GIT SURGERY MODULE

Dr. Mumin Farah

 Outline
• Lesions of the esophagus
• Esophageal atresia
• Achalasia
• GERD
• GI bleeding
• Esophageal Ca
• Hiatal hernia
• Esophageal Verices
 Outline
Other GIT
•Gastritis
•PUD
•Gastric Ca
•Schemic bowel disease
•Intestinal Obstruction
•Appendicitis
• Inflammatory Bowel disease
• Peritonitis
• Hemorrhoids
• Anal fissure
• Anal fistula
• Hernia
 LESSIONS OF THE EOSOPHAGUS
EOSOPHAGEAL ATRESIA
When a segment of the esophagus is congenitally
malformed and consists of only a thin,
noncanalized end, the lesion is termed
esophageal atresia. It is manifested by
swallowing difficulties from birth.
Clinical features difficult swallowing after birth,
inability to pass NG tube through esophagus
Management: Resuscitation, surgery
 ACHALASIA( MEGA ESOPHAGUS)
• This is a disorder of esophageal motility characterized
by incomplete relaxation of the lower esophageal
sphincter in response to swallowing. This produces
functional obstruction of the esophagus, with
consequent dilation of proximal esophagus.
There are three abnormalities in achalasia:
 Ineffective peristalsis in the lower two thirds of the
esophagus.
 Inadequate relaxation of the lower esophageal
sphincter during swallowing.
 Increased basal tone of the lower esophageal
sphincter.
Achalasia
 Pathophysiology
• Probably cause is loss of myenteric ganglion cells in the
wall of the body of the esophagus. Which aids the
contraction of esophagus to propel food down to
stomach.
CLINICAL FEATURES
Progressive dysphagia(difficult swallowing) and inability
to convey food to stomach especially liquid foods.
Regurgitation(effortless vomiting of food),
Weight loss and sensation of lump at the chest.
TREATMENT
Surgery - Esophagocardiomyotomy
 GI BLEEDING
• Hematomesis is vomiting of blood,
• Melena is defecation of blood with feces or
very black stool.
• Hematochezia is fresh bleedind from rectum
• Gastrointestinal bleeding is divided into
 Upper GI bleeding
 Lower GI bleeding
 Upper GI bleeding
• Bleeding from a lesion in the esophagus, stomach
or duodenum above the ligament of Treits( at the
middle of duodenum) is called upper GI bleeding.
Bleeding from upper GIT may present with
hematemesis or melena.
In the order of frequenc, the causes are following
 Chronic duodenal ulcer
 Chronic gastric ulcer
 Esophageal varices
 Esophagitis
 LOWER GI BLEEDING
• It is defined as bleeding arising below the
ligament of Treitz i.e. the small intestine and
colon. Majority of cases, arise from colon and
particularly the anorectal region.

• The causes of lower GI bleeding are:

Young pt below 50yrs

• Anorectal disease e.g. hemorrhoids,

• Infectious colitis: due to shigalla, E.coli.
• Ulcerative colitis

Old age above 50 yrs

• Neoplams
• Diverticulitis
 Esophageal Cancer
1. Definition: Relatively uncommon malignancy with high
mortality rate, because it is usually diagnosed late
2. Pathophysiology
• a. Squamous cell carcinoma
1.Most common affecting middle or distal portion of
esophagus
2.More common in African Americans than
Caucasians
3.Risk factors: cigarette smoking and chronic alcohol
use
• b. Adenocarcinoma
1.Nearly as common as squamous cell affecting distal
portion of esophagus
2.More common in Caucasians
3.Associated with Barrett’s esophagus, complication
of chronic GERD and achalasia
o Usually occur over 50 years of age
Esophageal tumor
 Manifestations
a) Initially asymptomatic then progressive
dysphagia (difficult swallowing) with solids at
first and then to liquids , he/she may also feel
pain while swallowing
b) Choking, hoarseness, cough
c) Anorexia, weight loss
Diagnosis
Barium meal, endoscopy, chest-xray, Hb
TREATMENT
Depend on the stage of presentation
 Esophagitis
Is the inflammation of the esophagus, flowing
are the causes of esophagitis:
1)Reflex of gastric content.
2)Prolonged gastric intubation.
3)Ingestion of alcohol, acids, pills and hot tea.
4)Viral, Bacterial, and Fungus.
 Pathophysiology
In acute stage hyperemia to ulcerative lesions
are seen.
In chronic stage fibrous thickening and then
stricture of the esophageal wall are seen.
Complication
Bleeding, stricture formation, barett’s
esophagitis.
 HIATAL HERNIA
• It is a disorder of gastroesophageal junction
that results in a saclike dilation of the stomach
through the esophageal hiatus (opening) such
that a portion of the stomach comes to lie
above the diaphragm.
 Types of Hiatal Hernia
1.Sliding hiatal hernia
2.Rolling hiatal hernia
Slidding hiatal hernia
In this type, there is an abnormally short
esophagus(congenital or due to fibrous
scaring) that pulls a portion of the stomach
above the diapharagm, it the most common
type of hiatal hernia
Rolling hiatal hernia
In this type, a defect or weakening of the diaghragmatic hiatus
such that a portion of the gastric fundus roles up alongside
the esophagus into the thorax. The junction between the
esophagus and stomach remains in its normal position.
CLINIACAL FEATURES
 Rolling type: sensation of fullness after eating, sometimes
twisting and srangulation of the herniated portion
produces an emergency
 Sliding type: only heart burn due to gastroesophageal
reflex.
TREATMENT
Medical; anti acid, proton pump inhibitors(Omeprazole)
Surgery
 ESOPHAGEAL VARICES
Abnormal dilation of the esophageal veins and
venous plexus is called esophageal varices.
ETIOLOGY AND PATHOPHYSIOLOGY
The basic cause of esophageal varices is the portal
hypertension which resulted usually from liver
cirrhosis. Normally venous blood returning from
the spleen, stomach and small intestine passes
through the liver were detoxification occurs and
then drained into inferior venacava to the right
atrium of the heart. The blockage of this system
inside the liver causes portal hypertention.
 Varices
• As a result of this blockage bypass develops
and the blood flows from the portal system
into the systemic circulation especially at the
lower end of the esophagus. The increased
pressure in the esophageal plexus produces
dilated tortuous vessels called varices.
Varices occur in approximately 2/3 of all
cirrhotic patients. The varices may rupture
and result in hematemeses.
 Esophageal varices

Turtous dilated viens in the submocusa of distal

esophagus
 Clinical features
Varices produce no symptoms untill they
rupture. Rupture of varices produce massive
hemorrhage and about 15% death in
advanced cirrhosis is due to rupture of varices.
TREATMEN
Medical: Propanalol – decrease esophageal
pressure
Surgery: Ligations/compression
Thanks