Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Surgery 22 Gastric Tichobeozar PPT-Powerpoint Presentations and lecture notes
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Gastric Trichobezoar
Gastric Lymphoma
Liver: Anatomy & Investigations
Gastric Trichobezoar
? Bezoars are concretions of undigestible matter that accumulate in
the stomach.
? Trichobezoars, (hairbal s) composed of hair, occur most commonly
in young women who swal ow their hair
? Phytobezoars are composed of vegetable matter
? Most commonly, bezoars produce obstructive symptoms, but they
may cause ulceration and bleeding.
? Diagnosis is suggested by upper GI series and confirmed by
endoscopy.
? Treatment options include enzyme therapy (papain, cel ulase, or
acetylcysteine), endoscopic disruption and removal, or surgical
removal
Trichobezoar forming cast of stomach and duodenum removed from a young female
Gastric Lymphoma
? Gastric lymphomas general y account for about 4% of gastric
malignancies.
? Over half of patients with non-Hodgkin's lymphoma have
involvement of the GI tract.
? Stomach is the most common site of primary GI lymphoma, and
over 95% are non-Hodgkin's type.
? Most are B-cel type, thought to arise in mucosa-associated
lymphoid tissue (MALT).
? In populations with a high incidence of gastric lymphoma, there is a
high incidence of H. pylori infection; patients with gastric lymphoma
also usual y have H. pylori infection.
? Low-grade MALT lymphoma, essential y a monoclonal proliferation of B
cel s, arises from a background of chronic gastritis associated with H.
pylori.
? These relatively innocuous tumors then undergo degeneration to high-
grade lymphoma.
? Remarkably, when the H. pylori is eradicated and the gastritis
improves, the low-grade MALT lymphoma often disappears.
? Thus low-grade MALT lymphoma is not a surgical lesion.
? Careful follow-up is necessary.
? High-grade gastric lymphoma require aggressive oncologic treatment for cure
? Systemic symptoms such as fever, weight loss, and night sweats occur in about
50% of patients
? The tumors may bleed and/or obstruct.
? Lymphadenopathy and/or organomegaly suggest systemic disease.
? Diagnosis is by endoscopy and biopsy.
? Primary lymphoma is usual y nodular with enlarged gastric folds.
? Diffusely infiltrative process akin to linitis plastica is more suggestive of secondary
gastric involvement by lymphoma.
? EUS; CT scanning of the chest, abdomen, and pelvis; and bone marrow biopsy.
? Treatment is with primary chemotherapy and radiation without surgery
Liver
Anatomy: Embryology
? The earliest appearance of the liver primordium occurs
on Day 22 after conception.
? It appears at the superior intestinal portal, caudal and
ventral to the heart.
? By Day 24 hepatic diverticulum grows into the
transverse septum that contains the vitelline and
umbilical veins
? By Day 51, the intrahepatic veins attain the
normal adult distribution and segmentation
? By the ninth week, the liver embraces as much
as 10% of body volume
Relative size of the left and right lobes of the liver in the foetus
? largest solid organ of the body
? Weight: adult male ranges from 1.4 kg to 1.8 kg
adult female from 1.2 kg to 1.4 kg
? wedge-shaped
Diaphragmatic aspect of the liver
Diagram of the posterior aspect of the liver
? Anatomic & nonanatomic factors responsible for the
fixation of the liver at the right upper quadrant of the
abdomen:
Anatomic
? Inferior vena cava
? Suprahepatic veins
? Several ligaments such as the round ligament and coronary
ligament
? Peritoneal folds
Nonanatomic
? Positive intraabdominal pressure
Parasagittal section through the upper abdomen showing the potential right
suprahepatic and sub hepatic spaces
The umbilical fissure separates the anatomic left lobe (segments 2 and 3) from the
right lobe (segments 4-8)
The middle hepatic vein runs within the main portal fissure (Cantlie's line), which
separates the left liver (segments 2 to 4) from the right liver (segments 5 to 8)
Vascular Distribution
? Hepatic artery
? Portal vein
? About one-fourth of the blood and one-half the oxygen come
by way of the hepatic artery.
? Remainder is carried by the portal vein
? Blood from these two sources mingles in the blood sinusoids
of the liver parenchyma and is drained by tributaries of the
hepatic veins
? These veins open into the inferior vena cava
Intrahepatic distribution of the hepatic artery
Survival of a liver segment following arterial
ligation is the result of all the following:
? Increased extraction of oxygen from portal venous
blood
? Extrahepatic collateral circulation
? Intrahepatic collateral circulation formed in response
to the ligation
Intrahepatic distribution of the hepatic portal vein
Intrahepatic distribution of the bile ducts
Lymphatics
? The liver sinusoids have an endothelial lining composed of flattened
squamous cel s and stel ate macrophages (Kupffer cel s)
? This endothelial layer is separated from the surrounding
hepatocytes by a narrow perivascular space (of Disse) partial y fil ed
by microvil i of the hepatocytes
? The perivascular space of Disse is the source of lymph produced by
the liver
? The lymphatics of the liver are usual y divided into superficial or sub
capsular and deep or portal systems
Nerve Supply
? The sympathetic fibres arise from thoracic spinal cord
segments 7 to 10
? The parasympathetic efferent fibres arise from the
hepatic division of the anterior and posterior vagal
trunks
The phrenic nerve supply via its C3, 4, 5 roots is probably
the basis of shoulder pain in biliary colic
Investigations
? Serum Liver Tests
Parenchymal
(hepatocytes)
AST, ALT
Canalicular
(biliary)
ALP, 5'NT, GGT, bilirubin
Synthetic
INR, factors V and VII, bilirubin,
function and
metabolism
albumin
? Radiologic Evaluation of the Liver
? Ultrasound
? Computed Tomography Scan
? Magnetic Resonance Imaging
? Positron Emission Tomography
? Angiography
? Percutaneous Biopsy
? Diagnostic Laparoscopy
This post was last modified on 08 April 2022