DOCSLIB.ORG

Stomach, Thick Muscular Wall Called Pyloric Sphincter and the Cavity of Pylorus Is Pyloric Canal (Length of Canal 2.5 Cm)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Stomach, Thick Muscular Wall Called Pyloric Sphincter and the Cavity of Pylorus Is Pyloric Canal (Length of Canal 2.5 Cm) Divisions: 1)Fundus: is dome-shaped projects upward , It is usually full of gas. 2)Body: This extends from level of cardiac orifice to incisura angularis ( constant notch in lower part of lesser curvature ). 3) Antrum: extends from incisura angularis to pylorus. 4) Pylorus: This is the most tubular part of stomach, thick muscular wall called pyloric sphincter and the cavity of pylorus is pyloric canal (length of canal 2.5 cm). Two Openings : *Cardiac orifice. *Pyloric orifice. Two Curvatures : * Greater curvature. *Lesser curvature. Two Surfaces : *Anterior surface. *posterior surface. The cardiac orifice is where esophagus enters stomach & it has a physiologic sphincter exists that prevents regurgitation of stomach contents into esophagus . The circular muscle coat of pylorus is much thicker here and forms anatomical pyloric sphincter Lesser curvature forms right border of stomach extends from cardiac orifice to pylorus. Greater curvature is much longer than lesser curvature ,extends from left of cardiac orifice over dome of fundus & along left border of stomach to pylorus . 1)Lesser omentum: suspended lesser curvature to liver. 2)Greater omentum: extends from the greater curvature to the transverse colon. 3) Gastrosplenic ligament : extends from upper part of greater curvature to spleen . Relations: Anteriorly: Anterior abdominal wall Left costal margin Left pleura and lung Diaphragm Left lobe of the liver . Posteriorly: The lesser sac Diaphragm spleen , splenic artery left suprarenal gland upper part of left kidney pancreas transverse mesocolon. transverse colon Arteries: 1) The left gastric artery : arises from celiac artery. It passes upward & to the left reach esophagus and then descends along the lesser curvature of stomach. It supplies lower part of esophagus and upper right part of stomach. 2)The right gastric artery : It arises from hepatic artery at upper border of pylorus. It supplies lower right part of stomach. 3)The short gastric arteries: It arise from splenic artery at hilum of spleen & supply the fundus. 4)The left gastroepiploic artery: it arises from splenic artery at hilum of spleen & supply stomach along upper part of greater curvature. 5)The right gastroepiploic artery: it arises from gastroduodenal branch of hepatic artery & supplies the lower part of greater curvature. Veins: 1)The left & right gastric veins: drain directly into portal vein. 2)The short gastric veins & left gastroepiploic veins: join the splenic vein then to portal vein. 3)The right gastroepiploic vein: joins the superior mesenteric vein then to portal vein. Lymph Drainage: All lymph from the stomach eventually passes to the celiac nodes located around the root of the celiac artery on the posterior abdominal wall. 1)Sympathetic Fibers : pain-transmitting fibers by celiac plexus. 2)Parasympathetic Fibers :secretomotor fibers: a)Anterior vagal trunk : left vagus supply the anterior surface of the stomach ,large hepatic branch & pyloric branch. b)Posterior vagal trunk: right vagus supply posterior surface of the stomach, large branch to the celiac & superior mesenteric plexuses and is distributed to the intestine . The mucous membrane of the stomach is thick and vascular and is thrown into numerous folds (rugae) that are mainly longitudinal in direction The folds flatten out when the stomach is distended. Portal tributary systemic tributary lower 1/3 esophagus: Middle 1/3 esophagus : esophageal branches of left esophageal veins draining in gastric vein. Azygos veins. Upper 1/2 of anal canal: Lower 1/2 of anal canal: superior rectal veins. middle & inferior rectal veins (internal pudendal vein). The veins of ascending The renal, lumbar& phrenic colon, descending colon, veins . duodenum, pancreas &liver . Portosystemic Anastmosis Portal tributary Systemic tributary The connection of left The superficial veins of branch of portal vein with the anterior abdominal paraumbilical veins travel in wall. falciform ligament. .
Load more

Recommended publications
  • Splenic Artery Embolization for the Treatment of Gastric Variceal Bleeding Secondary to Splenic Vein Thrombosis Complicated by Necrotizing Pancreatitis: Report of a Case
    Hindawi Publishing Corporation Case Reports in Medicine Volume 2016, Article ID 1585926, 6 pages http://dx.doi.org/10.1155/2016/1585926 Case Report Splenic Artery Embolization for the Treatment of Gastric Variceal Bleeding Secondary to Splenic Vein Thrombosis Complicated by Necrotizing Pancreatitis: Report of a Case Hee Joon Kim, Eun Kyu Park, Young Hoe Hur, Yang Seok Koh, and Chol Kyoon Cho Department of Surgery, Chonnam National University Medical School, Gwangju, Republic of Korea Correspondence should be addressed to Chol Kyoon Cho; [email protected] Received 11 August 2016; Accepted 1 November 2016 Academic Editor: Omer Faruk Dogan Copyright © 2016 Hee Joon Kim et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Splenic vein thrombosis is a relatively common finding in pancreatitis. Gastric variceal bleeding is a life-threatening complication of splenic vein thrombosis, resulting from increased blood flow to short gastric vein. Traditionally, splenectomy is considered the treatment of choice. However, surgery in necrotizing pancreatitis is dangerous, because of severe inflammation, adhesion, and bleeding tendency. In the Warshaw operation, gastric variceal bleeding is rare, even though splenic vein is resected. Because the splenic artery is also resected, blood flow to short gastric vein is not increased problematically. Herein, we report a case of gastric variceal bleeding secondary to splenic vein thrombosis complicated by necrotizing pancreatitis successfully treated with splenic artery embolization. Splenic artery embolization could be the best treatment option for gastric variceal bleeding when splenectomy is difficult such as in case associated with severe acute pancreatitis or associated with severe adhesion or in patients withhigh operation risk.
    [Show full text]
  • CASE REPORT Spinal Cord Infarction Following Endoscopic Variceal Ligation
    Spinal Cord (2008) 46, 241–242 & 2008 International Spinal Cord Society All rights reserved 1362-4393/08 $30.00 www.nature.com/sc CASE REPORT Spinal cord infarction following endoscopic variceal ligation K Tofuku, H Koga, T Yamamoto, K Yone and S Komiya Department of Orthopaedic Surgery, Kagoshima Graduate School of Medical and Dental Sciences, Kagoshima, Japan Study design: A case report of spinal cord infarction following endoscopic variceal ligation. Objectives: To describe an exceedingly rare case of spinal cord infarction following endoscopic variceal ligation. Setting: Department of Orthopaedic Surgery, Kagoshima, Japan. Methods: A 75-year-old woman with cirrhosis caused by hepatitis C virus, who was admitted to our hospital for the treatment of esophageal varices, experienced numbness of the hands and lower extremities bilaterally following an endoscopic variceal ligation procedure. Sensory and motor dysfunction below C6 level progressed rapidly, resulting in inability to move the lower extremities the following day. Magnetic resonance imaging of the spine revealed abnormal spinal cord signal on T2-weighted images from approximately C6 through T5 levels, which was diagnosed as spinal cord infarction. Results: The patient underwent hyperbaric oxygen treatment. Her symptoms and signs related to spinal cord infarction gradually remitted, and nearly complete disappearance of neurological deficits was noted within 3 months after the start of treatment. Conclusion: We speculate that the pathogenesis of the present case may have involved congestion of the abdominal–epidural–spinal cord venous network owing to ligation of esophageal varices and increased thoracoabdominal cavity pressure. Spinal Cord (2008) 46, 241–242; doi:10.1038/sj.sc.3102092; published online 19 June 2007 Keywords: endoscopic variceal ligation; hyperbaric oxygen; spinal cord infarction Introduction The spectrum of etiologies of spinal cord infarction is as On physical examination, her right upper extremity diverse as that for cerebral infarction.
    [Show full text]
  • Arteries and Veins) of the Gastrointestinal System (Oesophagus to Anus)
    2021 First Sitting Paper 1 Question 07 2021-1-07 Outline the anatomy of the blood supply (arteries and veins) of the gastrointestinal system (oesophagus to anus) Portal circulatory system + arterial blood flow into liver 1100ml of portal blood + 400ml from hepatic artery = 1500ml (30% CO) Oxygen consumption – 20-35% of total body needs Arterial Supply Abdominal Aorta • It begins at the aortic hiatus of the diaphragm, anterior to the lower border of vertebra T7. • It descends to the level of vertebra L4 it is slightly to the left of midline. • The terminal branches of the abdominal aorta are the two common iliac arteries. Branches of Abdominal Aorta Visceral Branches Parietal Branches Celiac. Inferior Phrenics. Superior Mesenteric. Lumbars Inferior Mesenteric. Middle Sacral. Middle Suprarenals. Renals. Internal Spermatics. Gonadal Anterior Branches of The Abdominal Aorta • Celiac Artery. Superior Mesenteric Artery. Inferior Mesenteric Artery. • The three anterior branches supply the gastrointestinal viscera. Basic Concept • Fore Gut - Coeliac Trunk • Mid Gut - Superior Mesenteric Artery • Hind Gut - Inferior Mesenteric Artery Celiac Trunk • It arises from the abdominal aorta immediately below the aortic hiatus of the diaphragm anterior to the upper part of vertebra LI. • It divides into the: left gastric artery, splenic artery, common hepatic artery. o Left gastric artery o Splenic artery ▪ Short gastric vessels ▪ Lt. gastroepiploic artery o Common hepatic artery ▪ Hepatic artery proper JC 2019 2021 First Sitting Paper 1 Question 07 • Left hepatic artery • Right hepatic artery ▪ Gastroduodenal artery • Rt. Gastroepiploic (gastro-omental) artery • Sup pancreatoduodenal artery • Supraduodenal artery Oesophagus • Cervical oesophagus - branches from inferior thyroid artery • Thoracic oesophagus - branches from bronchial arteries and aorta • Abd.
    [Show full text]
  • Dr. ALSHIKH YOUSSEF Haiyan
    Dr. ALSHIKH YOUSSEF Haiyan General features The peritoneum is a thin serous membrane Consisting of: 1- Parietal peritoneum －lines the ant. Abdominal wall and the pelvis 2- Visceral peritoneum - covers the viscera 3- Peritoneal cavity - the potential space between the parietal and visceral layer of peritoneum - in male, is a closed sac - but in the female, there is a communication with the exterior through the uterine tubes, the uterus, and the vagina ▪ Peritoneum cavity divided into Greater sac Lesser sac Communication between them by the epiploic foramen The peritoneum The peritoneal cavity is the largest one in the body. Divided into tow sac : .Greater sac; extends from diaphragm down to the pelvis. Lesser Sac .Lesser sac or omental bursa; lies behind the stomach. .Both cavities are interconnected through the epiploic foramen(winslow ). .In male : the peritoneum is a closed sac . .In female : the sac is not completely closed because it Greater Sac communicates with the exterior through the uterine tubes, uterus and vagina. Peritoneum in transverse section The relationship between viscera and peritoneum Intraperitoneal viscera viscera is almost totally covered with visceral peritoneum example, stomach, 1st & last inch of duodenum, jejunum, ileum, cecum, vermiform appendix, transverse and sigmoid colons, spleen and ovary Intraperitoneal viscera Interperitoneal viscera Retroperitoneal viscera Interperitoneal viscera Such organs are not completely wrapped by peritoneum one surface attached to the abdominal walls or other organs. Example liver, gallbladder, urinary bladder and uterus Upper part of the rectum, Ascending and Descending colon Retroperitoneal viscera some organs lie on the posterior abdominal wall Behind the peritoneum they are partially covered by peritoneum on their anterior surfaces only Example kidney, suprarenal gland, pancreas, upper 3rd of rectum duodenum, and ureter, aorta and I.V.C The Peritoneal Reflection The peritoneal reflection include: omentum, mesenteries, ligaments, folds, recesses, pouches and fossae.
    [Show full text]
  • Vessels and Circulation
    CARDIOVASCULAR SYSTEM OUTLINE 23.1 Anatomy of Blood Vessels 684 23.1a Blood Vessel Tunics 684 23.1b Arteries 685 23.1c Capillaries 688 23 23.1d Veins 689 23.2 Blood Pressure 691 23.3 Systemic Circulation 692 Vessels and 23.3a General Arterial Flow Out of the Heart 693 23.3b General Venous Return to the Heart 693 23.3c Blood Flow Through the Head and Neck 693 23.3d Blood Flow Through the Thoracic and Abdominal Walls 697 23.3e Blood Flow Through the Thoracic Organs 700 Circulation 23.3f Blood Flow Through the Gastrointestinal Tract 701 23.3g Blood Flow Through the Posterior Abdominal Organs, Pelvis, and Perineum 705 23.3h Blood Flow Through the Upper Limb 705 23.3i Blood Flow Through the Lower Limb 709 23.4 Pulmonary Circulation 712 23.5 Review of Heart, Systemic, and Pulmonary Circulation 714 23.6 Aging and the Cardiovascular System 715 23.7 Blood Vessel Development 716 23.7a Artery Development 716 23.7b Vein Development 717 23.7c Comparison of Fetal and Postnatal Circulation 718 MODULE 9: CARDIOVASCULAR SYSTEM mck78097_ch23_683-723.indd 683 2/14/11 4:31 PM 684 Chapter Twenty-Three Vessels and Circulation lood vessels are analogous to highways—they are an efficient larger as they merge and come closer to the heart. The site where B mode of transport for oxygen, carbon dioxide, nutrients, hor- two or more arteries (or two or more veins) converge to supply the mones, and waste products to and from body tissues. The heart is same body region is called an anastomosis (ă-nas ′tō -mō′ sis; pl., the mechanical pump that propels the blood through the vessels.
    [Show full text]
  • Portal Hypertensionand Its Radiological Investigation
    Postgrad Med J: first published as 10.1136/pgmj.39.451.299 on 1 May 1963. Downloaded from POSTGRAD. MED. J. (I963), 39, 299 PORTAL HYPERTENSION AND ITS RADIOLOGICAL INVESTIGATION J. H. MIDDLEMISS, M.D., F.F.R., D.M.R.D. F. G. M. Ross, M.B., B.Ch., B.A.O., F.F.R., D.M.R.D. From the Department of Radiodiagnosis, United Bristol Hospitals PORTAL hypertension is a condition in which there branch of the portal vein but may drain into the right is an blood in the branch. abnormally high pressure Small veins which are present on the serosal surface portal system of veins which eventually leads to of the liver and in the surrounding peritoneal folds splenomegaly and in chronic cases, to haematem- draining the diaphragm and stomach are known as esis and melaena. accessory portal veins. They may unite with the portal The circulation is in that it vein or enter the liver independently. portal unique The hepatic artery arises normally from the coeliac exists between two sets of capillaries, i.e. the axis but it may arise as a separate trunk from the aorta. capillaries of the spleen, pancreas, gall-bladder It runs upwards and to the right and divides into a and most of the gastro-intestinal tract on the left and right branch before entering the liver at the one hand and the sinusoids of the liver on the porta hepatis. The venous return starts as small thin-walled branches other hand. The liver parallels the lungs in that in the centre of the lobules in the liver.
    [Show full text]
  • The Diameter of the Originating Vein Determines Esophageal and Gastric Fundic Varices in Portal Hypertension Secondary to Posthepatitic Cirrhosis
    CLINICS 2012;67(6):609-614 DOI:10.6061/clinics/2012(06)11 CLINICAL SCIENCE The diameter of the originating vein determines esophageal and gastric fundic varices in portal hypertension secondary to posthepatitic cirrhosis Hai-ying Zhou, Tian-wu Chen, Xiao-ming Zhang, Li-ying Wang, Li Zhou, Guo-li Dong, Nan-lin Zeng, Hang Li, Xiao-li Chen, Rui Li Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan/China. OBJECTIVE: The aim of this study was to determine whether and how the diameter of the vein that gives rise to the inflowing vein of the esophageal and gastric fundic varices secondary to posthepatitic cirrhosis, as measured with multidetector-row computed tomography, could predict the varices and their patterns. METHODS: A total of 106 patients with posthepatitic cirrhosis underwent multidetector-row computed tomography. Patients with and without esophageal and gastric fundic varices were enrolled in Group 1 and Group 2, respectively. Group 1 was composed of Subgroup A, consisting of patients with varices, and Subgroup B consisted of patients with varices in combination with portal vein-inferior vena cava shunts. The diameters of the originating veins of veins entering the varices were reviewed and statistically analyzed. RESULTS: The originating veins were the portal vein in 8% (6/75) of patients, the splenic vein in 65.3% (49/75) of patients, and both the portal and splenic veins in 26.7% (20/75) of patients. The splenic vein diameter in Group 1 was larger than that in Group 2, whereas no differences in portal vein diameters were found between groups.
    [Show full text]
  • Downhill Varices Resulting from Giant Intrathoracic Goiter
    E40 UCTN – Unusual cases and technical notes Downhill varices resulting from giant intrathoracic goiter Fig. 2 Sagittal com- puted tomography of the chest. The goiter was immense, reaching the aortic arch, sur- rounding the trachea and partially compres- sing the upper esopha- gus. The esophagus was additionally com- pressed by anterior spinal spondylophytes. Fig. 1 Multiple submucosal veins in the upper esophagus, consistent with downhill varices. An 82-year-old man was admitted to the hospital because of substernal chest pain, dyspnea, and occasional dysphagia to sol- ids. His past medical history was remark- geal varices are called “downhill varices”, References able for diabetes mellitus type II, hyper- as they are located in the upper esophagus 1 Kotfila R, Trudeau W. Extraesophageal vari- – lipidemia, and Parkinson’s disease. On and project downwards. Downhill varices ces. Dig Dis 1998; 16: 232 241 2 Basaranoglu M, Ozdemir S, Celik AF et al. A occur as a result of shunting in cases of up- physical examination he appeared frail case of fibrosing mediastinitis with obstruc- but with no apparent distress. Examina- per systemic venous obstruction from tion of superior vena cava and downhill tion of the neck showed no masses, stri- space-occupying lesions in the medias- esophageal varices: a rare cause of upper dor or jugular venous distension. Heart tinum [2,3]. Downhill varices as a result of gastrointestinal hemorrhage. J Clin Gastro- – examination disclosed a regular rate and mediastinal processes are reported to enterol 1999; 28: 268 270 3 Calderwood AH, Mishkin DS. Downhill rhythm; however a 2/6 systolic ejection occur in up to 50% of patients [3,4].
    [Show full text]
  • Selective Esophagogastric Devascularization in the Modified
    Hindawi Canadian Journal of Gastroenterology and Hepatology Volume 2020, Article ID 8839098, 8 pages https://doi.org/10.1155/2020/8839098 Research Article Selective Esophagogastric Devascularization in the Modified Sugiura Procedure for Patients with Cirrhotic Hemorrhagic Portal Hypertension: A Randomized Controlled Trial Yawu Zhang,1,2,3 Lingyi Zhang,1,3,4 Mancai Wang ,1,2,3 Xiaoling Luo,1 Zheyuan Wang,1,2,3 Gennian Wang,1,2,3 Xiaohu Guo,1,2,3 Fengxian Wei,1,2,3 and Youcheng Zhang 1,2,3 1Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China 2Hepato-Biliary-Pancreatic Institute, Lanzhou University Second Hospital, Lanzhou 730030, China 3Gansu Provincial-Level Key Laboratory of Digestive System Tumors, Lanzhou 730030, China 4Department of Hepatology, Lanzhou University Second Hospital, Lanzhou 730030, China Correspondence should be addressed to Youcheng Zhang; [email protected] Received 7 June 2020; Revised 26 October 2020; Accepted 24 November 2020; Published 7 December 2020 Academic Editor: Kevork M. Peltekian Copyright © 2020 Yawu Zhang et al. .is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aim. Portal hypertension is a series of syndrome commonly seen with advanced cirrhosis, which seriously affects patient’s quality of life and survival. .is study was designed to access the efficacy and safety of selective esophagogastric devascularization in the modified Sugiura procedure for patients with cirrhotic hemorrhagic portal hypertension. Methods. Sixty patients with hepatitis B cirrhotic hemorrhagic portal hypertension and meeting the inclusion criteria were selected and randomly divided by using computer into the selective modified Sugiura group (sMSP group, n � 30) and the modified Sugiura group (MSP group, n � 30).
    [Show full text]
  • Normal Gross and Histologic Features of the Gastrointestinal Tract
    NORMAL GROSS AND HISTOLOGIC 1 FEATURES OF THE GASTROINTESTINAL TRACT THE NORMAL ESOPHAGUS left gastric, left phrenic, and left hepatic accessory arteries. Veins in the proximal and mid esopha- Anatomy gus drain into the systemic circulation, whereas Gross Anatomy. The adult esophagus is a the short gastric and left gastric veins of the muscular tube measuring approximately 25 cm portal system drain the distal esophagus. Linear and extending from the lower border of the cri- arrays of large caliber veins are unique to the distal coid cartilage to the gastroesophageal junction. esophagus and can be a helpful clue to the site of It lies posterior to the trachea and left atrium a biopsy when extensive cardiac-type mucosa is in the mediastinum but deviates slightly to the present near the gastroesophageal junction (4). left before descending to the diaphragm, where Lymphatic vessels are present in all layers of the it traverses the hiatus and enters the abdomen. esophagus. They drain to paratracheal and deep The subdiaphragmatic esophagus lies against cervical lymph nodes in the cervical esophagus, the posterior surface of the left hepatic lobe (1). bronchial and posterior mediastinal lymph nodes The International Classification of Diseases in the thoracic esophagus, and left gastric lymph and the American Joint Commission on Cancer nodes in the abdominal esophagus. divide the esophagus into upper, middle, and lower thirds, whereas endoscopists measure distance to points in the esophagus relative to the incisors (2). The esophagus begins 15 cm from the incisors and extends 40 cm from the incisors in the average adult (3). The upper and lower esophageal sphincters represent areas of increased resting tone but lack anatomic landmarks; they are located 15 to 18 cm from the incisors and slightly proximal to the gastroesophageal junction, respectively.
    [Show full text]
  • Color Doppler Evaluation of Left Gastric Vein Hemodynamics in Cirrhosis
    Published online: 2021-08-02 ABDOMINAL Color Doppler evaluation of left gastric vein hemodynamics in cirrhosis with portal hypertension and its correlation with esophageal varices and variceal bleed Subathra Adithan, Bhuvaneswari Venkatesan, Elangovan Sundarajan, Vikram Kate1, Raja Kalayarasan1 Departments of Radiodiagnosis and 1Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry - 605 006, India Correspondence: Dr. Subathra Adithan, Department of Radiodiagnosis, JIPMER, Dhanvantri Nagar, Pondicherry, India. E-mail: [email protected] Abstract Aim: The purpose of this study was to assess the value of Doppler evaluation of left gastric vein hemodynamics when monitoring portal hypertension patients, by correlating Doppler ultrasonography (USG) parameters with the severity of esophageal varices and occurrence of variceal bleeding. Methods: This study was carried out on 100 patients using Doppler USG and endoscopy. Forty- seven of these were patients with cirrhosis with portal hypertension, who had not had a recent variceal bleed (group 1) and 26 were patients with cirrhosis with portal hypertension, with a recent history of bleeding (group 2). The control group comprised of 27 subjects who did not have liver disease or varices on endoscopy (group 3). The hemodynamic parameters, namely the diameter of the left gastric vein and the direction and flow velocity in the vessel, were compared in these groups, with the grade of esophageal varices. Results: Hepatofugal flow velocity in the left gastric vein was higher in patients with large-sized varices compared to those patients with small-sized varices (P < 0.001). The left gastric vein hepatofugal flow velocity was higher in patients with a recent variceal bleed than in those patients without a history of a recent variceal bleed (P < 0.0149).
    [Show full text]
  • Residency Essentials Full Curriculum Syllabus
    RESIDENCY ESSENTIALS FULL CURRICULUM SYLLABUS Please review your topic area to ensure all required sections are included in your module. You can also use this document to review the surrounding topics/sections to ensure fluidity. Click on the topic below to jump to that page. Clinical Topics • Gastrointestinal • Genitourinary • Men’s Health • Neurological • Oncology • Pain Management • Pediatrics • Vascular Arterial • Vascular Venous • Women’s Health Requisite Knowledge • Systems • Business and Law • Physician Wellness and Development • Research and Statistics Fundamental • Clinical Medicine • Intensive Care Medicine • Image-guided Interventions • Imaging and Anatomy Last revised: November 4, 2019 Gastrointestinal 1. Portal hypertension a) Pathophysiology (1) definition and normal pressures and gradients, MELD score (2) Prehepatic (a) Portal, SMV or Splenic (i) thrombosis (ii) stenosis (b) Isolated mesenteric venous hypertension (c) Arterioportal fistula (3) Sinusoidal (intrahepatic) (a) Cirrhosis (i) ETOH (ii) Non-alcoholic fatty liver disease (iii) Autoimmune (iv) Viral Hepatitis (v) Hemochromatosis (vi) Wilson's disease (b) Primary sclerosing cholangitis (c) Primary biliary cirrhosis (d) Schistosomiasis (e) Infiltrative liver disease (f) Drug/Toxin/Chemotherapy induced chronic liver disease (4) Post hepatic (a) Budd Chiari (Primary secondary) (b) IVC or cardiac etiology (5) Ectopic perianastomotic and stomal varices (6) Splenorenal shunt (7) Congenital portosystemic shunt (Abernethy malformation) b) Measuring portal pressure (1) Direct
    [Show full text]