MBChB Year 5 CHM5003W: Surgery – Lower Gastrointestinal SurgeryJason Harry (HRRJAS005


Upper Gastrointestinal Surgery:
Core Curriculum:
 xxxx
 xxxx

1. Applied Anatomy and Physiology:

 Xxxx

2. Acute Upper Abdominal Pain:

 Rapid onset of severe abdominal pain
 Non-traumatic; signifies intra-abdominal pathology

Upper Gastrointestinal Bleeding (UGIB):


avoid NSAIDs  Endoscopic interventions with • Associated mucosa in a  PPIs or H2 blockers if intolerant to PPI  Surgery EARLY MANAGEMENT: Helicobacter with H. duodenum. mucosal prostaglandins. syndrome. partial gastrectomy. nausea and * urease testing = to assess for presence of H. respiratory. Zollinger– PERFORATION and BLEEDING disease (PUD)  ‘Peptic’ refers to ulcers in columnar mucosa in the normal or low NSAID use.g.g.g. pylori in selected cases 2 . pylori infection. poor peripheral perfusion. Type II. emergency indications include analgesic ingestion may implicate peptic ulcer duodenum  mucosal breach NSAID use. often cyclical Oesophagus: Oesophageal varices Ulcers Complications: Diagnostic Investigations: Mallory-Weiss tear  Acute upper GI bleeding  Endoscopy: urgent endoscopy is indicated when Stomach: Gastric ulcer oesophageal varices are suspected/continuing Classification:  Iron deficiency anaemia due to chronic low level Erosive haemorrhagic gastritis haemorrhage Gastric Ulcers Duodenal Atypical bleeding Small Duodenal ulcer  Angiography: continued bleeding. mild cramps. or small acid secretion. (fasting) For suspected Zollinger Ellison ligament of Treitz (suspensory ligament of the  Administer small dose of opiate analgesic (e. Oesophageal ulcers  Medical treatment • Associated 25–30y. less Breath and For H. Indications include gastric and with high with high high Epidemiology and Pathogenesis: outlet obstruction not responsive or suitable for History: may disclose source of bleeding alcohol intake. angiography. metronidazole and clarithromycin diagnostic investigations  definitive treatment 45% of cases of cases and or abnormally  Surgery rarely necessary. with MEN syndromes). weak and rapid multiple ulcers. smoking. acid levels of acid endoscopic dilatation  PYLOROPLASTY or type II  Periodic dyspepsia related to meals or excessive  Breakdown in the mucosal defence of the stomach or smoking. sites of gastric Vascular malformation TREATMENT: age of peak age of acid secretion Treatment: Oesophagitis incidence 50y. Meckel’s  H. occasionally cause is malignant Protective Mechanisms: therapy. Zollinger–Ellison syndrome  Attempt to estimate amount of blood lost Pathogenesis: • Associated • Due to hypergastrinaemia causing extensive. jaundice. 3:1. Resection of pancreatic tissue containing tumour. pulse. MBChB Year 5 CHM5003W: Surgery – Lower Gastrointestinal SurgeryJason Harry (HRRJAS005) OVERVIEW: DEFINITION AND AETIOLOGY  Standard crystalloid and colloid solutions  blood Ulcers cyclical Serological  UGIB: bleeding derived from a source proximal to the loss must be replaced adequately and promptly Dyspepsia Tests: with whole blood Epigastric fullness.) pylori in pylori in 85% diverticulum) Peptic Ulcer Disease: of PPI. see may suggest oesophageal varices bowel. or typical Clinical Examination: that fails to H. tumour tissue growth factors abnormal located by CT Liver failure: encephalopathy. cool extremities Mucus production. acid hypersecretion • Commonest cause is benign secretory gastrinoma  Cardiovascular.g. weight loss antral biopsy oesophageal varices to lower portal hypertension Duodenal Pain relieved by food. secretion (e. pylori on  Most common causes = peptic ulcer disease and rather blood and 5% dextrose. ulcers in • Diagnosed by raised serum gastrin level. peak ♂:♀. FFP and Octreotide vomiting. selective pancreatic venous palmar erythema. ectopic gastric  ↓ alcohol intake. secretion. 5:1. locations (e. 285). Usually due to  Gastric outlet obstruction due to chronic scarring at or Other: Tumours  Risk stratification: the Rockall Risk Score fundal prepyloric either atypical around the pylorus Stomal/anasmotic ulcers ♂:♀. pylori eradication therapy = usually triple therapy  History  clinical examination  resuscitation  (H. failed Ulcers Ulceration  Perforation Intestine: Erosive duodenitis endoscopy Type I. pallor. body. b p. Resuscitation:  Establish IV access (and CVP in severely shocked Diagnosis and Special Investigations: patients)  Urinary catheter Endoscopy Confirms diagnosis  Baseline biochemical and haematological Allows for biopsy investigations (including cross-match) Clinical Features: Barium meal seldom used (only if gastroscopy is contraindicated) Gastric Pain precipitated by food. NSAID ulceration. gastrinoma (associated Major bleeding: hypotension. stomach. • Treatment. spider naevi. belching Serum Syndrome (> 500 pg/mL) duodenum)  Potentially dangerous – all patients require admission morphine) Both Nocturnal upper abdominal pain Gastrin:  Patients with oesophageal varices should NOT be related to meals and management requires a multidisciplinary approach given sodium-containing crystalloid solutions.  Haemodynamic status respond to (ab)use. stop smoking. foetor hepaticus. but Associated heartburn. distal cannulation at ascites duodenum or surgery. Ellison  Excessive alcohol intake and known liver disease lower oesophagus. small bowel). hepatic and renal maximal (usually status medical intrapancreatic). flapping tremor. scanning. Aggresive Mechanisms: with ulceration persistent. incidence (e.

MBChB Year 5 CHM5003W: Surgery – Lower Gastrointestinal SurgeryJason Harry (HRRJAS005) 3 .