By George Wu
Few medical disciplines were remodeled so dramatically through developments in technological know-how and know-how as gastrointestinal surgical procedure. to start with, smooth ph- macology has nearly eradicated a few different types of surgical procedure altogether. If one have been to take a peek at a regular working room agenda in a hectic health center of the Nineteen Sixties, gastrectomies of 1 style or one other could have constituted a wide block of the most important surgical procedures. the appearance of powerful H2-histamine receptor antagonists and, extra + + lately, the H ,K -ATPase (proton pump) inhibitors resulted in a precipitous decline in these techniques such that they're hardly played at the present time. fascinating new methods to treating inflammatory bowel illnesses and their complications—such as fistulas— with anticytokine treatment may perhaps in the future have a equally profound impression on surgical procedure for this situation to boot. past pharmaceutics, advances in imaging ideas have enormously facilitated the id and characterization of pathology within the gastrointestinal tract in a fashion that might were incredible just a couple of years in the past. simply to visualize the pancreas ultimately was once a horrendous job until eventually belly ultrasound, magnetic resonance imaging, or machine tomography made it uncomplicated. the truth that the intestine is a hole organ that may be accessed throughout the mouth, anus, or perhaps throughout the wall of the stomach has been totally exploited with fiberoptic endoscopes which could bend round corners comfortably and allow surgical procedure to be carried out via them.
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Extra info for An Internist's Illustrated Guide to Gastrointestinal Surgery
There is often a “cricopharyngeal bar” seen on the lateral view of the swallow, which is present as a result of persistent spasm of the cricopharyngeus (CP). Contrast will pass through the spasm and into the esophagus in variable amounts. One must be vigilant for other causes of obstruction and look for irregularities of the mucosa and filling defects. Computed tomography (CT) scan with contrast can help to rule out other causes of obstruction and can demonstrate the Zenker’s as an air-filled sac.
Eighty percent of patients with GERD have type I hernia. Type II, or paraesophageal hernia, accounts for less than 5% of hiatal hernias (Figs. 1 and 2). Type II hernia occur more commonly in an older population than do sliding hiatal hernia. The esophagogastric junction remains fixed below the diaphragm, and the gastric fundus herniates through the defect into the mediastinum. Type III is a combination of both types I and II hernia (Fig. 3). Components of both sliding and paraesophageal hernia are present.
1–3). Normally, the distal esophagus rests within the abdomen. As the esophagus traverses the hiatus, the crura of the diaphragm compress the esophagus, increasing LES pressure. This compression is maximal during inspiration, when intrathoracic pressure decreases and risk of reflux is greatest. The intraabdominal pressure is also greater than that of the thorax. This high-pressure zone is transmitted to the distal intraabdominal esophagus, thus contributing to the LES pressure (4,5). Pathologic reflux occurs if the elements contributing to the LES are dysfunctional.