Apple core lesion

Pseudomyxoma peritonei

Ruptured mucocele with foreign body peritonitis
Male: cystadenocarcinoma of appendix
Female: cystadenocarcinoma of ovary

*Thickening of peritoneal + omental sufaces
*Omental cake
*Posterior fixation of bowel loops and mesentery
*Voluminous septated/loculated pseudoascites
*Several thin-walled cystic masses of different size throughout abdominal cavity
*Scalloped contour of liver and splenic margins
Annular / semicircular calcifications

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

Sign of Intraperitoneal Free Air

Rigler's sign
Triangle sign
Falciform ligament sign
Inverted V sign
Urachus sign
Hyperlucent liver sign
Hepatic age som
Doge cape sign
Anterior superior oal sign
Foot ball sign
Dolphin sign

The pathway of ascites flow over lower abdomen

a. The pelvic cavity, especially the pouch of Douglas
Pouch of Douglas - The most caudal and posterior part of the peritoneal cavity
Upper 4th sarcal segment
Fixation of the peritoneum to Denonvillier's fascia
b. The right lower quadrant at the termination of the small bowel mesentery
c. The superior aspect of the sigmoid mesocolon
d. The right paracolic gutter

Gastric Volvulus

Gastric volvulus
- Mesenteroaxial type: from lesser to greater curve
- Organoaxial type: from cardia to pylorus
Cause
- Diaphragmatic defect
- Intestinal malrotation
- Wandering spleen
-Absence of gastrophrenic ligament and gastrosplenic ligament
Resolve spontaneously sometimes.

*Organoaxial vovulus*

Juxtapapillary diverticula

Complication of subtotal gastrectomy

Esophageal Symptoms

Delayed Gastric Emptying

Recurrent Ulcers

Carcinoma

Afferent Loop Syndrome

Diarrhea

Weight Loss and Malabsorption

Anemia

Cholelithiasis

Dumping syndrome : early and late

Intestinal intussusception

Staging of colon cancer

Modified Duke Staging System
Modified Duke A
The tumor penetrates into the mucosa of the bowel wall but no further.
Modified Duke B
B1: tumor penetrates into, but not through the muscularis propria (the muscular layer) of the bowel wall.
B2: tumor penetrates into and through the muscularis propria of the bowel wall.
Modified Duke C
C1: tumor penetrates into, but not through the muscularis propria of the bowel wall; there is pathologic evidence of colon cancer in the lymph nodes.
C2: tumor penetrates into and through the muscularis propria of the bowel wall; there is pathologic evidence of colon cancer in the lymph nodes.
Modified Duke D
The tumor, which has spread beyond the confines of the lymph nodes (to organs such as the liver, lung or bone).
TNM Staging System (Tumor, Node, Metastisis)
Tumor
T1: Tumor invades submucosa.
T2: Tumor invades muscularis propria.
T3: Tumor invades through the muscularis propria into the subserosa, or into the pericolic or perirectal tissues.
T4: Tumor directly invades other organs or structures, and/or perforates.
Node
N0: No regional lymph node metastasis.
N1: Metastasis in 1 to 3 regional lymph nodes.
N2: Metastasis in 4 or more regional lymph nodes.
Metastasis
M0: No distant metastasis.
M1: Distant metastasis present.

Bowler Hat Sign

For differienation of polyp and diverticulm of colon.
Bowler hat pointing toward center of cup showed a polyp and pointing away from center of cup showed a diverticulum
When the bowler hat is nearly parallel to long axis of bowel, it is impossible to determine whether it is a polyp or a diverticulum