A Barium Study
Transcript of A Barium Study
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AN INTERESTING
CASE OF
VOMITINGDepartment of Medical GastroenterologyMadras Medical College
Chennai - 3
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HISTORY
MRS. N
80/F
CHENNAI
PRESENTING COMPLAINTS
PAIN ABDOMEN 4 YEARS.
VOMITING 4 YEARS.
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HISTORY
PAIN ABDOMEN, BURNING IN NATURE,NOT RADIATING, INCREASING WITHFOOD INTAKE & RELIEVED BYVOMITING, NO NOCTURNAL PAIN.
VOMITING INTERMITTENT, INDUCEDVOMITING.
H/O HEART BURN.
H/O HOLD UP IN LOWER CHEST.
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HISTORY
APPETITE REDUCED.WEIGHT STABLE. BOWEL HABITS REGULAR.
NO H/O GI BLEED.
MICTURITION NORMAL.
NO H/O FEVER, JAUNDICE OR DRUG
INTAKE (NSAID).
NO PAST H/O DM, HT, PT, IHD, COPDOR BLOOD TRANSFUSION.
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EXAMINATION NO PALLOR, ICTERUS, PEDAL EDEMA
PULSE: 80 / MIN BP: 130 / 80 mm of Hg
CVS: NORMAL.
RS: NORMAL.
CNS: NORMAL
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EXAMINATION
ABDOMEN:
NO DISTENSION, VGP OR VIP
FLANKS FREE
UMBILICUS NORMAL NO ENGORGED VEINS
TENDERNESS PRESENT OVER THE
EPIGASTRIC REGION NO ORGANOMEGALY
NO FREE FLUID
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INVESTIGATIONS
HB%: 9.6 gm, TC: 8600, DC: P56 L42 E2,ESR:12mm / Hr.
URINE: ALB, SUG, DEP : NIL
MOTION: OVA,CYST, OB : NIL
UREA: 18 mg%, SUGAR: 110mg%,CREATININE: 0.8mg%
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UGI ENDOSCOPY
OESOPHAGUS NORMAL. INABILITY TO PASS BEYOND CARDIA
AND FUNDUS INTO THE BODY OF THE
STOMACH. SCOPE PASSED DISTALLY WITH
DIFFICULTY, BY KEEPING THE PATIENTIN RIGHT LATERAL POSITION.
EROSIVE ANTRAL GASTRITIS.
NORMAL BULB AND D 2.
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RADIOLOGY
PLAIN X RAY ABDOMEN.
BARIUM MEAL STUDY.
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FINAL DIAGNOSIS
CHRONIC GASTRIC VOLVULUS
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DEFINITION
The term Volvulusrefers to an acquiredtwist of a viscus on itself and is derivedfrom the Latin word volvere, meaning totwist around.
Gastric volvulus is defined as anabnormal degree of rotation of one part
of the stomach around another.
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CLINICAL FEATURES
Acute volvulus
Borchardts triad
Severe epigastric pain and distension
Violent nonproductive retching Inability to pass a Ryles tube.
Chronic volvulus
Symptomless
Incidental finding
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CLASSIFICATIONType Organoaxial
Mesenterioaxial
Combination
Extent
Total Partial
Direction
Anterior
Posterior
Onset Acute
Chronic
Aetiology
Idiopathic
Secondary
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AXIS OF ROTATION1. MESENTREROAXIAL
2. ORGANOAXIALALONG THEBODY.
3. ORGANOAXIALALONG THE
GASTROESOPHAGEALAND PYLORICAXIS
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ORGANOAXIAL VOLVULUS
The rotation may occur around a linejoining the pylorus to theoesophagogastric junction.
The greater curvature usually swings
anteriorly and upward so that theposterior surface of the stomachbecomes the anterior.
This rotation results in an upside-downstomach, with the greater curvature onthe top and the lesser curvature on thebottom.
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MESENTEROAXIAL VOLVULUS
The axis of rotation is a horizontal linethat runs from the center of the greatercurvature to porta hepatis.
The pyloroantral area rotates from rightto left so that the posterior surface of thestomach becomes the anterior.
In this the stomach is right-side-up, butbackward.
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INVESTIGATION Plain x ray abdomen
Upper GI endoscopy
Barium meal series
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TREATMENTACUTE VOLVULUS
SURGERY
ENDOSCOPY
CHRONIC VOLVULUS
CONSERVATIVE
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