Upper GI : Stomach*

Upper GI : Stomach*

1. Gastritis

   • Acute
     • Cause
       • Alcohol
       • Drugs
         • NSAIDs/steroids
       • Smoking
       • Corrosive
       • Stress
         • Shock/trauma/ischaemia/burns
       • Uraemia
       • Gastric Irradiation
     • Presentation
       • Asymptomatic
       • Symptomatic
         • Nausea&Vomitting
         • Anaemia
         • Haematemesis
         • Malaena
         • Epigastric pain
   • Chronic
     • chronic mucosal changes (absence of erosion)
       • mucosal atrophy
       • epithelial metaplasia
     • Type
       • Heliobacter assoc gastritis
         • Any Age
         • site: antrum/corpus
         • H.Pylori
           • Urease producing (gram -ve rods)
             • generate ammonia & protease
           • stomach acid ---> epithelial damage
             • acute/chronic
             • Lymphoid aggregates
           • @ superfcial mucous layer
         • multifocal atrophic gastritis
           • intestinal metaplasia
             • gastric epithelium ---> small intestine epithelium
             • maybe dysplastic
               • inc risk ---> carcinoma
           • gastric ulcers/cancer
         • Inc risk PUD & gastric cancer
         • Dx
           • Urea breath test
           • Biopsy
           • Serology
           • Culture
       • Autoimmune chronic gastritis
         • Elderly
         • Autoantibody
           • Parietal cells
             • Hypochlorhydria (low stomach acid production)
           • Intrinsic Factor
             • Pernicious anaemia (megaloblastic anaemia)
               • B12 deficiency (loss of intrinsic factor)
           • Seen with other autoimmune disease
             • Hashimoto's thyroiditis
             • Addison's Disease
           • Microscopic
             • Gland destruction & mucosal atrophy
               • body and fundus stomach
               • loss of acid production & intrinsic factor
       • Chemical / reflux gastritis
         • Reflux of duodenal fluid + bile
         • Foveolar hyperplasia
           • edge is frilly in shape
         • Vascular ectasia
           • dilated small blood vessels in the antrum, or the last part of the stomach.

2. Peptic Ulcer Disease

   • Gastric acid
     • Duodenum
     • Stomach
     • Oesophagus
     • Gastric anastamoses
     • Meckel's diverticulum
   • Zollinger-Ellison syndrome
     • gastrin secreting tumour
     • hyperplasia of islet cells of pancreas
     • over production of gastric acid ---> PUD
   • Ulcer
     • breach in mucosa
       • muscularis mucosae to submucosa/ deeper
     • Acute Gastric Ulcers (Stress Ulcers)
       • area of acute erosive gastritis
       • Severe stress/shock
         • burns/trauma
         • Drugs
       • range from erosion --> ulceration
         • Ulcers <1mm , 1 or many
         • no scarring/ thickening of blood vessels
       • Outcome
         • Severe bleeding
         • heal with no scarring
         • Progress to chronic peptic ulcer
   • Appearence
     • gross
       • Round-oval (sharply punched out)
       • straight walls
       • Margin level with surrounding mucosa
       • base smooth and clean
       • oedematous & reddened
     • Microscopic
       • Ulcer - fibrosis @ base & wall
       • 3 zones
         • superficial slough
         • Chronically inflamed granulation tissue
         • deep fibrous/collagenous scar
       • Vessel wall - thicken by inflammation (thrombosed)
   • Clinical Presentation
     • Gastric
       • Epigastric pain
       • loss of appetite
       • weight loss
       • Nausea, vomitting, bloating, belching
       • worse @ night ,1-3 hrs after food
     • Duodenal
       • relived by eating/ alkali
       • penetrating ulcers: referred pain
         • back
         • chest
         • LUQ
       • Fe def anaemia
       • Heamatemesis
       • Melaena
       • Perforation
     • Complication
       • Haemorrhage
       • perforation
       • penetrating & intractable pain
       • Oedema Obstruction & Scarring (Pyloric Stenosis)
       • Malignant change

3. Tumour

   • Malignant
     • Type
       • Carcinoma
         • M>F
         • East-Japan & China
         • RF
           • Diet
             • Smoked & salted food
             • Nitrite
             • Lack of fruit & vegetables
           • PUD
           • H.Pylori infection
           • Blood G. A
         • Site
           • Distal Third
           • Proximal stomach
         • Presentation
           • Dyspepsia
           • Nausea
           • Anorexia
           • Weight loss
         • Metaplastic type
           • Intestinal
             • Glandular & Dysplastic
             • Single Mass
           • Diffuse
             • Signet ring carcinoma
             • involving whole stomach wall
       • Lymphoma
       • Carcinoid
       • Mesenchymal
         • GIST
         • Leiomyosarcoma
     • Spread
       • Local
       • Trans-coelomic
       • Lymphatic
       • Haematogenous
     • Prognosis
       • Depth of invasion
       • Nodal & distant Metastases
   • Benign: Polyp
     • Nodule/mass projecting above the mucosa
     • Type
       • Hyperplastic
       • Adenoma
         • Dysplastic epithelium: imply malignancy
         • Sessile/Pedunculated
       • Hamartoma
       • Fundic Gland Polyp
       • Lipoma
       • Schwannoma