Stomach

Beschreibung

Mindmap am Stomach, erstellt von chaitanyashah.dr am 02/04/2015.
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Zusammenfassung der Ressource

Stomach
  1. Gastroschisis
    1. Congenital malformation of abd wall exposing abd contents
    2. Omphalocele
      1. Persistent herniation of the bowel into the umblical cord
        1. due to failure of the herniated intestines to return
          1. Contents are covered by peritoneum
            1. Abd contents in a bubble
            2. Pyloric stenosis
              1. Congenital stenosis of pyloric sphincter
                1. Seen more commonly in males
                  1. Clinical features
                    1. Commonly presented after 2 weeks of birth
                      1. Projectile nonbilous vommiting
                        1. Visible peristalisis
                          1. Olive like mass in abdomen
                          2. Treatment is Myotomy
                          3. Acute Gastritis
                            1. Acidic Damage to stomach mucosa
                              1. Imbalance between mucosal defences and acidic imbalance
                                1. Mucin layer by foveolar cells
                                  1. Bicarbonate secretion by surface epithelium
                                    1. Normal blood supply which takes up leaked acid
                                    2. Risk Factors
                                      1. Severe Burn (curling ulcer)
                                        1. NSAIDs
                                          1. Alcohol
                                            1. Chemotherapy
                                              1. Increased ICP
                                                1. Increasead stimulation of vagus nerve > acid production
                                                2. Shock (multiple stress ulcers)
                                              2. Chronic Gastritis
                                                1. Chronic Inflammation of Gastric mucosa
                                                  1. Two types
                                                    1. Chronic Autoimmune
                                                      1. Autoimmune destruction of gastric parietal cells
                                                        1. Parietal cells are located in body and fundus
                                                          1. Pathogenesis mediated by T Cells (Type IV)
                                                            1. Diagnosis: Antibodies against Parietal Cells and IF
                                                              1. Clinical feaures
                                                                1. Atrophy of mucosa
                                                                  1. intestinal metaplasia
                                                                    1. Achlorhydria
                                                                      1. Megaloblastic anemia due to lack if IF
                                                                        1. risk of gastric adenocarcinoma
                                                                      2. Chronic H.pylori
                                                                        1. Most common form of Gastritis
                                                                          1. H.pylori secretes ureases and proteases
                                                                            1. Antrum is most common site
                                                                              1. Clinical Features
                                                                                1. MALT
                                                                                  1. Abdominal Pain
                                                                                    1. Gastric Adenocarcinoma risks
                                                                                    2. Triple Therapy
                                                                                      1. Resolves Gastric ulcer
                                                                                        1. Negative urea breath & lack of stool antigen to confirm eradication of H.pylori
                                                                                          1. Reverses intestinal metaplasia
                                                                                    3. Peptic Ulcer Disease
                                                                                      1. Solitary mucosal ulcer in duodenum (90%) or in gastric mucosa (10%)
                                                                                        1. Two types
                                                                                          1. Duodenal
                                                                                            1. always due to H.pylori rarely due to ZE
                                                                                              1. epigastric pain improving with meals
                                                                                                1. Hypertrophy of Brunner glands on Endo
                                                                                                  1. Rupture of Anterior ulcer- Gastroduodenal Artery bleeding
                                                                                                    1. Posterior ulcer Rupture - Acute pancreatitis
                                                                                                      1. Never Malignant
                                                                                                      2. Gastric
                                                                                                        1. H. Pylori (75%
                                                                                                          1. NSAID & bile reflux
                                                                                                            1. Located usually on the antrum
                                                                                                              1. Pain worsens after meal
                                                                                                                1. Rupture leads to bleed from Left epigastric A
                                                                                                                  1. May turn into malignant
                                                                                                                    1. Large irregular with heaped up margins
                                                                                                                    2. Benign are generally small (<3cm)
                                                                                                                      1. Punched out margins with radiating folds of mucosa
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