Estômago Flashcards
5 vasos que nutrem o estômago, de qual vaso eles vem e as regiões que vascularizam.
Adenocarcinoma Gástrico, quem pode ressecção endoscópica?
The standard criteria for endoscopic resection consideration are intestinal type adenocarcinoma, tumor confined to the mucosa, absence of lymphovascular invasion, nonulcerated, and less than 2 cm in diameter
Quando e como reabordar a ressecção endoscópica?
Patients with positive lateral margins can be considered for repeat endoscopic therapy or close surveillance. Patients with positive vertical margins, lymphovascular invasion, or submucosal invasion should be referred for gastrectomy with lymphadenectomy.
O que é um Câncer gástrico localmente avançado?
Patients with advanced disease that is deemed unresectable be- cause of adjacent organ involvement, generally the pancreas or spleen, or extensive nodal disease, including the para-aortic nodes, are particularly challenging.
Como fazer o acompanhamento do paciente após tto do adenocarcinoma?
- Complete history and physical examination:
Every 3 to 6 months for 1 to 2 years
Every 6 to 12 months for 3 to 5 years
Annually thereafter. - Laboratory tests, including complete blood count and liver function tests, should be performed as clinically indicated.
- CT or PET/CT scans can be obtained if there is clinical suspicion of recurrence, although some perform these routinely in high-risk patients.
Linfoma gástrico primário, definição, sintomas, idade e sexo?
Patients are considered to have primary gastric lymphoma if the stomach is the exclusive or predominant site of disease.
most common site of extranodal lymphoma.
epigastric pain, early satiety, and fatigue. Constitutional B symptoms (i.e., fever, night sweats) occur in only about 10% of patients
older patients, with the peak incidence in the sixth and seventh decades, and there is a slight male predominance.
Como é a avaliação e estadiamento do linfoma gástrico? 5passos para avaliar metástase
1- Endoscopia com biópsia, EUS is useful to determine the depth of gastric wall invasion and to evaluate for regional lymph node involvement.
2- Search evidence of distant disease:
- upper airway examination
-Bone marrow biopsy
- CT of chest and Abdomen
- biópsia de linfonodo aumentados
- histologia para h. Pylori
3- Estadiamento pelo sistema modificado de Lugano
Tratamento Linfoma gástrico?
Quimioterapia, mais comum é R-CHOP ( rituximab, cyclophosphamide, hydroxydsunomycin, onco in, prednisona)
Cirurgia é usada somente em : patients with symptomatic recur- rence after treatment failure and patients who develop complica- tions, such as bleeding, gastric outlet obstruction, or perforation.
MALT Linfoma, associação, tratamento?
Normalmente é precedido por gastrite por H. pylori.
Tratamento:
1- Pacientes H. Pylori + : tratar H. Pylori e careful follow-up is necessary, with repeat endoscopy in 2 months to document clearance of the infection and biannual endoscopy for 3 years to document regression.
2- h. pylori - ou falha após tratamento: químio e radioterapia
GIST, o que é, o que expressa e onde mais aparece?
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of the GI tract.
Expressam : KIT (CD117) e CD34.
They most commonly arise in the stomach (40%–60%), small intestine (20%– 40%), and colon/rectum (5%–15%).
Diagnóstico e manejo do GIST gástrico?
Mallory-Weiss, o que é, o que causa, quem está em maior risco para hemorragia e como manejar?
1- Mallory-Weiss tears are mucosal lacerations related to forceful vomiting, retching, coughing, or straining that cause disruption of the gastric mucosa high on the lesser curve at the GE junction.
2- greatest risk for massive hemorrhage in alcoholic patients with preexisting portal hypertension.
3- Most patients with active bleeding can be managed by endoscopic methods.
Dieulafoy Gastric Lesion, o que é, quem é mais afetado e como tratar?
1- Abnormally large (1–3 mm), tortuous artery coursing through the submucosa without a primary ulcer. Ero- sion of the superficial mucosa overlying the artery occurs sec- ondary to the pulsations of the large submucosal vessel. The artery is then exposed to the gastric contents, and further erosion and bleeding occur.
2- Dieulafoy lesions are more common in men
(2:1), with associated comorbidities including cardiovascular disease, chronic kidney disease, and diabetes.
3- Diagnóstico e tto por endoscopia, caso negativo angiografia com embolização.
Varizes gástricas, o que são, quais os tipos e possíveis origens, como manejar?
1- Gastric varices are dilated submucosal veins commonly seen in patients with portal hypertension and cirrhosis.
Classified into two types: isolated gastric varices and GE varices.
2- Gastric varices can develop secondary to portal hypertension, in conjunction with esophageal varices, or secondary to sinistral hypertension from splenic vein thrombosis, comumente resultado de pancreatite.
3-Gastric varices in the setting of splenic vein thrombosis are readily treated by splenectomy.
Acutely bleeding gastric varices in the setting of portal hy- pertension should be managed similarly to esophageal varices. Endoscopia, caso não responda pode se pensar em Transjugular intrahepatic portosystemic shunting
Volvo Gástrico, qual a tríade e como manejar?
1- Tríade de Borchardt: The sudden onset of constant and severe upper abdominal pain, recurrent retching with pro- duction of little vomitus, and the inability to pass an NG tube
2- Acute volvulus is a surgical emergency. NG decompression should be performed immediately
O que é um Bezoar, quais as condições que o tornam mais comum, quais os sintomas, diagnóstico e como tratar?
1- Bezoars are collections of nondigestible materials, usually of vegetable origin (phytobezoar) but can also be composed of hair (trichobezoar), medications (pharmacobezoars)
2- Bezoars are most commonly found in patients who have underlying gastric dysmotility issues.
3- Patients are often asymptomatic or have gradual symptom onset over years. The symptoms of gastric bezoars include early satiety, pain, nausea/vomiting, and weight loss.
4- Radiografia + endoscopia.
5- Initial management of symptomatic bezoars is attempted chemical dissolution. Se falhar - endoscopia, se falhar - cirurgia.
