Large bowel obstruction

colonic obstruction at the level of splenic flexure
air under the diaphragm : sign of  bowel perforation

courtesy of Charles McCabe,MD

Achalasia

Achalasia

Definition : Primary oesophageal motility disorder , characterized by failure of the lower oesophageal sphincter to relax and absence of oesophageal peristalsis

Symptoms:

• dysphagia ( both liquid and solid)
• heartburn
• regurgitation
• chest pain
• weight loss

Investigation:

a) Imaging :

• barium swallow: oesophagus appears dilated , contrast material passes slowly into the stomach as the LES opens intermittenly .Distal oesophagus is narrowed( resembling bird`s beak)

b) Prodecural

• OGDS  : to rule out ca of gastroeophageal junction or fundus

c) other test

• oesophageal manometry : to diagnose achalasia

1. incomplete relaxation of LES in response to swallowing
2. high resting LES pressure
3. absent of oesophageal peristalsis

• prolonged oesophageal pH monitoring : to rule out GERD

Treatment

• reduce LES pressure : calcium channel blockers and nitrates
• intrasphincteric injection of botulinum toxin : restore balance between excitatory and inhibitory neurotransmitters
• pneumatic dilatation surgery : balloon inflated at the gastroesophageal junction to rupture the muscle fibers 

Intestinal obstruction

Cardinal features of intestinal obstruction

• vomiting
• constipation
• abdominal pain
• abdominal distension

Small bowel obstruction

Figure 1 : normal bowel

Figure 2 : Small bowel obstruction. multiple step ladder pattern of air-fluid level in the intestine

Causes of acute pancreatitis

Causes of acute pancreatitis

• G all stone
• E thanol
• T rauma
• S teroids
• M umps
• A utoimmune (PAN
• S corpion bite
• H yperlipidaemia
• H yperparathyroidism
• H ypothermia
• E RCP
• D rugs