Digestive System (GIT) – Surgery

1. Esophagus: Disorders and Management

Esophagus Anatomy: Length: 25 cm long, a muscular tube.

1. Infections and Esophagitis:

1. Candida Esophagitis:
   • History: Common in immunocompromised patients.
   • Symptoms: Painful swallowing, possible dysphagia.
   • Endoscopy Findings: White plaques adhering to the mucosa.
   • Cause: Candida albicans.
2. Cytomegalovirus (CMV) Esophagitis:
   • In Older or Immunocompromised Patients: More common in these individuals.
   • Diagnosis: Intracytoplasmic inclusion bodies in esophageal cells (diagnostic for CMV).
   • Treatment: Ganciclovir.
3. Herpes Simplex Virus (HSV) Esophagitis:
   • Treatment: Acyclovir.

2. Achalasia and Esophageal Spasm:

Symptoms:

• Dysphagia: Difficulty swallowing.
• Poor Appetite: Often associated with difficulty swallowing.
• Sensation of Early Fullness: Feeling full quickly while eating.
• Corkscrew-shaped Esophagus: Indicative of esophageal spasm.
• Bird Beak Appearance: Seen in achalasia cardia, where the lower esophageal sphincter does not relax properly, leading to a “bird beak” appearance on imaging.

Diagnosis:

• Manometry: Gold standard for diagnosing achalasia, which measures the pressure in the esophagus and lower esophageal sphincter.

Treatment for Achalasia:

1. Calcium Channel Blockers (CCB): To relax the smooth muscles of the esophagus.
2. Nitric Oxide: Can help in relaxing the lower esophageal sphincter.
3. Botox Injections: Used to relax the lower esophageal sphincter, providing symptom relief.
4. Definitive Treatment:
   • Heller Myotomy: Surgical procedure to cut the muscle at the lower esophageal sphincter, allowing food to pass more easily.

3. Barrett’s Esophagus

Intestinal Metaplasia:

• Stratified squamous epithelium changes to simple columnar epithelium.
• Can progress to adenocarcinoma.

Cancer Types:

• 1/3 of cases are adenocarcinoma.
• 2/3 of cases are squamous cell carcinoma.

4. Plummer-Vinson Syndrome

• Clinical Features:
  • Dysphagia.
  • Iron deficiency.
  • Esophageal web.

Bisphosphonates

• Use: Commonly used in rheumatology.
• Cause of Esophagitis: Can lead to esophagitis as a side effect.

2. Stomach

• Shape: J-shaped
• Function: Storage of food

Cell Types:

1. Parietal Cell:
   • Secretes HCl (Hydrochloric Acid).
   • Important for Vitamin B12 absorption.
2. Chief Cell:
   • Secretes Pepsinogen, which is converted into pepsin for protein digestion.

Types of Ulcers:

1. Burn Culling Ulcer:
   • Associated with burns and trauma.
2. ICP Raised Cushing Ulcer:
   • Seen in patients with increased intracranial pressure (ICP).
3. Gastric Ulcer:
   • Typically affects the left gastric artery.
4. Duodenal Ulcer:
   • Typically affects the gastroduodenal artery.

2. H. Pylori Treatment

• First-line treatment:
  • PPI (Proton Pump Inhibitor)
  • Clarithromycin
  • Amoxicillin or Flagyl

Diagnosis of H. Pylori Infection:

• Blood test
• Stool test
• Urea breath test

3. Gastric Ulcer and Complications:

• History of Rheumatoid Arthritis:
  • Long-term NSAID use can lead to gastric ulcer and epigastric pain.
  • Biopsy of the ulcer may be required to rule out gastric carcinoma.

4. Cancer Spread and Lymph Node Involvement:

• Virchow’s Node:
  • Left supraclavicular lymph node, often associated with gastric cancer.
• Sister Mary Joseph Nodule:
  • A palpable nodule in the umbilicus, often indicative of abdominal malignancy.
• Krukenberg Tumor:
  • Metastatic gastric cancer to the ovaries.

5. Irritable Bowel Syndrome (IBS)

Gender Distribution:

• Females > Males
• Commonly affects individuals aged 20-40 years.

Clinical Features:

• Abdominal bloating, often relieved after defecation.

Management:

• Diet Changes:
  • Increase intake of vegetables and fluids.
• Laxatives: Used for constipation-type IBS.

6. Carcinoid Tumor

A tumor that results in increased serotonin levels in the body.

Common Locations:

• Ileum
• Appendix

Clinical Features:

• Facial flushing: A common symptom due to serotonin release.
• Chronic diarrhea: Caused by serotonin’s effect on the gastrointestinal tract.
• Weight loss: Often seen in patients with carcinoid syndrome.

Diagnosis:

• 5-HIAA (5-Hydroxyindoleacetic acid) in urine
• CT Scan.

Treatment:

• Octreotide.
• Surgery.

Tricuspid Valve Involvement:

• Seen in IV drug abusers with carcinoid tumors. The increased serotonin can cause tricuspid valve fibrosis, leading to tricuspid regurgitation.

7. Carcinoid Syndrome

Clinical Presentation:

• Dementia
• Dermatitis
• Diarrhea

Biochemical Imbalance:

• Increased tryptophan (which is converted to serotonin).
• Increased serotonin levels.
• Decreased niacin (Vitamin B3) due to tryptophan being used for serotonin production, leading to niacin deficiency.

Here are other materials for NLE NRE step 1

8. Gastrointestinal Symptoms: Diarrhea and Abdominal Bloating

1. Lactose Intolerance:

• Cause: Inability to digest lactose, typically due to lactase deficiency.
• Symptoms: Diarrhea and bloating after consuming dairy products.
• Management:
  • Lactose-free diet.
  • Use of lactulose (sometimes as a laxative).
  • Avoidance of dairy products.

2. Celiac Disease:

• Cause: An autoimmune disorder triggered by wheat-containing foods, specifically gluten.
• Symptoms: Diarrhea, abdominal bloating, and malabsorption.
• Diagnostic Test: Anti-endomysial antibody test.
• Skin Manifestation: Dermatitis herpetiformis.
• Treatment:
  • Dapsone (used for managing dermatitis herpetiformis).
  • Gluten-free diet to manage the disease.
• Complication: Iron deficiency anemia due to malabsorption.