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  • ESOPHAGUS (FOOD PIPE)
  • STOMACH
  • DUODENUM
  • INTESTINES
  • APPENDIX
  • LARGE INTESTINE (COLON)
  • LARGE INTESTINES (RECTUM AND ANUS)
  • SPLEEN
  • LIVER
  • PANCREAS
  • GALL BLADDER

ESOPHAGUS (FOOD PIPE)

Esophagus is a tube which carries the food we eat from the mouth to the stomach. For most of its length,esophagus lies in the chest. Small segments of the esophagus lie in the neck and within the abdominal cavity.

Disease

Presentation

  • difficulty in swallowing (dysphagia)
  • retrosternal chest discomfort and pain
  • hoarseness of voice and loss of weight
  • regurgitating food into the mouth

Common investigations for detecting esophageal diseases

  • Blood tests
  • X-ray chest
  • CT/MRI chest and abdomen
  • Upper GI Endoscopy
  • Barium swallow
  • Esophageal manometery

STOMACH

The stomach is a bag like organ which receives the food brought to it by the esophagus. It produces acid which helps in starting the process of digesting ingested food. The stomach has an effective churning mechanism which breaks up the food into small particles which are then propelled further into the intestine.

Diseases

Presentation

  • loss of appetite
  • nausea
  • burning in the upper part of abdomen
  • sometimes pain which can be severe
  • weight loss
  • vomiting
  • hematemesis (blood vomiting)
  • passage of black stools (malena)
  • anemia

Common investigations for stomach diseases

  • Blood tests
  • Endoscopy
  • Abdominal ultra sonography
  • Endoscopic ultrasound
  • CT abdomen
  • Stool examination

DUODENUM

This is a tube which lies between the stomach and the small intestine. It propels the food forward and continues the digestive process begun in the mouth and stomach. The bile produced by the liver is stored in the gall bladder and is mixed with the food in the duodenum. The juices of the pancreatic gland also mix with the food in the duodenum. Both the bile and the pancreatic juice help in digestion of proteins and fats.

Diseases

Presentation

  • pain in the upper abdomen
  • vomiting
  • loss of appetite
  • jaundice and itching of the skin, if there is a duodenal disease which obstructs the common bile duct

Common investigations for duodenal disease

  • Blood and stool tests
  • Side viewing endoscopy
  • CT abdomen

INTESTINES

The human intestine is a long tubular structure 22-26 feet long. Intestines are of two types small and large.

Small intestine(Jejunum and Ileum)

Small intestine starts from the duodenum and ends in the caecum which is the beginning of the large intestines. The small intestine itself is made up of two parts, the jejunum and the ileum.

Diseases

  • Infections
  • Small bowel strictures
  • Sub Acute Intestinal Obstruction (SAIO)
  • Intestinal obstruction
  • Intussusception
  • Small bowel tumors
  • Inflammatory Bowel Disease (IBD)
  • Enteric perforation and small gut volvulus
  • Meckels diverticulum

Presentation

  • pain abdomen, usually colicky (comes and goes) sometimes may be constant
  • nausea
  • vomiting
  • abdominal distension
  • inability to pass wind (gas)
  • diarrhea
  • weight loss
  • fever

Common investigation for small bowel disease

  • Plain X-ray abdomen
  • Barium meal and follow through
  • Ultrasound abdomen
  • CT abdomen
  • Enteroscopy

APPENDIX

It is a worm like structure arising from the caecum and lying the right lower abdomen. It has no useful function in humans. It is a vestigeal organ of our evolution into homo sapiens. It has a lot of lymphoid tissue and when infected and inflamed it can cause the commonly easily recognized disease of acute appendicitis.

Diseases

  • Acute appendicitis
  • Appendicular tumors
  • Carcinoid appendix
  • Appendicular perforation

Presentation

  • anorexia (loss of appetite)
  • pain right lower abdomen, right flank
  • nausea and vomiting
  • lump or mass in the right lower abdomen
  • sometimes diarrhea and dysuria (discomfort during urination)

Investigation

  • X-ray abdomen
  • Ultrasound abdomen
  • CT abdomen

LARGE INTESTINE (COLON)

This is a wide diameter tube which receives the digested food from the small intestines. The semi solid intestinal contents pass through the colon and become firm as water is absorbed.

The colon begins in the right lower flank as the caecum. From the caecum the colon ascends upwards and is here known as the ascending or right colon.
It then turns to the left of the abdomen and lies in a transverse fashion in the upper abdomen. This is known as the transverse colon. It continues down the left flank as the descending or left colon. In the left lower abdomen the colon continues as a sigmoid tube known as sigmoid colon which continues as the rectum lower down to end in the anal canal and anal opening.

Diseases of the colon

  • Cancers of the caecum
  • Colon
  • Sigmoid colon
  • Ulcerative colitis
  • Colonic perforation
  • Tuberculosis
  • Polyps and adenomas
  • Diverticulosis

Presentation

  • abdominal pain
  • classically infra umbilical
  • dysentery
  • bleeding per rectum
  • alteration in bowel habits
  • weight loss
  • fever
  • abdominal bloating
  • distension

Investigation

  • Blood tests
  • Stool test
  • Colonoscopy
  • CT abdomen
  • Barium meal and barium meal follow through

LARGE INTESTINES (RECTUM AND ANUS)

The rectum is the end of the colon and serves as a receptacle for the faeces. Here the stool awaits an appropriate time and place to be expelled out through the anal canal. Because faeculent intestinal contents lie here for a long time the rectum is the seat of many diseases.

Diseases of the rectum

  • Infection
  • Proctitis
  • Rectal ulcers
  • Solitary Rectal Ulcer Syndrome -SRUS
  • Rectum cancer
  • Haemorrhoids or piles
  • Fissure
  • Fistula

Presentation

  • pain during passing stools
  • bleeding during passage of stools
  • feeling of incomplete evacuation of stools
  • weight loss
  • anemia

Investigation for diseases of rectum and anus

  • Blood tests
  • Stool tests
  • Sigmoidoscopy
  • Proctoscopy
  • MRI
  • Endo ultrasound
  • Anorectal manometry

SPLEEN

Spleen is a fist size organ which lies tucked away in the left upper abdomen. Its main function is in regulating the counts of various components of human blood.
It has a rich blood supply and can bleed profusely when injured often endangering life. It can enlarge massively and result in hypersplenism requiring surgery. Small and moderately enlarged spleens can be removed if required by minimally invasive laparoscopic techniques- allowing early recovery and return to work.

Diseases of the Spleen

  • Hypersplensim
  • Chronic Myeloid Leukaemia – CML
  • Portal hypertension
  • Chronic malaria
  • Kalazar
  • Tropical splenomegaly
  • Splenic abscess and splenic hydatid
  • Splenic injury

Presentation

  • weakness
  • fever
  • lump in the abdomen
  • pain in the abdomen
  • vomiting blood
  • passing black stools

Investigation for splenic disease

  • Blood tests
  • Ultrasonography
  • CT
  • Bone marrow testing
  • Doppler studies

LIVER

Liver is a complex organ. Complex both in anatomy and function.

It is a large organ lying in the upper abdomen under the right diaphragm. It has a double blood supply. Arterial coming from the heart and portal coming from the veins draining the intra abdominal gastro intestinal tract.
Functionally it is site for synthesis of many proteins for different body functions. It plays an important role in carbohydrate and fat metabolism. Bile is produced by the liver and stored and concentrated in the gall bladder. Bile is the only known excretory pathway for cholesterol and other fats in the body. Liver is the site of breakdown of insulin and toxins absorbed in the intestine. It stores glucose, Vit A, B and D. It produces albumen and has vital immunological functions.

Diseases

  • Cirrhosis liver
  • Liver tumors
  • Hepatoma HCC
  • Cholangiocarcinoma
  • Adenoma
  • Haemangioma
  • Liver metastasis from cancers of the colon, stomach, gall bladder and other organs of the abdomen
  • Extra hepatic portal vein obstruction – EHPVO
  • Hepatic venous outflow tract obstruction – HVOTO
  • IVC block – Budd Chiari Syndrome
  • Non Cirrhotic Portal Fibrosis

Presentation

  • pain abdomen
  • loss of appetite
  • weight loss
  • jaundice
  • bloating of abdomen
  • weakness

Investigations

  • Blood tests
  • Ultrasound abdomen,
  • CECT abdomen
  • MRI\Doppler
  • Liver Biopsy

PANCREAS

Pancreas lies deep in the upper abdomen. It has two main functions. The endocrine function regulates blood sugar level. The exocrine function helps with digestion of proteins and fats.

For anatomical description it is divided into :

  • Head Pancreas
  • Neck Pancreas
  • Body Pancreas
  • Tail Pancreas

Diseases

  • Acute pancreatitis
  • Chronic pancreatitis
  • Chronic Calcific Pancreatitis of the Tropics (CCPT)
  • Pancreatic pseudo cyst
  • Pancreatic cancer
  • Periampullary carcinoma
  • Pancreatic neuro endocrine tumors

Presentation

  • pain classically in the upper abdomen radiating to the back
  • weight loss
  • abnormal blood sugar levels and diabetes mellitus
  • passage of foul smelling stools difficult to flush
  • jaundice
  • lump in abdomen

Investigation

  • Blood tests
  • Ultrasound abdomen
  • Endoscopic retrograde cholangio pancreaticography (ERCP)
  • MRI
  • MRCP
  • CECT abdomen- pancreatic protocol triple phase

GALL BLADDER

The gall bladder is a small balloon shaped organ lying between the liver and intestines. Its function is to store bile produced in the liver and propel the bile into the intestines whenever needed. While the bile is in the gall bladder its water content is absorbed and the bile gets concentrated. If the concentrated bile is super saturated with crystals of fat and pigment, stones form in the gall bladder.

Diseases

  • Gall stone disease – cholelithiasis
  • Acute cholecystitis
  • Chronic cholecystitis
  • Empyema gall bladder
  • Stones in common bile duct- choledocholithiasis
  • Cancer gall bladder

Presentation

  • severe acute pain
  • nausea and vomiting
  • fever
  • weight loss
  • pain in the right upper abdomen
  • jaundice
  • lump in the abdomen

Investigations

  • Blood tests
  • Ultrasound abdomen
  • CT abdomen