nodes, densities, architectural distortions and associated findings. Mammographic findings are characterized based on morphology, distribution and other features, and an assessment of likelihood of malignancy is provided. The importance of synthesizing all findings to provide an overall final assessment is emphasized.
This document discusses the evaluation of mediastinal masses. It begins by describing the anatomy of the mediastinum, which is divided into anterior, middle, and posterior compartments. The differential diagnosis of a mediastinal mass depends on which compartment it arises in. Common mass types are then reviewed for each compartment. Imaging studies like CT are important for evaluating the mass, and biopsy or surgery may be needed for diagnosis or treatment. The management approach depends on the specific diagnosis and characteristics of the mass.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
3. Case 1
••Dilatation of the oesophagusDilatation of the oesophagus
with a smooth narrowing of itswith a smooth narrowing of its
lower end.lower end.
••The large volume of containedThe large volume of contained
fluid indicates delayedfluid indicates delayed
emptying.emptying.
••The appearance of the lowerThe appearance of the lower
oesophagus resembles the tail ofoesophagus resembles the tail of
a rat or a long curved beak of aa rat or a long curved beak of a
bird.bird.
4. Case 2
Incidental finding in aIncidental finding in a
young woman underyoung woman under
investigation forinvestigation for
dyspepsia.dyspepsia.
5. Case 2
The stomach and duodenalThe stomach and duodenal
cap are under filled.cap are under filled.
The bowel lies on the rightThe bowel lies on the right
side, but is otherwiseside, but is otherwise
normal.normal.
Instead of winding aroundInstead of winding around
the head of the pancreas tothe head of the pancreas to
the normal site of thethe normal site of the
duodenoduodeno--jejunal flexurejejunal flexure
on the upper left margin ofon the upper left margin of
the second lumbarthe second lumbar
vertebra, the bowel lies invertebra, the bowel lies in
the right parathe right para--colic gutter.colic gutter.
There is no extrinsicThere is no extrinsic
impression or obstructionimpression or obstruction..
6. Case 3
Adult male with abdominalAdult male with abdominal
pain and sudden recentpain and sudden recent
change in bowel habit.change in bowel habit.
7. The erect plain view shows aThe erect plain view shows a
thick line of gas marking thethick line of gas marking the
irregular narrowing of theirregular narrowing of the
splenic flexure andsplenic flexure and
descending colon.descending colon.
The extreme length ofThe extreme length of
involved bowel implies localinvolved bowel implies local
lack of peristaltic activity.lack of peristaltic activity.
9. Achalasia
= failure of organised peristalsis and relaxation at the level o= failure of organised peristalsis and relaxation at the level of the lower oesophagealf the lower oesophageal
sphincter.sphincter.
Cause unknown, however histology demonstrates degeneration of thCause unknown, however histology demonstrates degeneration of the myenteric plexus ine myenteric plexus in
the region of the gastrothe region of the gastro--oesophageal junction (GOJ). The end result is failure of relaxaoesophageal junction (GOJ). The end result is failure of relaxationtion
of the GOJ. Association with Chagas disease.of the GOJ. Association with Chagas disease.
1 in 100,000 people.1 in 100,000 people.
Can affect all age groups.Can affect all age groups.
Presentation: insidious, increasing dysphagia, repeated attackPresentation: insidious, increasing dysphagia, repeated attacks of aspiration pneumonia ares of aspiration pneumonia are
common.common.
Long standing disease of more than 20 yearsLong standing disease of more than 20 years –– SCC due to the degree of oesophagealSCC due to the degree of oesophageal
obstruction and thus stasis.obstruction and thus stasis.
10. BARIUM STUDIES
Early changes: defective distal peristalsis associated with sliEarly changes: defective distal peristalsis associated with slight narrowing of GOJght narrowing of GOJ
Disease progresses: characteristic birdDisease progresses: characteristic bird--beak/rattail appearance of GOJ. Body of thebeak/rattail appearance of GOJ. Body of the
oesophagus slightly dilated and aperistalsisoesophagus slightly dilated and aperistalsis
Severe achalasia: dilatation of the oesophagus containing residuSevere achalasia: dilatation of the oesophagus containing residue of food and food debrise of food and food debris
CXR
right convex opacity behind the right heart borderright convex opacity behind the right heart border
air filled fluid level at the level of the aortic arch or aboveair filled fluid level at the level of the aortic arch or above
small/absent gastric air bubble patchy bilateral alveolar opacitsmall/absent gastric air bubble patchy bilateral alveolar opacitiesies -- acute chronic aspirationacute chronic aspiration
pneumoniapneumonia
lateral viewlateral view –– anterior displacement and bowing of the tracheaanterior displacement and bowing of the trachea
TREATMENTTREATMENT
Pneumatic dilatation or surgical myotomy.Pneumatic dilatation or surgical myotomy.
DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS
1.1. Neoplasm (separation of the gastric fundus from the diaphragm, nNeoplasm (separation of the gastric fundus from the diaphragm, normal peristalsis andormal peristalsis and
asymmetric tapering).asymmetric tapering).
2.2. Peptic stricture of the oesophagus.Peptic stricture of the oesophagus.
11. Oesophageal CarcinomaOesophageal Carcinoma
Clinical presentation:Clinical presentation:
Mature adult female with dysphagia andMature adult female with dysphagia and
weight loss.weight loss.
There is an irregular narrowing withThere is an irregular narrowing with
an "apple core" appearance and aan "apple core" appearance and a
neighbouring soft tissue mass of theneighbouring soft tissue mass of the
midmid--oesophagus.oesophagus.
The lumen is narrowed by irregularThe lumen is narrowed by irregular
thickening of the wall with lobulationthickening of the wall with lobulation
and fissures.and fissures.
The abnormal area forms an acuteThe abnormal area forms an acute
angle with normal mucosa inferiorly,angle with normal mucosa inferiorly,
indicating mucosal thickening.indicating mucosal thickening.
12. Small Bowel Malrotation
Malrotation of the intestine occurs when the normal embryologicMalrotation of the intestine occurs when the normal embryologic sequence of bowelsequence of bowel
development and fixation is interrupted and there is incompletedevelopment and fixation is interrupted and there is incomplete rotation of therotation of the
intestine (<270° of antiintestine (<270° of anti--clockwise rotation).clockwise rotation).
Development of the human gut takes place during the first monthsDevelopment of the human gut takes place during the first months of fetal life.of fetal life.
Normal embryosNormal embryos -- physiological herniation of the gut through the umbilicus at 6physiological herniation of the gut through the umbilicus at 6
weeks’ gestation + a 270° antiweeks’ gestation + a 270° anti--clockwise rotation of the developing intestine aroundclockwise rotation of the developing intestine around
the superior mesenteric artery (SMA).the superior mesenteric artery (SMA).
1010--12 weeks, the intestine returns to the abdomen and assumes its n12 weeks, the intestine returns to the abdomen and assumes its normal adultormal adult
anatomic position.anatomic position.
Normal small bowel mesentery has a broad attachment stretching dNormal small bowel mesentery has a broad attachment stretching diagonally fromiagonally from
the duodenojejunal junction (ligament of Treitz) in the left uppthe duodenojejunal junction (ligament of Treitz) in the left upper quadrant, to theer quadrant, to the
cecum, in the right lower quadrant.cecum, in the right lower quadrant.
13. Malrotation disorders can be divided into 3 categories:Malrotation disorders can be divided into 3 categories:
NONNON--ROTATIONROTATION -- 0° to 90° of anti0° to 90° of anti--clockwise rotation, occurring before 6 weeksclockwise rotation, occurring before 6 weeks
REVERSE ROTATIONREVERSE ROTATION -- abnormal rotation between 90° and 180°, causingabnormal rotation between 90° and 180°, causing
obstruction or reversal of the normal duodenal/SMA relationship,obstruction or reversal of the normal duodenal/SMA relationship, occurring inoccurring in
weeks 6weeks 6--1010
MALROTATION most often associated with malfixation, between 180°MALROTATION most often associated with malfixation, between 180° and 270°and 270°
of antiof anti--clockwise rotation, occurring after 10 weeksclockwise rotation, occurring after 10 weeks
ANATOMYANATOMY
The DJF is low and to the right of the normal location.The DJF is low and to the right of the normal location.
The proximal small bowel (jejunum) is in the right upper quadranThe proximal small bowel (jejunum) is in the right upper quadrant.t.
The cecum is in the upper and/or left abdomen.The cecum is in the upper and/or left abdomen.
The large bowel is in the left abdomen.The large bowel is in the left abdomen.
14. FREQUENCYFREQUENCY
1 in 500 live births (actual frequency of malrotation is unknow1 in 500 live births (actual frequency of malrotation is unknown because manyn because many
asymptomatic patients never present)asymptomatic patients never present)
No racial or gender predilectionNo racial or gender predilection
AGEAGE
60% of patients presents by 1 month of age.60% of patients presents by 1 month of age.
Another 20Another 20--30% of patients present at 130% of patients present at 1--12 months of age.12 months of age.
May remain clinically "silent" for some time and can present atMay remain clinically "silent" for some time and can present at any age.any age.
MORTALITY/MORBIDITYMORTALITY/MORBIDITY
Midgut volvulus: The close proximity of the cecum to the duodenuMidgut volvulus: The close proximity of the cecum to the duodenum is associatedm is associated
with a narrow stalk of mesentery around which the gut may twist,with a narrow stalk of mesentery around which the gut may twist, resulting inresulting in
midgut volvulus Accompanying superior mesenteric vascular compromidgut volvulus Accompanying superior mesenteric vascular compromise (firstmise (first
venous, followed by arterial) can lead to lifevenous, followed by arterial) can lead to life--threatening ischemia of the small bowelthreatening ischemia of the small bowel
and gangrenous necrosis. Mortality associated with midgut volvuland gangrenous necrosis. Mortality associated with midgut volvulus is at least 15%,us is at least 15%,
and there is a high incidence of short gut syndrome, total parenand there is a high incidence of short gut syndrome, total parenteral nutritionteral nutrition
dependence, and resultant cirrhosis.dependence, and resultant cirrhosis.
Duodenal obstruction: Coiling of the duodenum with the ascendingDuodenal obstruction: Coiling of the duodenum with the ascending colon producescolon produces
complete or partial duodenal obstruction.complete or partial duodenal obstruction.
15. Clinical DetailsClinical Details
Neonates:Neonates: malrotation with midgut volvulus classically presents withmalrotation with midgut volvulus classically presents with
bilious vomiting and high intestinal obstructionbilious vomiting and high intestinal obstruction
Older children :Older children : failure to thrivefailure to thrive
chronic recurrent abdominal painchronic recurrent abdominal pain
malabsorption, or other vague presentations.malabsorption, or other vague presentations.
nonnon--rotation may be asymptomatic/incidental findingrotation may be asymptomatic/incidental finding
Associated anomaliesAssociated anomalies
Seen in approximately 60% of patients and include…Seen in approximately 60% of patients and include…
congenital heart disease with heterotaxycongenital heart disease with heterotaxy
congenital diaphragmatic hernia and abdominal wall defectscongenital diaphragmatic hernia and abdominal wall defects
imperforate anusimperforate anus
duodenal atresiaduodenal atresia
duodenal webduodenal web
preduodenal portal veinpreduodenal portal vein
annular pancreasannular pancreas
biliary atresia.biliary atresia.
16. Plain Abdominal RadiographPlain Abdominal Radiograph
may appear normal.may appear normal.
in midgut volvulusin midgut volvulus
Partial or complete duodenal obstructionPartial or complete duodenal obstruction
gasless abdomen, ileus, or a distal small bowel obstruction withgasless abdomen, ileus, or a distal small bowel obstruction with multiple dilatedmultiple dilated
loops and airloops and air--fluid levels.fluid levels.
Barium ExaminationBarium Examination
The DJF is displaced downward and to the rightThe DJF is displaced downward and to the right
The duodenum has an abnormal courseThe duodenum has an abnormal course
Abnormal positioning of the jejunumAbnormal positioning of the jejunum
In malrotation with midgut volvulusIn malrotation with midgut volvulus
a dilated, fluida dilated, fluid--filled duodenumfilled duodenum
a proximal small bowel obstructiona proximal small bowel obstruction
a "corkscrew" pattern (proximal jejunum spiralling downward in ta "corkscrew" pattern (proximal jejunum spiralling downward in the righthe right-- oror
midmid--upper abdomenupper abdomen
mural oedema and thick foldsmural oedema and thick folds
17. Ischaemic Colitis
Reduced blood supply to part of the colon sufficient to compromiReduced blood supply to part of the colon sufficient to compromise cellular viability.se cellular viability.
Presenting with sudden onset abdominal pain, rectal bleeding, abPresenting with sudden onset abdominal pain, rectal bleeding, abdominal tendernessdominal tenderness
and diarrhoeaand diarrhoea
Age > 50 years oldAge > 50 years old
Ppt Factors:Ppt Factors: 1. Bowel Obstruction: volvulus, cancer (proximal bowel segment1. Bowel Obstruction: volvulus, cancer (proximal bowel segment
affected)affected)
2. Thrombosis: CVS disease, collagen vascular disease, sickle ce2. Thrombosis: CVS disease, collagen vascular disease, sickle cellll
disease, haemolyticdisease, haemolytic--uraemic syndrome, OCPuraemic syndrome, OCP
3. Trauma: history of aorto3. Trauma: history of aorto--iliac reconstruction (2% with ligation ofiliac reconstruction (2% with ligation of
IMA)IMA)
Location:Location: Left colon (90%)Left colon (90%)
Splenic flexure (80%)Splenic flexure (80%)
SigmoidSigmoid
Rectum sparingRectum sparing
18. Plain film usually normal, may be segmental thumbprintingPlain film usually normal, may be segmental thumbprinting
BE in 90% are abnormal.BE in 90% are abnormal.
Thunbprinting (75%) due to subThunbprinting (75%) due to sub--mucosal haemorrhage and oedema.mucosal haemorrhage and oedema.
Transverse ridging = markedly enlarged mucosal folds (spasm)Transverse ridging = markedly enlarged mucosal folds (spasm)
Serrated mucosa =inflammatory oedemaSerrated mucosa =inflammatory oedema
Superficial longitudinal /circumferential ulceration.Superficial longitudinal /circumferential ulceration.
Deep penetrating ulcers (late)Deep penetrating ulcers (late)
CTCT
symmetrical lobulated segmental thickening of colonic wall.symmetrical lobulated segmental thickening of colonic wall.
Irregular narrowed atonic lumen (thumbprinting)Irregular narrowed atonic lumen (thumbprinting)
curvilinear collection of intramural gas,curvilinear collection of intramural gas,
portal and mesenteric venous air.portal and mesenteric venous air.
Blood clot in SMA/SMV.Blood clot in SMA/SMV.
AngiogramAngiogram
normal slightly attenuated arterial supplynormal slightly attenuated arterial supply
mild acceleration of AV transit timemild acceleration of AV transit time
Small tortuous ectatic draining veins.Small tortuous ectatic draining veins.
19. “transient” ischaemic colitis“transient” ischaemic colitis -- minimal damage and the colon soon returns to normalminimal damage and the colon soon returns to normal
“gangrenous” ischaemic colitis“gangrenous” ischaemic colitis -- extensive necrosisextensive necrosis
“stricturing” ischaemic colitis“stricturing” ischaemic colitis -- ulceration that healed with fibrosis and structureulceration that healed with fibrosis and structure
formation.formation.
ComplicationsComplications
toxic megacolontoxic megacolon
free perforationfree perforation
clostridial invasion of the necrotic wall with the production ofclostridial invasion of the necrotic wall with the production of
intramural gas or gas in veins (e.g intrahepatic portal tracts).intramural gas or gas in veins (e.g intrahepatic portal tracts).
Treatment is symptomatic, although surgery may be required for gTreatment is symptomatic, although surgery may be required for gangrene,angrene,
perforation or stricture formationperforation or stricture formation
22--3 months after acute attack barium enema to exclude stricture fo3 months after acute attack barium enema to exclude stricture formation.rmation.
20. MCQ 1
Regarding the radiological features of colitis:Regarding the radiological features of colitis:
A)A) Normal mucosal islands seen on plain film indicate severe diseasNormal mucosal islands seen on plain film indicate severe disease.e.
B)B) A transverse colon diameter of greater than 5.5cm combined withA transverse colon diameter of greater than 5.5cm combined with thethe
presence of normal mucosal islands is sufficient evidence to diapresence of normal mucosal islands is sufficient evidence to diagnosegnose
toxic megacolon.toxic megacolon.
C)C) The usual site of perforation in UC is the caecum.The usual site of perforation in UC is the caecum.
D)D) The presence of ascities favours a diagnosis of pseudoThe presence of ascities favours a diagnosis of pseudo--membranousmembranous
colitis.colitis.
E) The right side of the colon tends to be dilated in ischaemicE) The right side of the colon tends to be dilated in ischaemic colitis.colitis.
21. MCQ 1
Regarding the radiological features of colitis:Regarding the radiological features of colitis:
A)A) Normal mucosal islands seen on plain film indicate severe diseasNormal mucosal islands seen on plain film indicate severe diseasee
B)B) A transverse colon diameter of greater than 5.5cm combined withA transverse colon diameter of greater than 5.5cm combined with the presencethe presence
of normal mucosal islands is sufficient evidence to diagnose toxof normal mucosal islands is sufficient evidence to diagnose toxic megacolonic megacolon
C)C) The usual site of perforation in UC is the caecumThe usual site of perforation in UC is the caecum
D)D) The presence of ascities favours a diagnosis of pseudoThe presence of ascities favours a diagnosis of pseudo--membranous colitis.membranous colitis.
E) The right side of the colon tends to be dilated in ischaemicE) The right side of the colon tends to be dilated in ischaemic colitiscolitis
A)A) TRUETRUE These represent islands of normal mucosa and their existenceThese represent islands of normal mucosa and their existence
implies that a large area of mucosa has been ulcerated.implies that a large area of mucosa has been ulcerated.
Sometimes ulceration is so extensive that few mucosal islandsSometimes ulceration is so extensive that few mucosal islands
remain.remain.
B)B) TRUETRUE Changes are seen best in the transverse colon, which is the leasChanges are seen best in the transverse colon, which is the leastt
dependent part of the colon and thus accumulates the greatestdependent part of the colon and thus accumulates the greatest
amount of air.amount of air.
C)C) FALSEFALSE The most common site of perforation is the sigmoid colon. It isThe most common site of perforation is the sigmoid colon. It is
usually the result of deep ulceration or toxic megacolon.usually the result of deep ulceration or toxic megacolon.
D)D) TRUETRUE
E)E) TRUETRUE This is because the ischaemic segment at the splenic flexure actThis is because the ischaemic segment at the splenic flexure actss
as an area of functional obstruction.as an area of functional obstruction.
22. MCQ 2
The following are normal features of the oesophagus on a bariumThe following are normal features of the oesophagus on a barium
swallow:swallow:
A)A) The cervical oesophagus starts at the cricopharyngeus impressionThe cervical oesophagus starts at the cricopharyngeus impression ––
usually C3usually C3--C4 level.C4 level.
B)B) The postThe post--cricoid impression is a small, posterior, webcricoid impression is a small, posterior, web--like indentation.like indentation.
C)C) Herring bone pattern of mucosal folds on double contrast examinaHerring bone pattern of mucosal folds on double contrast examination.tion.
D) The A ring (tubulovestibular junction) varies in calibre durD) The A ring (tubulovestibular junction) varies in calibre during theing the
examination.examination.
E)E) The mucosal gastroThe mucosal gastro--oesophageal junction cannot be identified onoesophageal junction cannot be identified on
double contrast studies.double contrast studies.
23. MCQ 2
The following are normal features of the oesophagus on a bariumThe following are normal features of the oesophagus on a barium swallow:swallow:
A)A) The cervical oesophagus starts at the cricopharyngeaus impressioThe cervical oesophagus starts at the cricopharyngeaus impressionn –– usuallyusually
C3C3--C4 level.C4 level.
B)B) The postThe post--cricoid impression is a small, posterior, webcricoid impression is a small, posterior, web--like indentation.like indentation.
C)C) Herring bone pattern of mucosal folds on double contrast examinaHerring bone pattern of mucosal folds on double contrast examination.tion.
D) The A ring (tubulovestibular junction) varies in calibre durD) The A ring (tubulovestibular junction) varies in calibre during theing the
examination.examination.
E)E) The mucosal gastroThe mucosal gastro--oesophageal junction cannot be identified on doubleoesophageal junction cannot be identified on double
contrast studies.contrast studies.
A)A) FALSEFALSE The cricoThe crico--phayrngeal impression is usually at C5phayrngeal impression is usually at C5--C6 level.C6 level.
B)B) FALSEFALSE This is an anterior impression (as opposed to the posteriorlyThis is an anterior impression (as opposed to the posteriorly ––
placed cricopharyngeus impression, that is like a web butplaced cricopharyngeus impression, that is like a web but
changes shape with swallowing.changes shape with swallowing.
C)C) TRUETRUE This is a normal transient phenomenonThis is a normal transient phenomenon
D)D) TRUETRUE This ring is visible only if the vestibule and tubularThis ring is visible only if the vestibule and tubular
oesophagus are adequately distended.oesophagus are adequately distended.
E)E) FALSEFALSE This normal feature is occasionally visible as a thin, slightlyThis normal feature is occasionally visible as a thin, slightly
radiolucent line. It is also known as the Z line, or ora serratradiolucent line. It is also known as the Z line, or ora serrata.a.
24. MCQ 3
Plain radiographic signs supporting a diagnosis of sigmoid volvuPlain radiographic signs supporting a diagnosis of sigmoid volvuluslus
include:include:
A)A) The presence of haustra.The presence of haustra.
B)B) The margin of the dilated loop overlaps the soft tissue shadow oThe margin of the dilated loop overlaps the soft tissue shadow of thef the
inferior border of the liver.inferior border of the liver.
C)C) The dilated loop overlies dilated large bowel in the left flank.The dilated loop overlies dilated large bowel in the left flank.
D)D) The apex of the loop usually underlies the right hemiThe apex of the loop usually underlies the right hemi--diaphragm.diaphragm.
E)E) Shouldering is present on a barium enema.Shouldering is present on a barium enema.
25. MCQ 3
Plain radiographic signs supporting a diagnosis of sigmoid volvuPlain radiographic signs supporting a diagnosis of sigmoid volvulus include:lus include:
A)A) The presence of haustraThe presence of haustra
B)B) The margin of the dilated loop overlaps the soft tissue shadow oThe margin of the dilated loop overlaps the soft tissue shadow of thef the
inferior border of the liverinferior border of the liver
C)C) The dilated loop overlies dilated large bowel in the left flankThe dilated loop overlies dilated large bowel in the left flank
D)D) The apex of the loop usually underlies the right hemiThe apex of the loop usually underlies the right hemi--diaphragmdiaphragm
E)E) Shouldering is present on a barium enemaShouldering is present on a barium enema
A)A) FALSEFALSE Haustra are more often absentHaustra are more often absent
B)B) TRUETRUE This is the soThis is the so--called liver overlap signcalled liver overlap sign
C)C) TRUETRUE This is the so called left flank overlap sign and indicates thatThis is the so called left flank overlap sign and indicates that,,
as the descending colon is dilated the obstruction is distal toas the descending colon is dilated the obstruction is distal to
thisthis
D)D) FALSEFALSE The apex of the loop usually lies underneath the left hemiThe apex of the loop usually lies underneath the left hemi--
diaphragm in sigmoid volvulusdiaphragm in sigmoid volvulus
E)E) TRUETRUE In chronic volvulus, shouldering may be seen due to localisedIn chronic volvulus, shouldering may be seen due to localised
thickening of bowel wall at the site of the twistthickening of bowel wall at the site of the twist