Anatomy-Surgical Approach to Abdomen Flashcards
Areas that have a high liklihood of intra-abdominal abscesses and collection of other fluids
Subphrenic, gutters, pelvic and lesser sac
A 45 year old man presents with difficulty swallowing over the past 6 months. He also notes a 10 pound weight loss. PMH reveals 10 pack/year smoking history. Physical exam is unremarkable. Upper GI barium swallow is shown below. Esophagogastroduodenoscopy (EGD) is done and no anotomic variation is shown. What is your diagnosis?
Achalasia. This is due to failure of the esophagus to relax and absent peristalsis. This often due to vagus nerve damage and/or loss of myenteric plexus neurons.
What is shown below?
Z-line of the squamo-columnar junction (GE junction)
How do you treat achalasia?
Achalasia is due to non-relaxation of the LES. You can burn the circular muscle fibers in the esophagus to relieve LES tension (Heller myotomy). You can also do ballon dilation of the LES.
A 45 year old man presents with difficulty swallowing over the past 6 months. He also notes a 10 pound weight loss. PMH reveals 10 pack/year smoking history. Physical exam is unremarkable. Upper GI barium swallow is shown below. Esophagogastroduodenoscopy (EGD) is done and you diagnose him with GERD and Barrett’s esophagus. What did you see on endoscopy?
Stricture, tongues of salmon-colored intestinal mucosa (with goblet cells on biopsy)
How do you treat a patient with Barrett’s esophagus?
High grade dysplasia = esophagectomy. No dysplasia = hight dose PPIs or fundoplicationm (putting the esophagus from the negative pressure thorax to the positive pressure abdomen and wrapping the stomach around it).
A 45 year old man presents with difficulty swallowing over the past 6 months. He also notes a 10 pound weight loss. PMH reveals 10 pack/year smoking history. Physical exam is unremarkable. Upper GI barium swallow is shown below. Esophagogastroduodenoscopy (EGD) is done and you diagnose him with stage IIa esophageal cancer. How do you treat this patient?
Esophagectomy and replacement with the stomach.
A 65 year old man comes in with hematochezia and weight loss. He smokes and labs reveal iron deficiency anemia. His colonoscopy is shown below. How do you treat this condition?
Colon cancer is treated by colectomy of areas at risk for regional spread.
Most common site for diverticuli?
Sigmoid colon
Why does the transverse colon typically have a triangular shape?
Tenia coli
How do you find the appendix on colonoscopy?
The tenia coli all converge to form the appendix
What region of the GI tract is this?
Past duodenum 1, note the folds
What region of the GI tract is this?
Ileocecal valve
What ligament do you need to get by in treatment of achalasia?
Phrenoesophageal.
