Stomach & Duodenum 1 anatomy blood supply

STOMACH AND DUODENUM

1. ANATOMY

The stomach is the most dilated portion of the entire digestive

tubular system.

*  It has a fundus, body and antrum and its proximal end is

   continuous with the abdominal oesophagus. The antrum opens

   through the pylorus into the duodenum. (fig above)

*  The cardia (opening of the oesophagus) lies to the left of the

   midline at the level of the tenth dorsal vertebra.

*  The pylorus is situated to the right of the midline at the level

   of the space between first and second lumbar vertebra

   (transpyloric plane).

1.1 The blood supply of the stomach is mainly through six vessels

(fig above).

*  The left and right gastric arteries supply the lesser

   curvature.

*  The left and right gastroepiploic arteries supply the greater

   curvature.

*  The splenic artery through the short gastric arteries supplies

   the fundus

*  The gastroduodenal artery supplies the pylorus

Any questions be sent to drmmkapur@gmail.com

All older posts are stored n archives for access and review.

Visitors that follow may post contributions to the site.

To create consumer/provider engagement visit www.drmmkapur.blogspot.com

www.otmanage.blogspot.com      

Carcinoma Esophagus 4 Treatment

TREATMENT

There are three available modes of treatment for this condition :

*  Surgery

*  Radiotherapy

*  Chemotherapy

None  of  these has improved the results when  used  alone.  Some

improvement is being obtained if the lesion is detected early.

 

Curative surgery can be performed in the early cases.

 

Stage  I  tumours  where the tumour is  confined  to  the  lamina

propria, submucosa and surgery can ensure a 60% 5 year survival.

 

In  all  other tumours a combination of  surgery  and  adjunctant

radiotherapy  and chemotherapy are utilised.   Different  regimes

have yet not produced an acceptable cure rate.

Palliation  can be obtained by passing tube (Celestin)  past  the

tumour in the lumen of the oesophagus, this allows the patient to

eat a soft diet, the average survival in these cases is less than

six months. 

In early cases the tumour bearing oesophagus can be excised and

stomach  mobilised for anastomosis with the  proximal  oesophagus

for continuity (Fig. above).

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site.

To create consumer/provider engagement visit www.drmmkapur.blogspot.com

www.otmanage.blogspot.com  

Carcinoma Esophagus 3 Diagnosis Evaluation

Diagnosis  can be  confirmed in  any patient  with  perisistent

dysphagia  by a barium study or oesophagoscopy.Biopsy  will  als

provide  diagnosis regards the type of carcinoma  (squamous  or

adenocarcinoma).

EVALUATION

Since 1980 endoscopy ultra sound has made it possible to  define         

invasion  of muscle  of  oesophagus  and establish  lymph  node

involvement.   This mode of examination is however  limited  to

those where  the ultra sound probe canpass  through  the lumen

beyond the  tumour.  However, barium study should be  the first

mode of examination.  Chest Xray mayalso give information  such

as:

*  air fluid level in oesophagus

*  abnormal mediastinal soft tissue mass

*  mass pulmonary effusion or lung secondaries

CT  scanning   permits  retrieval  of   information   regarding

oesophageal   wall thickening  and  tumour  spread   into   the

mediestinum   and lymph  nodes,  pulmonary liver   or   adrenal

metastasis can also be identified.

Bronchoscopy  should be  done  in all cases  to  eliminate the

possibility of extension to the respiratorypassages.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review

Visitors that follow may post contributions to the site.

To create consumer/provider engagement visit www.drmmkapur.blogspot.com

www.otmanage.blogspot.com  

Carcinoma esophagus 2 Presentation

CLINICAL PRESENTATION

The  predominant  symptom is dysphagia and may be preceded  by  a

vague  retrosternal or epigastric discomfort on intake  of  food. 

Weight  loss is manifest as the dysphagia becomes  more  complete

and continuous.

 

Box

Presenting symptoms of Esophageal carcinoma

Symptom                                                                                          Incidence (%)

Dysphagia                                                                                                    87

Weight loss                                                                                                  71

Substernal or epigastric pain/burning                                                          46

Vomiting or regurgitation                                                                             28

Aspiration pneumonia                                                                                  14

Palpable cervical nodes                                                                                14

Hoareseness                                                                                                   7

Coughing and choking                                                                                   3

 

Diagnosis  can  be  confirmed in  any  patient  with  perisistent

dysphagia  by a barium study or oesophagoscopy. Biopsy  will  als

provide  diagnosis  regards the type of  carcinoma  (squamous  or

adenocarcinoma).

 

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow ay post contributions to the site.

To create consume/provider engagement visit www.drmmkapur.blogspot.com

www.otmanage.blogspot.com