Download MBBS Surgery Presentations 22 Gastric Tichobeozar Lecture Notes

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


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