Stomach

Stomach

Pyloric Stenosis
1. genetic
  1. first male child
  2. concentric hypertrophy of circular muscle layer
  3. Regurgitation, PROJECTILE vomiting, palpable epigastric OLIVE-LIKE mass, visible peristalsis
  4. Treatment: MYOTOMY of the hypertrophied stomach and the stenosed part
2. Acquired
  1. Chronic antral gastritis, peptic upcelrs, malignancy
Gastritis
1. ACUTE
  1. RISK
    1. NSAIDS
      1. Inhibit Prostaglandin synthesis
        No mucus
    2. alcohol
    3. Smoking
      1. Toxins that damage the mucosa
    4. Ischemia/ SHOCK
    5. Burn (Curling Ulcer)
      1. Hypovolemia
        Less blood flow to the stomach
        systemic Acidocic
    6. Infections
    7. Uremia
    8. Head trauma (Cushing Ulcer)
      1. Increased intracranial pressure
        increased vagal stimulation to reduce hypoxia (PSNS)
        increased ACh
        activates parietal cells
        increased acid secretion
      2. Hypoxia
    9. Chemotherapy
  2. Mucosal erosion
    1. Edema and congestion of lamina propria
  3. Neutrophils in surface epithelial glands
  4. Epigastric pain, nausea, vomiting
  5. Hematamesis
  6. Complication
    1. Acute Gastric Ulcer
      3. multiple small ulcers with non-indurated bases
      4. normal gastric rugae
  7. NOT -itis - NOT inflammation
  8. hyperemia, and hemorrhage
2. CHRONIC
  1. AUTOIMMUNE Chronic Gastritis
    1. Fundus/ body
    2. Type II HS
    3. NO Lymphoid aggregates
    4. destroy parietal cells
      1. achlorhydria
        can't cleave pepsinogen
        NO relief with Anti-acid because there's no acid produced to begin with due to anti parietal Ab
    5. Atrophic Gastritis
      1. fundus/ body becomes antralized
    6. Intestinal metaplasia
      1. dysplasia
        intestinal gastric adenocarcinoma
    7. G- cell hyperplasia
      1. increase gastrin
        increase enterochromaffin
        Dysplasia
        Type I carcinoid
        preneoplastic - produces histamine
    8. Pernicious anemia
      1. decrease IF
        decrease B12
        increase methylmalonic acid
        Neurological defic
  2. H. pylori
    1. Chronic Gastritis
      1. Antrum - lesser curvature
      2. lymphoid aggregates in LP
        + neutrophils = Chronic ACTIVE Gastritis
        uncontrolled B cells
      3. Produce urease > amonia to neutrolize acid, phospholipase to break through mucosa,
        diffuse effacement of mucosa by lymphocytes
        peptic ulcer/ chronic gastritis (> 2cm)
        duodenum, stomach, GE junction, margins of gastrojej, Meckel's, Zollinge _ food makes it better _ worse at night _ gastric obstruction
      4. Complication: infla >> intestinal metaplasia >> dysplasia
      5. UREA IN BREATH, endoscopy (rapid urease test), silver stain, regression of tumor with Ab (CONFIRMATORY), Ag in stool, PCR of saliva, IgA, IgG
    2. Chronic Gastric Ulcer
      1. PRE-MALIGNANT
        Lesser curvature (more common)
        Greater curvature (less common BUT higher chance of malignancy)
      2. Punched out ulcer with sharp raised margins
      3. Also caused by
        NSAIDs
        Tobaco
        Alcohol
        Psych stress
        Zollinger Ellison Syndrome
      4. rugae - spokes of a wheel
      5. Stages:
        N: Necrosis
        I: Infla cells (lymphocytes, plasma, PMNs
        G: granulation tissue (Type III collagen)
        S: Scar (Type I collagen)
      6. complications: Melena _ Iron deficiency anemia _ perforation (peritonitis) _Obstruction as it heals via scarring (PROJECTILE VOMITING _ hematemesis _ malignant transformation (intestinal)
      7. Pain upon eating at night - weight loss because they're scared to eat
    3. Duodenal Ulcer
      1. MOST COMMON
      2. NEVER MALIGNANT
      3. Eating makes it better!
    4. MALToma
      1. dyspepsia, abdominal pain, nausea, vomiting, WL
      2. Treat with Ab, chemotherapy/ Rituximab (if relapses - 10% of cases)
      3. Extranodla marginal zone lymphoma
    5. Gram (-) on surface of lumen
      1. intestinal gastric adenocarcinoma
        Japan, South Korea
        Also caused by : autoimmune, smoked food, nitrosamines
        malignant glands that make mucin invade the submucosa and muscularis propria (PROGNOSIS: DEPTH OF INVASION) (Early: mucosa to submucosa _ Advanced: beyond muscularis)
        Type 1: Diffuse - Young women - familial
        Mutation E-cadherin - signet ring cells with mucin - leather bottle stomach/linitis plastica"
        NO INTESTINAL METAPLASIA
        Complications (diffuse ONLY): Krukenberg tumor (ovarain metastasis) -- also comes from invasive lobar carcinoma of breast and colon cancer
        Type 2: Intestinal - Elderly
        her2neu/EGF
        Chronic Gastritis
        intestinal metastasis
        epigasric mass / pain / early satiety / cachexia (TNF alpha)) / bleeding / melena (iron deficiency anemia)
        General complication: supraclavicular/ Virchow's LN metastasis
        Periumbilical metastasis >> Sister Mary Joseph nodule
        CEA: PGCLubs - Pancreas, Gallbladder, Colon, Lungs, Breast, Stomach
  3. mucosal atrophy and epithelial metaplasia - nausea, vomiting, dyspepsia
  4. Smoking and alcohol, anterectomy, radiation, Chron's, Sarcoidosis
Gastrointestinal Stromal Tumor (GIST)
1. #1 mesenchymal tumor in GIT (stomach mostly
2. derived from interstitial cells of Cajal (pacemaker cells)
3. Express CD117 (c-Kit) with - majority have c-Kit mutation on exon 11
4. Spindle-shaped tumor cells - submucosal
5. Treatment: TKI (Imantinib, Gleevec) Same treatment as Chronic Myeloid Leukemia

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	Created by Nazik Al-Hashimi about 9 years ago