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Bedah 1

surgey finals

What is the diffential diagnosis of dysphsgia? -In the lumen of esophagus -In the wall of esophagus -Outside the wall of esophagus -General
In the wall cause of dyspahagia In the wall  inflammatory stricture,  caustic stricture,  achalasia,  tumour of oesophagus or gastric cardia,  pharyngeal pouch,  Plummer-Vinson syndrome,  diffuse oesophageal spasm,  scleroderma and oesophageal web
In the lumena and outside the wall cause of dyspahgia Lumen-Foreign body Outside lumen-  retrosternal goitre,  enlarged left atrium  bronchogenic carcinoma
General cause of dysphagia? bulbar palsy,myasthenia gravis and hysteria
What is bulbar palsy? impairment of function of the cranial nerves IX, X, XI and XII, which occurs due to a lower motor neuron lesion in the medulla oblongata or from lesions of the lower cranial nerves outside the brainstem.
What is pseudobulbar palsy? impairment of function of cranial nerves IX-XII due to upper motor neurone lesions of the corticobulbar tracts in the mid-pons
Hx to focus on dyspagia -onset -degree of dyspagia-solid/liquid/nothing at all Associated symptoms: 1. weight loss 2. dyspepsia qs 3. norturnal cough 4. hemetemsis 5. fatigue-anemia, upper gi bleed, PVS 6. brethlessness-a/bc/ap 7. neurological-sensation/upper limb
Early stoma complication? HIROO-haemorrhage, ischemia, stoma retraction, obstruction(adhesion), high output(hypo K)
Delayed stoma complication? FISH P2OD Fistulae, intussusception, stenosis, parastoma hernia, prolapse, psychosexual, obstruction, dermatitis
what is the primary gold standard in diagnosing dysphagia? barium swallow
List all the investigation of dysphagia -CXray-simple, non invasive -barium swallow-gold standard -esophagoscopy-bx in carcinoma -endoscopy u/s-staging -CT/MRI-stage -mannometry-strenght, coordination of perstalsis, pressure of spinchter -pH monitoring -Bronchoscopy
Risk of OGD procedure- rare, 1/2000 1) Perforation to oesophagus or lining of stomach 2) bleeding 3) damage to teeth 4) risks associated with sedation 5) Aspiration
Early complication of partial gastrectomy HADAR H-haemorrahge • Haemorrhage • Acute pancreatitis • Duodenal stump disruption • Anastomotic leak • Respiratory compromise
Late complication of partial gastrectomy Dumping syndrome • Bile reflux and vomiting • Diarrhoea • Recurrent stomal ulceration • Metabolic abnormalities: iron deficiency, vit B12 deficiency
Created by: student_rc