FACTS & HINTS

High-Yield Facts

Clinical Points

page 146

page 147

Hiatus hernia

Herniation of part of the stomach through the esophageal hiatus of the diaphragm

Maycause pain and discomfort and predispose to refluxof gastric contents

Sliding hernias involve the cardia of the stomach sliding superiorly

Rolling hernias (less common) involve part of the fundus extending through the hiatus

Congenital hypertrophic pyloric stenosis

Thickening of smooth muscle of the pylorus Causes severe stenosis of the pyloric canal

Gastric emptying is greatlyreduced and typicallyleads to the presentation of projectile vomiting following a feeding More common in males, and usuallypresents 3 to 8 weeks after birth

Diagnosis made bypalpating a pyloric mass in the right upper quadrant (RUQ) during a test feeding

Intestinal volvulus

Rotation of a loop of bowel upon its mesentery Maycause acute bowel obstruction

Can compromise the vascular supplyleading to ischaemia, infarction, and eventuallynecrosis

Most commonlyoccurs in the mobile small bowel, but mayalso affect the sigmoid colon, owing to the length of its mesentery Prompt surgical decompression maybe required, although passage of a flatus tube is usuallysufficient in cases of sigmoid volvulus

Mnemonics

Memory Aids

Memory Aids

222 / 425