GI Section 1: Luminal (Misc. Gastric Conditions) Flashcards
“Multiple gastric ulcers”
Chronic Aspirin Therapy
Obviously this is non- specific, but some sources say it occurs in 80% of patient’s with chronic aspirin use.
Aspirin on Duodenal ulcers:
aspirin does NOT cause duodenal ulcers.
If you see multiple duodenal ulcers (most duodenal ulcers are solitary) you should think
Zollinger- Ellison.
This is a normal fine reticular pattern seen on double contrast
Areae Gastricae
when does Areae Gastricae “enlarge ” ?
in elderly and patient’s with H. Pylori.
Also it can focally enlarge next to an ulcer.
It becomes obliterated by cancer or atrophic gastritis.
It’s an idiopathic gastropathy, with regular rugal thickening that classically involves the fundus and spares the antrum.
Menetrier’s Disease
+FUNDUS
- ANTRUM
Involves the fundus, and spares the antrum.
Menetrier’s Disease
Ram’s Horn Deformity (Pseudo Billroth I)
Tapering of the antrum causes the stomach to look
like a Ram’s Horn
Seen in:
Scarring in peptic ulcers
Granulomatous diseases:
Crohns, Sarcoid, TB, Syphillis
Scirrhous Carcinoma
The stomach is the most common GI tract location for what disease?
Sarcoid
Gastric Volvulus two types
Organo axial and mesenteroaxial
Greater Curvature flips over the lesser curvature
Organoaxial Gastric volvulus
Twisting over the mesentery
Mesenteroaxial Gastric volvulus
Gastric Antrum BELOW the GE Junction
Organoaxial Gastric volvulus
Gastric Antrum ABOVE the GE Junction
Mesenteroaxial Gastric volvulus
Gastric diverticulum (common in the posterior fundus)
Mistaken for an adrenal mass (find the normal adrenal)
splenic vein thrombus causing isolated gastric varices
Gastric Varices
the most common complication of Gastric Band
Stomal stenosis = band too tight
Pylorus is removed and the proximal stomach is sewed directly to the duodenum.
Billroth 1
Partial gastrectomy, but this time the stomach is attached to the jejunum.
Billroth 2
Indications for Billroth 1
Gastric CA
Pyloric Dysfunction or ulcers
Less Post Op Gastritis but MORE early post op complications vs Billroth 2
Indications for Billroth 2
Gastric CA or Ulcers (distal stomach)
Risks
Dumping Syndrome
Afferent loops syndrome
Increased risk of gastric CA post surgery
Stomach is divided to make a “pouch.” This gastric pouch is attached to the jejunum. The excluded stomach attaches to the duodenum as per normal. The jejunum is attached to the other
jejunum to form the bottom of the Y.
Roux-en-Y
Indications of Roux-en-Y surgery
For obesity
Billtroth alternative for Gastric CA if with direct invasion of the duodenum or head of the pancreas
Less reflux, less risk for recurrent gastric CA
risks: leaks, fistulas, gallstones and hernias
