tailieunhanh - Upper Gastrointestinal Surgery - part 3

Thử nghiệm cảm giác cũng có thể được thực hiện với điện gây ra tiềm năng và động cơ toàn vẹn thần kinh có thể được đánh giá bằng cách sử dụng kích thích cộng hưởng điện từ. Tất cả những điều tra hữu ích trong trường hợp khó khăn, nơi mà các cuộc điều tra tiêu chuẩn và phương pháp điều trị | 72 6 UPPER GASTROINTESTINAL SURGERY Figure . Graph of refluxing pH trace. or clinemetry. Sensory testing can also be done with electrically induced potentials and motor neurone integrity can be assessed using electromagnetic resonance stimulation. All these investigations are useful in a difficult case where the standard investigations and therapies have been unsuccessful. Hiatus Hernia The presence or absence of a hiatus hernia is not important in the distinction of the diagnosis of GORD but is important in the decision about potential treatment strategies. Hiatus hernia may be present as a sliding or rolling hernia Figure . Sliding hernias type 1 are very common and may contribute to the symptoms of dysphagia. The remaining symptoms in sliding hiatus hernia are usually due to the presence of acid reflux rather than the presence of the hernia itself. In contrast a rolling type 2 hiatus hernia will present definitive symptoms of vomiting regurgitation chest pain of a character different to heartburn pressure symptoms within the chest which if related to a large hernia may cause dyspnoea. A combination of both sliding and rolling or para-oesophageal hiatus hernia type 2b can also occur but this is rare. Complications of GORD The complications of reflux include oesophagitis with varying degrees of ulceration see Figure LA grading stricture formation in the oesophagus and Barrett s oesophagus with a growth of intestinal metaplasia in the lower oesophagus. Barrett s columnar lined lower oesophagus occurs in 10 of patients with GORD. In contrast to reflux itself which does seem to have a genetic familial tendency the development of Barrett s oesophagus does not 73 BENIGN DISEASE OF THE OESOPHAGUS Figure . Diagram illustrating differing types of hiatus hernia. and seems to occur sporadically. The degree of reflux in Barrett s oesophagus is usually severe when measured. Paradoxically some patients with Barrett s oesophagus have little in the way of reflux .