Volvulus (Gastric)

Question 1

def

Answer 1

abnormal rotation of all or part of the stomach by >180degrees causing obstruction

Question 2

how is gastric volvulus classified

Answer 2

1 subdiaphragmatic (1/3)
2 supradiaphragmatic (2/3)

or on basis of axis rotation

1 organoaxial: rotation along longitudinal axis through the gastrooesophageal junction and the pylorus
2 mesentoroaxial: rotation along an axis perpendicular to its longitudinal axis
astrosplenic, gastroduodenal, gastrohepatic, gastrophrenic ligaments3 combination

Question 3

what is more common subdiaphragmatic or supradiaphragmatic

Answer 3

supradiaphragmatic

Question 4

aetiology

Answer 4

1 subdiaphragmatic
-abnormal laxity of gastric ligaments
2 supradiaphragmatic
-congenital/acquired anatomical abnormalities in the diaphragm

Question 5

epi

Answer 5

organoaxial is most common
10-20% occur in children <1yr
rest above 50yrs

Question 6

history

Answer 6

1 acute volvulus
-severe epigastric/chest pain
-non-productive retching
2 chronic volvulus
-epigastric pain + fullness after meals
-in children, stunted growth

Question 7

examination

Answer 7

1 upper abdominal distension + tenderness

2 borchardt’s triad

Question 8

what is borchardt’s triad

Answer 8

1 epigastric pain
2 retching
3 inability to pass a NG tube

Question 9

what is borchadt’s triad associated with

Answer 9

gastric volvulus

Question 10

investigations

Answer 10

1 CXR
-gas bubble behind heart if intrathoracic
2 AXR
-gas shadow of distended organs

Question 11

when is barium swallow or CT scan used

Answer 11

diagnosis of acute cases