GI haemorrhage & gastric neoplasms Flashcards
What are the common causes of upper GI bleeding?
- Peptic ulceration (40%)
- Gastroduodenal erosions (15%)
- Oesophagitis (15%)
- Mallory-Weiss syndrome (tears at the gastro-oesophageal junction due to violent vomiting - 15%)
- Varices (10%) - dilated veins in the oesophagus
- Upper GI malignancy (1%)
What are the symptoms of upper GI bleeding?
What are the signs?
Symptoms:
- Haematemesis
- Malaena (blood altered by bacteria thus tarry stools)
- Haematochezia (unaltered PR blood, can rarely occur in massive upper GI bleeds)
- Abdominal pain
Signs will be of any underlying cause, and of shock
Chronic GI blood loss presents with sign/symptoms of iron-deficient anaemia - kolionychia, angular stomatitis, brittle nail/hair. Fatigue, weakness, headaches, cardiovascular symptoms. Pallor, tachycardia.
What are the risk factors for gastric cancer?
- H. Pylori infection leading to metaplasia
- High salt/nitrate (red meat) diet
- Smoking
- Genetic factors - blood group A/HNPCC, Japanese heritage
- Pernicious anaemia
- Adenomatous polyps (benign (noncancerous) growths)
- Low socio-economic status
What are symptoms and signs that would suggest gastric cancer?
Symptoms:
- Often non-specific
- Epigastric pain, as with gastric peptic ulcer
- Nausea and vomiting (vomiting is frequent if the tumour is near the fundus)
- Dysphagia (if the tumour is near the fundus)
- Anorexia/weight loss
Signs:
- Palpable epigastric mass (50%)
- Large left supraclavicular node (Virchow’s)
- Hepatomegaly, jaundice & ascites
- Acanthosis nigricans (brown to black, poorly defined, velvety hyperpigmentation of the skin. It is usually found in body folds)
Describe the classification of morphology of gastric cancers
Gastric adenocarcinomas, which make up over 90% of gastric neoplasms, may be classified as:
- Intestinal (Type 1)
- well to moderately differentiated glandular (tubular) structures, with multiple lumens.
- Often associated with HPylori, and may be polypoid (presents earlier with bleeding and easier to resect) or ulcerative (the most common form, has a raised edge and a necrotic base)
- Diffuse (Type 2)
- poorly cohesive “signet ring” cells (keep mucous inside), linitus plastica (leather bottle stomach), and infiltration (worse prognosis).
- The tightening and thickening of the mucosa causes a reduction in stomach capacity.
Describe the natural history of gastric cancer
- Most occur in the antrum
- Metastases are local by direct invasion of abdominal viscera, lympathic (Virchow’s) and then to the liver by portal dissemination
- Transcoelomic spread may cause peritoneal seedings, including bilateral ovarian ‘Krukenberg’ tumours (name for any secondary ovarian tumour)
List diagnostic methods used to investigate patients with suspected gastric neoplasia
Staging?
Diagnosis:
- Oesophageal-gastric-duodenal endoscopy and multiple edge biopsy
Staging:
- Endoscopic USS and CT for staging
