3. GI p244-247 (The Stomach) Flashcards
H.Pylori gastritis - location
Usually Antrum
Zollinger-Ellison location (3)
Ulcerations in stomach/jejunum (Jejunal ulcer is buzzword).
Duodenal bulb is most common location or ulcers.
ZE is from gastrinoma, associated with MEN syndromes
Crohn’s location
Unusual for stomach, but if it is it likes Antrum.
Memetrier’s location
Usually fundus, classically spares antrum
Lymphoma location
“Crosses the pylorus” is classic description, although adenicarcinoma does it more often.
Gardener syndrome (4)
FAP (Hyperplastic stomach, adenopatous bowel polyps) +
- Desmoid tumours
- Osteomas
- Papillary thyroid tumours
Turcot’s syndrome (3)
FAP (Hyperplastic stomach, Adenomatous bowel polyps) +
- Gliomas
- Medulloblastomas
Hereditary Non-polyposis Syndrome (Lynch syndrome) (2)
DNA Mismatch repair.
Causes cancers in basically everywhere
Peutz-Jeghers (3)
Hamartomas,
Mucinous pigmentation,
Small and large bowel Ca, Pancreatic Ca, Gynae Ca
Cowden’s syndrome (2)
Hamartomas,
Breast Ca, Thyroid Ca, Lhermitte-Dulcose (posterior fossa brain tumours)
Cronkite-canada (2)
Hamartomas,
Stomach, small bowel, colon Ca, Ectodermal stuff (skin, hair, nails)
Juvenile polyps
Hamartomas
Zenker diverticula
Posterior, above cricopharyngeus
GIST - trivia (3)
Most common mesenchymal tumour of GI tract.
70% occur in stomach.
Rare before age 40.
GIST - features (4)
Lymph node enlargement is not classically seen.
Malignant ones tend to be big (>10cm with ulceration +/- perf).
Association with Carney’s triad (Extra-adrenal phaeochromocytoma, GIST, Pulmonary chordoma (hamartoma).
Association with NF-1
Stomach ulcers - malignant vs benign (6)
Width > depth vs Depth > width.
Located within lumen vs projecting behind expected lumen.
Nodular, irregular edges vs sharp contour.
Folds adjacent to ulcer vs folds radiating to ulcer.
Carmen Meniscus sign vs Hamptom’s line.
Can be anywhere vs usually on Lesser curvature
Gastric cancer - types (2)
Lymphoma (<5%) or Carcinoma (95%)
Gastric carcinoma features/trivia (6)
Median age 70.
H.Pylori is most tested risk factor.
Ulcerated carcinoma “penetrating cancer” has look of advanced cancer.
Metastatic spread to ovary referred to as Krukenberg tumour.
Gastroenterostomy for gastricu lcer disease (was done prior to PPIs) have 2-6x increased risk of developing carcinoma in gastric remnant.
Swollen left supraclavicular node = Virchow’s node.
Ulcers - trivia (5)
Gastric ulcers have 5% chance of bein gcancer.
Duodenal ulcers are never cancer (in exams).
Gastric ulcers occur due to “altered mucosal resistance”.
Duodenal ulcers occur from “increased peptic acid”.
Duodenal ulcers are usually solitary, if not, think Zollinger Ellison.
Gastric lymphoma (6)
Can be primary (MALT) or secondary (due to systemic lymphoma).
Stomach is commonest extranodal site for non-hodgkin lymphoma.
Rarely causes gastric outlet obstruction.
Classically described to “cross the pylorus”, but actually gastric carcinoma does this more commonly.
Can have multiple appearances, even looking like linitis plastica potentially.
Can rupture with treatment (chemo)
Linitis plastica (3)
Leather bottle stomach.
Result of scirrhous adenocarcinoma with dense infiltration.
Can be from breast or lung mets.
Gastric carcinoma vs Lymphoma (4)
Carcinoma is more likely to:
- Cause gastric outlet obstruction
- Be in distal stomach
- Extend beyond the serosa and obliterate adjacent fat planes
- Be a focal mass (95% of primary gastric tumours are adenocarcinoma)
Menetrier’s disease (5)
Idiopathic gastropathy with rugal thickening.
Classically inolves fundus and spares antrum.
Bimodal age distribution.
Childhood version thought to be CMV related.
Low albumin due to loss into gastric lumen.
Ram’s horn deformity (4)
aka pseudo Billroth I
Tapering of antrum causes stomach to look like ram’s horn.
Can be seen with scarring via peptic ulcers, granulomatous disease (Crohn’s, Sarcoid, TB, Syphillis) or Scirrhous carcinoma.
Sarcoid in the GI tract - trivia
Stomach is the commonest GI location for sarcoid.
Gastric volvulus - types (7)
Organoaxial
- greater curvature flips over lesser curvature.
- Seen in old ladies with paraoesophageal hernias.
- More common.
Mesenteroaxial
- Twisting over mesentery,
- Causes ischaemia and needs fixed.
- Causes obstruction
- More common in kids
Gastric diverticulum (2)
Most commonly in the posterior mediastinum.
Find normal adrenal to differentiate from adrenal mass.
Gastric varices.
Isolated gastric varices are caused by splenic vein thrombus.
Areae Gastricae (4)
Normal, fine retucular pattern seen on double contrast.
Enlarges in elderly and patient’s with H.Pylori.
Can focally enlarge next to an ulcer.
Becomes obliterated by cancer or atrophic gastritis.
Chronic aspirin therapy (3)
“multiple gastric ulcers” is buzzword.
Occurs in 80% of chronic aspirin users.
Aspirin does NOT cause duodenal ulcers.
