surgey finals
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
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| What is the diffential diagnosis of dysphsgia? | -In the lumen of esophagus
-In the wall of esophagus
-Outside the wall of esophagus
-General
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| 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
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| In the lumena and outside the wall cause of dyspahgia |
Lumen-Foreign body
Outside lumen-
retrosternal goitre,
enlarged left atrium
bronchogenic carcinoma
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| General cause of dysphagia? | bulbar palsy,myasthenia gravis and hysteria
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| 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.
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| 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
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| 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
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| Early stoma complication? |
HIROO-haemorrhage, ischemia, stoma retraction, obstruction(adhesion), high output(hypo K)
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| Delayed stoma complication? | FISH P2OD
Fistulae, intussusception, stenosis, parastoma hernia, prolapse, psychosexual, obstruction, dermatitis
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| what is the primary gold standard in diagnosing dysphagia? | barium swallow
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| 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
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| 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
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| Early complication of partial gastrectomy | HADAR
H-haemorrahge
• Haemorrhage
• Acute pancreatitis
• Duodenal stump disruption
• Anastomotic leak
• Respiratory compromise
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| Late complication of partial gastrectomy |
Dumping syndrome
• Bile reflux and vomiting
• Diarrhoea
• Recurrent stomal ulceration
• Metabolic abnormalities: iron deficiency, vit B12 deficiency
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