Sharp objects can be removed over overtubes and not always require surgery. Lead batteries can corrode and decay in the stomach or intestine and should always be removed. Most common impacted foreign bodies are food boluses above a pathological narrowing and require endoscopic break up
Contrast examination is not always required and might complicate things
This is an interesting question because this is one tumor in which breakthrough has not been achieved in the last 70 years. Pancreatic cancer remains one of the deadliest cancers of the GI tract and whipple's surgery continues to have high morbidity.
We discuss the role and response of chemotherapy also
Dumping syndrome are most common after billroth II gastrectomy followed by BI and Truncal vagotomy and gastro jejunostomy.
Dumping can occur 30 mins after food, (early dumping) or 2 hours after eating (late dumping). Early dumping has GI symptoms such as nausea, vomiting, epigastric fullness, diarrhea and abdominal pain.
Early dumping occurs due to rapid emptying of chyme in jejunum. This hyperosmolar fluid draws water from extracellular compartment to the lumen of small intestine causing intestinal distension and autonomic changes.Serotonin, bradykinin-like substances, neurotensin, and enteroglucagon are involved in early dumping.
Late dumping syndrome has more cardiovascular symptoms such as palpitations, light headedness, dizziness, tachycardia, diaphoresis, flushing and blurred vision.
It occurs due to delivery of carbohydrates into jejunum, their absorption causes hyperglycemia and insulin release. Excessive insulin release leads to development of symptoms.
Treatment
Diet - Avoid carbohydrates, frequent small meals of protein and fat and separate liquids from solids
Q) According to Siewert classification tumors at GE junction are
a) Type I
b) Type II
c) Type III
d) Type IV
Answer b
Type I Lower (center located within between 1-5cm above the anatomic OGJ)
Type II Real GE junction (within 1cm above and 2cm below the OGJ)
Type III (2-5cm below OGJ)
This classification has only 3 subtypes
According to the Siewert-Stein classification,
Type I tumour 25% approx
Type II - Most common 49%
Type III was present in 25%
This classification helps in deciding the operative management and unified pre op classification
Types of Surgery
Type I cancer--depending of the size of the tumour--distal 2/3 oesophagectomy with the resection of the proximal lesser curve of the stomach or total gastrectomy or THE
In patients with types II and III cancers total gastrectomy
