haitus hernia etc. (see DM)

Question 1

what components help to stop reflux into the oesophagus (anti-reflux barrier)

Answer 1

1. lower oesopageal sphincter
2. diaphragm
3. gastroesophageal junction (flap)

Question 2

what is a hiatus hernia

Answer 2

the protrusion of an organ from the abdominal cavity into the thorax through the oesophageal hiatus - typically the stomach

Question 3

what are the 4 types of hiatus hernia

Answer 3

1. sliding (most common)
2. rolling
3. mixed
4. other

Question 4

what is a sliding haitus hernia

Answer 4

when the gastro-oesophageal junction (GOJ), the abdominal part of the oesophagus, and frequently the cardia of the stomach move (or “slides”) upwards through the diaphragmatic hiatus into the thorax

Question 5

what is a rolling haitus hernia

Answer 5

an upward movement of the gastric fundus occurs to lie alongside a normally positioned GOJ, which creates a ‘bubble’ of stomach in the thorax; This is a true hernia with a peritoneal sac

Question 6

what is a mixed hiatus hernia

Answer 6

both the gastric fundus and the GOJ herniate above the hiatus, with the fundus lying above the GOJ

Question 7

what is a small hiatus hernia

Answer 7

<2cm

Question 8

what is a large hiatial hernia

Answer 8

> 5cm

Question 9

examples of bariatric surgery (3)

Answer 9

1. sleeve gastrectomy (portion of stomach excised, removal of fundus results in reduced ghrelin production)
2. roux en Y gastric bypass (bypasses duodenum so food is not mixed with biliary secretions)
3. laproscopic adjustible gastric band (LAGB)

Question 10

3 complications of roux en Y gastric bypass surgery

Answer 10

1. anastomotic leak
2. internal herniation
3. access to gastric reminant for gastric cancer

Question 11

what is a slipped band (bariatric surgery)

Answer 11

when the distal stomach herniates upward through the band causing proximal pouch dilation - can result in ischaemia and necrosis if nor treated

Question 12

slipped band (bariatric surgery) presentaion

Answer 12

1. upper abdominal/chest pain
2. dysphagia
3. regurgitation of all fluid

Question 13

why is NAFLD associated w bariatric surgery

Answer 13

Weight loss triggers catabolism of peripheral adipose reserves and importation of toxic lipids to the liver which trigger steatosis, inflammation and hepatocyte cell death. This manifests with deranged serum liver enzymes and raised bilirubin.