Mx of achalasia :
Heller myotomy & fundiplication

الدعاء إذا كان في وقت إجابة كآخر ساعة من يوم الجمعة،ثم صادف خشوعا واستقبل القبلة على طهارة،ورفع يديه، وبدأ بحمدالله والثناء عليه، وصلى على رسولهﷺ ،وقدم بين يديه الاستغفار، وألح على الله في المسألة،وتوسل إليه بأسمائه وصفاته، وقدم بين يديه صدقة فإن هذا الدعاء لا يكاد يرد أبدا.

ساعة إستجابة ألحوا بالدعاء ♥️

✔️Hiatus Hernia:

🔵 SLIDING HIATUS HERNIA (TYPE I):

• herniation of both the stomach and the gastroesophageal (GE) junction into thorax

• 90% of esophageal hernias

🔷Risk Factors

• age

• increased intra-abdominal pressure (e.g. obesity, pregnancy, coughing, heavy lifting)

• smoking

🔶Clinical Features

• majority are asymptomatic

• hernias frequently associated with GERD due to decreased competence of LES

🔷Complications:

• most common complication is GERD

• other complications are rare and are related to reflux

• esophagitis (dysphagia, heartburn)

• consequences of esophagitis (peptic stricture, Barrett’s esophagus, esophageal carcinoma)

• extra-esophageal complications (aspiration pneumonitis/pneumonia, asthma type bronchospasm, cough, laryngitis)

🔶Investigations:

• barium swallow, endoscopy (esophago-gastroscopy), or esophageal manometry (technique for measuring LES pressure)

• 24 h esophageal pH monitoring to quantify reflux

• endoscopy with biopsy to document type and extent of tissue damage and rule out esophagitis, Barrett’s esophagus, and cancer


🔷Treatment:

• lifestyle modification
■ stop smoking, weight loss, elevate head of bed, no meals <3 h prior to sleeping, smaller and more frequent meals, avoid alcohol, coffee, mint, and fat

• medical ■
antacid, H2-antagonist, PPI, prokinetic agent

• surgical (<15%)
■ if failure of medical therapy, complications of GERD such as esophageal stricture, severe nocturnal aspiration, Barrett’s esophagus
■ anti-reflux procedure (usually laparoscopic) e.g. Nissen fundoplication
      ◆ fundus of stomach is wrapped around the lower esophagus and sutured in place
        ◆ 90% success rate

🔴PARAESOPHAGEAL HIATUS HERNIA (TYPE II)

• herniation of all or part of the stomach through the esophageal hiatus into the thorax with an undisplaced GE junction

• least common esophageal hernia (<10%)

🔶Clinical Features

• usually asymptomatic due to normal GE junction

• pressure sensation in lower chest, dysphagia

Complications • hemorrhage, incarceration, strangulation (gastric volvulus), obstruction, gastric stasis ulcer (Cameron’s lesion – causes Fe-deficiency anemia)

🔷 Treatment

• surgery to address symptoms or treat/prevent complications

• reduce hernia and excise hernia sac, repair defect at hiatus, and anti-reflux procedure (e.g. Nissen fundoplication)

• may consider suturing stomach to anterior abdominal wall (gastropexy)

• in very elderly patients at high surgical risk consider PEG (percutaneous endoscopic gastrostomy) to anchor the stomach in the abdomen

🔵MIXED HIATUS HERNIA (TYPE III):

• combination of Types I and II

TYPE IV HERNIA

• herniation of stomach and other abdominal organs into thorax: colon, spleen, small bowel

• Fe-deficiency anemia is common........✅✅✅

👆The characteristic feature of achalasia on barium swallow; a bird’s beak🐤🐤or called rat tail appearance caused by failure of relaxation of the L.E.S.

‏والقَلق الذي يعتريك ولا يعلمه إلّا الله اجعل لهُ ركعتين في جَوف اللَّيل ،تسيبحةو إستغفار لا يراهُم إلّا الله وتوكل علي الحي القيوم ♥️

ماتنسوش أذكاركم
من كان مع الله كان الله معه ♥️

#Stomach supply.

Vagotomy types.
-A&B with pyloroplasty
-C preserve pyloris.

Biliroth type 1&2

حتى يطيب لك النَّهار ‏ويطرح الله لك البركة في يومك
‏خُذ من ركعتي الضحى ما يؤنس قلبك❤️

﴿إنّهم كانوا يسارعون في الخيرات﴾

GS I- 7. Fluid & electrolytes ( summary ).wav