HTHSCI 2F03 Lecture Notes - Lecture 5: Hiatus Hernia, Intestinal Metaplasia, Stomach

• School: McMaster University
• Department: Health Sciences
• Course: HTHSCI 2F03
• Professor: Bruce Wainman

Document Summary

Los dysfunction reflux of gastric contents oesophagitis. Worse lying down (e. g. @ night) / stooping. Small regular meals 3h before bed. Stop drugs: nsaids, anti-achm, nitrates, ccb, tcas. 2: no response double dose ppi bd. Mobilise gastric fundus and wrap around lower oesophagus. Gastro-oesophageal junction remains in abdomen but a bulge of stomach rolls into chest alongside the oesophagus. Cxr: gas bubble and fluid level in chest. 24h ph + manometry: exclude dysmotility or achalasia. Surgery if intractable symptoms despite medical rx. Should repair rolling hernia (even if asympto) as it may strangulate. Acid secretion stimulated by gastrin (from antral g cells) and vagus n. Acid secretion directly and via gastrin. Must be combined c pyloroplasty (widening of pylorus) or gastroenterostomy. Vagus nerve only denervated where it supplies lower oesophagus and stomach. Nerves of laterjet (supply pylorus) left intact. Billroth 2 /polya: to small bowel loop c duodenal stump oversewn. Reflux or bilious vomiting (improves c time)