We often take for granted the simple act of drinking. Where does the drink go? Here’s a drink of barium, which shows on an X-ray. This is done to diagnose patients with difficulty in swallowing.

A barium swallow, showing the passage of barium down… behind the voice box and down the oesophagus

However, this patient couldn’t swallow properly, food and drinks get stuck in the throat. See the bulge marked with red? That’s a tumour blocking the smooth passage of food down the oesophagus. So, be happy that you can swallow well.. it’s something that we don’t even think twice about when we drink.

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Now, what are the risk factors of oesophageal cancer? Among them are cigarette smoking, gastro-oesophageal reflux and too much of these:

A hard message to swallow but as Mary Poppins says, “A spoonful of sugar makes the medicine go down.”

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Eventually, after drinking, the water goes gets excreted. The majority of the water excretion is done via the urine. A urogram shows the passage of urine from the kidneys at the top to the bladder at the bottom.

Here is the reason that children in Malaysia are getting Hepatitis B vaccination.

The AFP (alpha-fetoprotein) was more than 350mg/L.
Hepatitis B surface antigen serology was positive.

A forty-something-year-old man presented with abdominal pain for the previous few weeks. He had history of being a Hepatitis B carrier but was not on a surveillance program. He was not jaundiced. Abdominal examination detected localised tendernass. The CT scan shows a mass in the right lobe of the liver.

The red line marks the tumour. The yellow line marks the rest of the (normal) liver.

“Surveillance” is the serial follow-up of patients who are at high risk of developing further problems. For example, Hepatitis B patients are at high risk of developing liver cancer. All patients with chronic Hepatitis B infection should be on a surveillace program. For those with neither Hepatitis B infection nor immunity, i.e. Hepatitis B surface antibody is negative, get vaccinated.

Have you ever felt heartburn? It is the pain or discomfort that arises from the upper abdomen or lower chest and spreads upwards to the neck. It feels like a sharp pain or tightness that can sometimes be confused with cardiac pain (a heart attack). Some might describe it as a burning sensation, which gives it the name “heartburn”.

It occurs more frequently while lying down and after meals. Some patients may have a sudden increases in saliva production when it occurs, called a “waterbrash”. Some patients may just have a chronic, recurrent sore throat. Or even “asthma” symptoms at night, i.e. dry coughing.

These symptoms are due to acid reflux from the stomach up to the oesophagus. Gastro-oesophageal reflux disease (GORD, or GERD in the US) is multi-factorial but one of the causes is hiatus hernia. This is the protrusion of the upper end of the stomach from the abdominal space up above the diaphragm into the chest space.

View from the endoscope: looking from the top, i.e. the oesophagus.

View from the bottom: i.e. the stomach. You can see the big space around the scope (the black tube). Normally the stomach-oesophagus junction should hug the tube tightly and there’s no empty space around the tube.

On the left is the normal site of the stomach. On the right is hiatus hernia. The upper end of the stomach has moved up through the diaphragm (represented by the red line)

Usually the treatment is medical. Occasionally, the symptoms may not be resolved and require surgery.

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Can’t make head or tail of the photo?

The blue line marks the scope. The red line marks the junction between the oesophagus and the stomach. It should be hugging the scope.