3. GI (The Stomach)

Question 1

H.Pylori gastritis - location

Answer 1

Usually Antrum

Question 2

Zollinger-Ellison location (3)

Answer 2

Ulcerations in stomach/jejunum (Jejunal ulcer is buzzword).
Duodenal bulb is most common location or ulcers.
ZE is from gastrinoma, associated with MEN syndromes

Question 3

Crohn’s location

Answer 3

Unusual for stomach, but if it is it likes Antrum.

Question 4

Memetrier’s location

Answer 4

Usually fundus, classically spares antrum

Question 5

Lymphoma location

Answer 5

“Crosses the pylorus” is classic description, although adenicarcinoma does it more often.

Question 6

Gardener syndrome (4)

Answer 6

FAP (Hyperplastic stomach, adenopatous bowel polyps) +
- Desmoid tumours
- Osteomas
- Papillary thyroid tumours

Question 7

Turcot’s syndrome (3)

Answer 7

FAP (Hyperplastic stomach, Adenomatous bowel polyps) +
- Gliomas
- Medulloblastomas

Question 8

Hereditary Non-polyposis Syndrome (Lynch syndrome) (2)

Answer 8

DNA Mismatch repair.
Causes cancers in basically everywhere

Question 9

Peutz-Jeghers (3)

Answer 9

Hamartomas,
Mucinous pigmentation,
Small and large bowel Ca, Pancreatic Ca, Gynae Ca

Question 10

Cowden’s syndrome (2)

Answer 10

Hamartomas,
Breast Ca, Thyroid Ca, Lhermitte-Dulcose (posterior fossa brain tumours)

Question 11

Cronkite-canada (2)

Answer 11

Hamartomas,
Stomach, small bowel, colon Ca, Ectodermal stuff (skin, hair, nails)

Question 12

Juvenile polyps

Answer 12

Hamartomas

Question 13

Zenker diverticula

Answer 13

Posterior, above cricopharyngeus

Question 14

GIST - trivia (3)

Answer 14

Most common mesenchymal tumour of GI tract.
70% occur in stomach.
Rare before age 40.

Question 15

GIST - features (4)

Answer 15

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

Question 16

Stomach ulcers - malignant vs benign (6)

Answer 16

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

Question 17

Gastric cancer - types (2)

Answer 17

Lymphoma (<5%) or Carcinoma (95%)

Question 18

Gastric carcinoma features/trivia (6)

Answer 18

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.

Question 19

Ulcers - trivia (5)

Answer 19

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.

Question 20

Gastric lymphoma (6)

Answer 20

Can be primary (MALT) or secondary (due to systemic lymphoma).
Stomach is commonest extranodal site for non-hodgkin lymphoma.
Rarely causes gastric outles 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)

Question 21

Linitis plastica (3)

Answer 21

Leather bottle stomach.
Result of scirrhous adenocarcinoma with dense infiltration.
Can be from breast or lung mets.

Question 22

Gastric carcinoma vs Lymphoma (4)

Answer 22

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)

Question 23

Menetrier’s disease (5)

Answer 23

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.

Question 24

Ram’s horn deformity (4)

Answer 24

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.

Question 25

Sarcoid in the GI tract - trivia

Answer 25

Stomach is the commonest GI location for sarcoid.

Question 26

Gastric volvulus - types (7)

Answer 26

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

Question 27

Gastric diverticulum (2)

Answer 27

Most commonly in the posterior mediastinum.
Find normal adrenal to differentiate from adrenal mass.

Question 28

Gastric varices.

Answer 28

Isolated gastric varices are caused by splenic vein thrombus.

Question 29

Areae Gastricae (4)

Answer 29

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.

Question 30

Chronic aspirin therapy (3)

Answer 30

“multiple gastric ulcers” is buzzword.
Occurs in 80% of chronic aspirin users.
Aspirin does NOT cause duodenal ulcers.