Plating 4 part 1 : porto caval and diseases of GE system

SMA & Splenic V

Portal vein is formed by union of

Left gastric vein

Right gastric vein

Cystic veins

Posterior superior pancreaticoduodenal vein

Tributaries of portal vein

Peristalsis

Involuntary wave like muscles contraction moving down along the GI tract

Lower third of the esophagus

Paraumbilical area

Upper end of anal canal

Retroperitoneal

Bare area of liver

Fives sites of portal / systematic circulation LPURB

Lower third of esophagus

Left gastric ( portal tributaries ) anatomies with the esophageal veins draining into the middle third of the esophagus into the azygos vein

Middle third of esophagus

Drains into the azygous veins (systemic tri)

Esophageal varices

Clinical dilation of lower third of esophagus

Paraumbilical area

Left branch of portal vein with the superficial veins of AAB

Caput medusae

Clinicals for Paraumbilical area

middle and inferior rectal veins

Anal canal - Superior rectal veins draining the upper half of the anal canal anatomose with ___

Retroperitoneal

Colic Veins of AcDcDPL (portal) anastamose with RLPh Veins (systemic)

Ascites

Acculturation of fluid in the peritoneal cavity

Bare area of liver

Anastomiss netween portal venous channels and azygos system brings above diaphragm

Portal hypertension

Increase in blood pressure in the veins of the portal system caused by obstruction of liver

Liver cirrhosis

thrombophlebitis / thrombosis of portal vein

Obstruction of liver causing enlargement of collateral veins and spenomegaly

Esophageal varices

Patients have Haematemesis and black tarry stools

Endoscopy

Esophageal varices can be visualized using

Caput Medusae

Swollen and bulging vein in Paraumbilical

Hemorrhoid’s

Painful swollen veins in the lower portion of the rectum or anus

Hematochezia

Blood in poopoo

Hematuria

Blood in urine

Band ligation

Sclerogheraphy

Portosystemic shunts

TIPPS

Treatment

Duodenum

25 cm (10 in.) long & receive juices from pancreas, liver.
• To receive chyme from stomach • To neutralize acids before they can damage the absorptive surfaces of the small intestine

Mucosa

Submucosa

Muscularis

Serosa

Layers of GI tract MSMS

Muscosa Innermost

Absorptive and secretary (mucus) layer of GI

Submucosa

Strongest layer

Absorbed molecule of mucosa picked up by BC

Muscularis

Controlled peristalsis

serosa

Outermost

Protective layer and secretary

Upper endoscopy

Gold standard for detecting upper GI tract clinicals

Capsule endoscopy

What is swallowed with a camera for endoscopy

Upper GI endoscopy

Diagnostic for GI bleedinh, dysphasia, reflux, ulcers, intestinal disease

Esophagitis

frequent acid reflux when sphincter is not okay

Gastro esophageal reflux disease

stomach tolerates high acid but the esophagus doesn’t causing reflex into esophagus (GERD, heartburn)

Esophageal

Heart burn, acidic taste in mouth

Extraesophageal

Asthma

Peptic ulcer

Defect in Gi mucosa

Dependent on acid peptic activity

DI

Peptic ulcer happens at what part of d

Gastric and duodenal mucosa

PUD occurs in

Endoscopy

Diagnosis for PUD

H Pylori mechanism

is gram negative, niche is stomach

involves elucidation of primary defense to counteract peristalsis to establish persistent infection

Invasive = endoscopic Bx

non-invasive = urea breath test

Detection and treatment of h pylori

Triple Therapy = PPI +Clarithomycin + amoxicillin

Treatment for h pylori

Diarrhea

Increase vol7me of stool or frequency of defecation

Constipation

Usually caused by the slow movement of stool through the colon

Dyspepsia

Problem of the upper gut, bloating, nausea

ibuprofen and aspirin

Most common NSAID

Lactose intolerance

Inability to digest diary containing lactose due to lack of lactase enzyme

H. Pylori

NSAID

2 reasons causing peptic ulcer

Colonoscopy

Lower GI detection

Jejunum

2.5 meters (8.2 ft) long •Chemical digestion •Nutrient absorption

Ileum

3.5 meters (11.48 ft) long Ends at the IC valve, a sphincter that controls flow of material from the ileum into the large intestine

Biliary tract

Irritable Bowel Syndrome (IBS)

problem of' lower gut

• Abdominal pain associated with disturbed defecation and relieved with defecation

• Stools looser or more frequent at pain onset

Ulcerative colitis

Crohn’s disease

Indeterminate colitis

Inflammatory bowel diseases

Ulcerative colitis

Effects the generally mucosa of the colon and rectum

Crohn’s disease

• This may affect any segment of the gastrointestinal tract

• Diarrhea, oral ulcer, RQ pain

• Cobblestone like mucosal patterns (endoscopic view)

Indeterminate colitis

• 15% patients with IBD impossible to differentiate

Intestinal tuberculosis

• Clinical Symptoms:

• Diarrhea, specific abdominal pain in right quadrant, fever, arhtlargia,

Ulcerative lesion at IC valve

Endoscopic view of ITb

Ulcerative colitis

UC disease of Musca diarrhea with blood

“Natae”

Colonoscopy

strictures, thickening of wall (IC valve)

Radiological view

Anti TB drugs Isoniazid Rifampicin,

What are the treatments for ITb

Pyrazinamide × 9mons & if acute Abdomen

Surgery

Small bowel obstruction

• Intermittent, Crampy Abdominal Pain

• Nausea / Emesis

• Distension

• Obstipation

• Peristaltic Rushes on Auscultation

• Focal Tenderness

• Diffuse Peritonitis

• Adhesions

• Malignancy

• External or Internal Hernia

• Volvulus

• Crohn's Disease

• Intra-abdominal Abscess

Small bowel obstruction etiologies

Upper abdominal xray

Diagnostic for small bowel obstruction

• Colon Cancer

• Diverticulitis

• Extrinsic Cancer

• Fecal Impaction

• Intussusception

• Volvulus

• Incarcerated Hernias

Large bowel obstruction etiologies

IVF

NGT

Treatment for LBO

Ostomy

If Right vs. Left-sided Lesions

Traditional vs. Newer Attitudes

Appendicitis

Inflammation of appendix

Adolescents and young adults

Appendicitis is most common in

Appendicitis

is the most common cause for acute, severe abdominal pain.

Faecolith

•Acute appendicitis seems to be the end result of a primary obstruction of the appendk.

McBurney’s point

one third of the distance from the right anterior superior iliac spine to the umbilicus. This corresponds to the location of the base of the

Fecal impaction and/or a fecality

Lymphoid hyperplasia

Parasites

Most common causes of appendicitis

Surgery

Is indicated if appendicitis is diagnosed.

Antibiotics and intravenous fluids (ivf)

To prevent fluid and electrolytes imbalance, these are done before surgery is performed

Appendectomy

surgical removal of the appendix) is performed as soon as possible to decrease the risk of perforation. It may be performed under a general or spinal anesthetic with a low abdominal incision or by laparoscopy.

• Congestive

• Suppurative

Stages of non complicated appendicitis

Ruptured

Gangrenous

Stages of complicated appendicitis

Diverticulitis

Inflammation associated with diverticula (weakling of abdominal wall)

Diverticulosis

presence of diverticula without inflammation