Foregut Flashcards
DDX Dyspepsia
GERD, esophagitis, esophogeal dysmotility, PUD, DGE, cardio-pulmonary disease, biliary disease, malignancy
Diagnostic work-up of GERD
UGI barium swallow
EGD/colonoscopy
2 rotations of PEH
Organoaxial vs. mesoaxial
What can EGD assess for in GERD
Esophagitis, Barrett’s (intestinal metaplasia), stricture, Cameron’s ulcers, malignancy
What is a Cameron’s ulcer?
Ulcer where the stomach is constricted by the thoracic diaphragm
4 types of hiatal hernias
Type 1: sliding 90-95%; migration of GEJ through hiatus while maintaining normal anatomic relationship
Type 2: “true” GEJ normal anatomic position, portion of the stomach herniates through the hiatus
Type 3: herniation of GEJ and gastric fundus above the diaphragm
Type 4: another intra-abdominal organ i.e. colon migrating into the thorax alongside a PEH
Common signs/symptoms of PEH
GERD, dysphagia, atypical chest pain, SOB (negative cardiac work-up), chronic anemia, regurgiation, cough, pneumonia
Under what situation is a PEH emergent?
Gastric volvulus; decompression/reuscitate
- Reduction with crural closure and gastropexy
Post-operative management of PEH
- Remove foley
- No NGT
- No CXR (small PTX normal)
- LCLD without carbonation –> mechanical soft 24-48 hours
Unexplained tachycardia or SOB in a post-op PEH patient
UGI with gastrograffin followed by barium to evaluate for esophogeal perforation
If a leak is discovered following PEH
Immediate exploration with primary repair and drainage; diagnostic laparoscopy
T/F You should consider PEH in the setting of chronic anemia when no other source is found
True
Surgical principles of repair of PEH
Complete reduction, crural closure, fundoplication/gastropexy
Differential diagnosis for GERD
Achalasia, +/- PEH
Difference experience of heartburn in GERD vs. achalasia
GERD / 30 min of eating; achalasia / hours (fermentation of undigested food in the esophagus)
