Stomach anatomy +congenital hypertropic pyloric stenosis.pptx

Lecture notes for medical students

1. Tips on using my ppt. You can freely download, edit, modify and put your name etc. Don’t be concerned about number of slides. Half the slides are blanks except for the title. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. At the end rerun the show – show blank> ask questions > show next slide. This will be an ACTIVE LEARNING SESSION x three revisions. Good for self study also. See notes for bibliography.

2. Introduction & History.

3. Introduction & History. It is a muscular, highly vascular bag-shaped organ that is distensible and may take varying shapes, depending on the build and posture of the person and the state of fullness of the organ

4. Parts

5. Parts The esophagogastric junction ( cardia ),  The cardiac notch ( incisura cardiaca gastri ) fundus   body (corpus)  pyloric antrum   pyloric canal,  convex greater curvature  concave lesser curvature  The junction of the vertical and horizontal parts of the lesser curvature is called incisura angularis .

6. Arterial Supply

7. Arterial Supply celiac trunk (axis)- common hepatic artery, splenic artery, and the left gastric artery left gastric artery right gastric artery branch from the proper or common hepatic artery Pancreaticoduodenal artery-   right gastro- omental ( gastroepiploic ) artery splenic artery left gastro-epiploic (gastro- omental ) artery short gastric arteries from splenic art.

8. Arterial Supply

9. Venous Drainage

10. Venous Drainage Portal Vein left gastric (coronary) vein right gastric  right gastro- omental veins left gastro- omental vein  short gastric veins splenic vein,

11. Lymphatic Drainage

12. Lymphatic Drainage 4 levels- Level I ( perigastric lymph nodes) - Right paracardiac (1), left paracardiac (2), along lesser curvature (3) along greater curvature (4), suprapyloric (5), infrapyloric (6) Level 2 - Along LGA (7), along CHA (8), along celiac axis (9), at splenic hilum (10), along splenic artery (11)

13. Lymphatic Drainage 4 levels- Level 3 - In hepato -duodenal ligament (12), behind duodenum and pancreas head (13), at the root of small bowel mesentery (14) Level 4 - Mesocolic (15), paraaortic (16)

14. Nerve Supply

15. Nerve Supply Parasympathetic- Right and left Vagus Sympathetic- celiac ganglia (T5-T9).

16. Relations

17. Relations Anterior left lobe (segments II, III and IV) of the liver anterior abdominal wall the distal transverse colon. Posterior(stomach bed). left hemidiaphragm Spleen left kidney (and adrenal) pancreas The omental bursa (lesser sac) lies behind the stomach and in front of the pancreas;

18. Attachments/Supports

19. Attachments/Supports To liver by the hepatogastric ligament (the left portion of the lesser omentum)  to the left hemidiaphragm by the gastrophrenic ligament, to the spleen by the gastrosplenic / gastrolienal ligament   to the transverse colon by the gastrocolic ligament (part of the greater omentum Few peritoneal bands may be present between the posterior surface of the stomach and the anterior surface of the pancreas. 

20. Microscopic Anatomy

21. Microscopic Anatomy columnar epithelium chief ( zymogenic ) cells in the fundus secrete protein digesting pre-enzyme pepsinogen ; parietal ( oxyntic ) cells in the body (corpus) of the stomach secrete acid (H+ ions) and intrinsic factor G cells in the antrum secrete gastrin  

22. Pediatric Hypertrophic Pyloric Stenosis

23. Etiology

24. Etiology Idiopathic Congenital Traumatic Infections /Infestation Autoimmune Neoplastic (Benign/Malignant) Degenerative

25. Etiology Now believed to be aquired . Early exposure to erythromycin (at 3-13 days of life decreased expression of neuronal NOS genes on loci 11q14-22 and Xq23.  genetic predisposition is suggested in families with occurrences of pyloric stenosis reported in at least three generations Involvement in twins has been reported, with an 85.7% concordance rate in monozygotic twins and an 8.4% concordance rate in dizygotic twins.

26. Pathophysiology

27. Pathophysiology Hypertrophy of the circular muscle of the pylorus, resulting in narrowing and obstruction of the pyloric channel  Grossly, the pylorus is enlarged, resembling a tumor approximating the size and shape of an olive ( ie , 2 cm long and 1 cm in diameter) Microscopically, the circular muscle hypertrophies, with increased connective tissue in the septa between the muscle bundles.

28. Pathophysiology Gastric fluid loss is associated with the loss of H + and Cl – This fluid loss is unlike that in conditions caused by vomiting with an open pylorus, which involves losses of gastric, pancreatic, biliary , and intestinal fluid.  Hypochloremic hypokalemic  metabolic alkalosis is the characteristic biochemical disturbance  Paradoxic aciduria -urinary excretion of K +  and H + increases in an attempt to preserve Na +  and volume..

29. Clinical Features

30. Clinical Features Demography Symptoms Signs Prognosis Complications

31. Demography

32. Demography 1 case per 3000-4000 live births to as many as 8.2-12 cases per 1000 live births rarely found in patients of Asian  more common in males than in females (male-to-female ratio, 4:1)

33. Symptoms

34. Symptoms most often occurs in neonates and infants aged 1-10 weeks (mean, 5 weeks; range, 5 days to 5 months). projectile vomiting always nonbilious but may have brown discoloration or a coffee-ground appearance The vomiting occurs within 30-60 minutes after feeding The infant remains hungry and usually attempts to feed immediately after vomiting.

35. Signs

36. Signs Weight loss and evidence of dehydration ( eg , decreased tearing and urinary output, with poor skin turgor ) visible gastric contractions occurring in a wavelike manner from left to right across the abdomen. oblong, smooth, hard mass that is 1-2 cm in lengthin the epigastrium just above the umbilicus, either in the midline or just to the right

37. Prognosis

38. Prognosis Good if operated

39. Investigations

40. Investigations Laboratory Studies Routine Special Imaging Studies Tissue diagnosis Cytology FNAC Histlogy

41. Investigations Laboratory Studies An electrolyte panel Urinalysis with normalization of urinary pH (correction of paradoxic aciduria )

42. Diagnostic Studies

43. Diagnostic Studies Imaging Studies X-Ray USG CT Angiography MRI Endoscopy Nuclear scan

44. Diagnostic Studies Imaging Studies On ultrasonography Pyloric diameter >14 mm Muscular thickness >4 mm Length >16 mm Upper gastrointestinal (UGI) contrast studies

45. Differential Diagnosis

46. Differential Diagnosis gastroesophageal reflux duodenal atresia malrotation pyloric spasm central nervous system (CNS) lesions

47. Management

48. Management Resucitation + - cimetidine   Ramstedt’s pyloromyotomy laproscopic pyloromyotomy endoscopic pyloromyotomy oral atropine

49. Get this ppt in mobile Download Microsoft PowerPoint from play store. Open Google assistant Open Google lens. Scan qr code from next slide.

50. Get this ppt in mobile

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