Gastric pathology Flashcards
Define what dyspepsia is
This is any combination of the following symptoms:
- Epigastric pain or burning (epigastric pain syndrome)
- Postprandial fullness (postprandial distress syndrome)
- Early satiety (postprandial distress syndrome)
What are the causes/classification of dyspepsia ?
Organic causes - 25% of cases
- Peptic ulcer disease
- Drugs (esp NSAIDs, COX2 inhibitors)
- Gastric cancer
Functional (idiopathic, NU) dyspepsia - 75% of cases
- This is dyspepsia with no evidence of culprit structural disease proved by OGD & other tests
- It is associated with other functional gut disorders e.g. IBS
What is it important to differentiate dyspepsia from ?
- Differentiate if from heartburn/reflux
- Note - GORD may coexist/predominate
When should patients with dyspepsia be referred to hospital for assessment and urgent endoscopy ?
If they have any alarm symptoms:
- Dysphagia
- Evidence of GI blood loss
- Persistent vomiting
- Unexplained weight loss
- Upper abdo mass
If someone has symptoms of dyspepsia but no alarm symptoms how are they managed ?
- 1st line = Lifestyle advice + review medications
- 2nd line = do a H.pylori test and then treat if +ve if neg then antacid treatment (PPI or H2 PRN)
What are the 2 main types of gastric tumours ?
- Carcinoma ( Adenocarcinomas )
- Lymphoma
Where in the world is gastric cancer most common ?
In Japan, China, Finland and Colombia compared to the West
List the risk factors for gastric carcinoma (adenocarcinoma) development
- H. pylori infection
- blood group A: gAstric cAncer
- gastric adenomatous polyps
- pernicious anaemia
- smoking
- diet: salty, spicy, nitrates
Where do most gastric carcinomas arise within the stomach ?
- In UK proximal tumours of cardia/GOJ increasing and distal & body gastric carcinomas are decreasing
Note - The cardia (or cardiac region) is the point where the esophagus connects to the stomach and through which food passes into the stomach.
Histologically what cells may be seen in gastric cancer ?
Signet ring cells
What are the signs/syptoms of gastric cancer ?
Symptoms:
- dyspepsia
- nausea and vomiting
- anorexia and weight loss
- dysphagia
- anaemia
Signs
- Epigastric mass
- Palpable left supraclavicular node (virchows node) - finding of this is troisiers sign
- periumbilical nodule (Sister Mary Joseph’s nodule), or left axillary node (Irish node).
- Hepatomegaly, jaundice, ascites (signs of spread)
How is gastric carcinoma diagnosed?
1st line = endoscopy (gastroscopy) + biopsy
After diagnosis of gastric carcinoma what needs to be done and how ?
Staging:
- 1st line = endoscopic ultrasound (determins T & N stage)
- 2nd line = Followed by CT of chest/abdo/pelvis (determines if metastatic or not) or PET CT particular if its a junctional cancer
- 3rd line = staging laproscopy = Considered in patients with negative radiographic studies prior to definitive therapy.
What is the typical places for gastric carcinomas to spread?
- Local: Into other organs and into peritoneal cavity and ovaries…Kruckenberg
- Lymph nodes
- Haematogenous: To the liver
What is the treatment of gastric cancer ?
- Disease > 5-10cm from the OG junction may be treated by sub total gastrectomy
- Total gastrectomy if tumour is <5cm from OG junction
- For type 2 junctional tumours (extending into oesophagus) oesophagogastrectomy is usual
- Endoscopic sub mucosal resection may play a role in early gastric cancer confined to the mucosa and perhaps the sub mucosa
D2 Lymphadenectomy should be performed & most patients will receive chemotherapy either pre or post op.
