Diseases of the Stomach

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Other Gastric Lesions

Menetrier’s Disease Menetrier’s disease (giant hypertrophic gastritis) is an uncommon disorder of unknown cause that is charac¬terized by massive enlargement of rugal folds due to hyperplasia of the gastric glands. There is usually hy posecretion of acid and excessive secretion of gastric mucus. Loss of protein into the lumen of the stomach may result in hypoproteinemia and edema. The thick-ened gastric rugae become contorted and folded on each other in a convolutional pattern suggestive of the gyri and sulci of the brain. Enlarged rugal folds are particu¬larly prominent along the greater curvature. Although the disorder is classically described as a […]

Benign Tumors of The Stomach

Leiomyoma and Rare Benign Tumors Spindle cell tumors constitute the overwhelming majority of benign submucosal gastric neoplasms. These lesions vary in size from tiny nodules, often discovered incidentally at laparotomy or autopsy, to bulky tumors with large intraluminal components, that can be associated with hemorrhage, obstruction, or perforation. Exo-gastric extension of these tumors can mimic extrinsic compression of the stomach by normal or enlarged liver, spleen, pancreas, or kidney. It may be extremely difficult to distinguish radiographically between benign spindle cell tumors and their malignant counterparts. Although large, markedly irregular filling defects with prominent ulcerations suggest malignancy, a radiographically benign […]

Malignant Tumors of the Stomach

Carcinoma Carcinoma of the stomach has a dismal prognosis because symptoms are rarely noted until the disease is far advanced. The incidence of gastric cancer varies widely throughout the world. It is very high in Japan, Chile, and parts of eastern Europe, while low in the United States, where for an unknown reason the incidence of the disease has been decreasing. Atrophic gastric mucosa, as in pernicious anemia, especially when associated with intestinal metaplasia, appears to be a predisposing factor. Adenomatous gastric polyps more than 2 cm in diameter frequently contain carcinoma, although it is un clear whether these uncommon […]

Complications and Syndromes After Peptic Ulcer Surgery

Recurrent Ulceration Recurrent (marginal) ulceration develops in about 5 percent of patients following surgery for peptic ulcer disease. Recurrence is much more common following vagotomy and pyloroplasty (6 to 8 percent) than after vagotomy and antrectomy (less than 2 percent). The marginal ulcer is really not a recurrent one, but rather represents a new ulceration due to the residual action of acid and pepsin on the sensitive intestinal mucosa. Thus it is usually situated in the jejunum within the first few centimeters of the anastomosis. Because marginal ulcers are rarely found on the gastric side of the anastomosis, development of […]

Complications of Peptic Ulcer Disease

Bleeding Peptic ulcer disease is the most common cause of acute upper gastrointestinal bleeding. The proper diagnostic approach depends on the severity and activity of the hemorrhage. Patients with massive hemorrhage, whose vital signs cannot be maintained, require emergency surgery for both diagnostic and therapeutic purposes. In the patient with acute upper gastrointestinal hemorrhage who has relatively stable vital signs, endoscopy, not a barium study, is the initial diagnostic procedure of choice. The 95 percent accuracy of endoscopy is substantially higher than the accuracy of barium studies, even using double-contrast technique. Barium examinations may be technically difficult to perform in […]

Peptic Ulcer Disease

  Duodenal Ulcer Duodenal ulcer is the most common manifestation of peptic disease. More than 95 percent of duodenal ulcers occur in the first portion of the duodenum (duodenal bulb). An unequivocal diagnosis of active duodenal ulcer requires demonstration of the ulcer crater, which can be seen using double-contrast techniques in about 90 percent of ulcers. When seen in profile, the ulcer crater is a small collection of barium projecting from the lumen. When seen en face, the ulcer niche appears as a rounded or linear collection of contrast material surrounded by lucent folds that often radiate toward the crater […]

Abnormal Gastric Emptying

  Gastric Outlet Obstruction In adults, peptic ulcer desiase is by far the most common cause of gastric outlet obstruction.The obstructing lesion in peptic ulcer disease is usually in the duodenum, occasionally in the pyloric channel or prepyloric gastric antrum, and rarely in the body of the stomach.Narrowing of the lumen due to peptic ulcer disease can result from spasm, acute inflammation and edema, muscular hypertrophy, or contraction of scar tissue. The second leading cause of gastric obstruction is an annular constricting lesion near the pylorus representing carcinoma of the antrum.Other infiltrative primary malignant tumors or metastatic lesions obliterating the lumen […]

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