Various Appearance of Portal Hypertension ~ To be continued

Spenoadrenorenal shunt

GIST

Esophageal GIST

Gastric GIST

Hiatal hernia

Sliding hernia (axial type): 95%
- GEJ is aboe the diaphragm
- Reflux is more likely with larger hernias
- May be reducible in erect position
Paraesophageal hernia
- GEJ is in its normal position
- Part of the fundus is herniated above the diaphragm through esophageal hiatus and lies to the side of the esophagus
- Not reflux
- More prone to mechanical complications
- Usually nonreducible

*Gastric folds aboe diaphragm
*B line above diaphragm
*Schatzki's ring above diaphragm

%Esophagitis
%Duodenal ulcers

Von Hippel-Lindau Disorder

•Autosomal dominant disorder (Chroosome 3) with 1/35000-1/40000 incidence in America
•Most attacked in 2nd to 3rd decades
•M:F is about 1:1
Diagnostic Criteria
•> 1 hemangioblastoma of CNS
•1 hemangioblastoma + visceral manifestation
•1 manifestation + family history

Subclassification by NIH

•Type I: Renal + pancreatic cysts, high risk for RCC, no pheochromocytoma
•Type IIA: Pheochromocytoma, pancreatic islet cell tumor
•Type IIB: Pheochromocytoma + renal + pancreatic disease

Angiomatous lesions

- Retinal hemangioblastomas -> Von Hippel tumor
- CNS hemangioblastomas -> Lindau tumor
- Endolymphatic sac tumors
- Renal cell carcinoma - Pancreatic cysts and tumors
- Pheochromocytomas
- Epididymal cystadenomas

Metastasis with hepatoduodenal ligament extension

Gastric cancer with hepatic hilum invasion and common hepatic artery encased.

The spreading from hepatoduodenal ligament can be domostrated from this image