Stomach Flashcards
thickened gastric fold ddx
H pylori, ZE, eosinohilic gastritis, menetrier disease, crohn disease, gastric varices, lymphma, submucosal lymphoma
eosinophilic gastritis
thickened folds in stomach/small bowel, history of allergy
menetrier disease
protein-losing enteropathy; proximal stomach
replacement of parietal cells by hyperplastic epithelial cells»_space; achlorhydria
?? association with gastric carcinoma
crohn disease stomach
distal half of stomach; apthous ulcers
fundic gland polyposis syndrome
variant of familial adenomatous polyposis (FAP) that involves stomach
polyps are hyperplastic
hyperplastic polyp
inflammatory polyp; cystic dilation of gastric gland in response to inflammation
adenomatous polyp, size/ treatment
neoplastic polyp with malignant potential; > 2cm, can have risk of malignant transformation
treat: endoscopic biopsy/polypectomy
harmartomatous polyp
associated with peutz jegher, juvenile polyposis, cronkhite canada syndrome
benign gastric masses
lipoma, GIST, ectopic pancreatic rest
gastric lipoma
fatty attenuation on CT
indistinguishable from GIST on fluoro
gastric GIST
most common submucosal gastric tumor
arise from interstitial cells of Cajal (pacemaker cells drive peristalsis); more likely to be malignant as they increase in size
differential for submucosal gastric mass
mesenchymal tumor (GIST, fibroma, lipoma, neurofibroma), carcinoid, ectopic pancreatic rest
ectopic pancreatic rest
heterotopic pancreas in gastric submucosa
umbilicated submucosal nodule with umbilication representing a focus of normal epithelium
malignant gastric masses
gastric cancer, GIST (malignant), lymphoma, mets
gastric cancer risk factors
ingestion of polycyclic hydrocarbons/nitrosamines, atrophic gastritis, pernicious anemia, post-subtotal gastrectomy
krukenberg tumor
met spread of gastric carcinoma to ovary
gastric cancer spread
lymphatic spread along lesser curvature»_space; gastrohepatic liagement and greater curvature
benign gastric ulcers
radiatic gastric folds: smooth/symmetric
ulcer extends beyond contour of lumen
Hampton line: nonulcerated acid-resistant mucosa
gastric carcinoma ulcers
asymmetric ulcer crater with nodular tissue; does not project beyond location of gastric wall
abrupt transition between normal gastric wall/surrounding tissue
carman meniscus sign: splaying open of large flat malignant ulcer when compression applied
RYGB
small gastric pouch created
roux limb created by transecting jejunum and anastamosing to gastric pouch
excluded stomach/pancreaticoviliary limb (afferent limb) connected via jejunojejunostomy
placement of roux limb
antecolic favored (in front of transverse colon)
retrocolic requires defect through transverse mesocolon; risk of transmesocolic hernia
how does RYGB work for weight loss
early satiety (small stomach) and malabsorption (bypass to jejunum)
complications of roux en y surgery
postoperative leak, gastrogastric fistula, SBO, internal hernia, stomal stenosis, marginal ulcers
roux en y postoperative leak
diagnosed 10 days after surgery
diagnosed with upper GI study
leaks from distal esophagus, gastric pouch, blind ending jejunal limb
gastrogastric fistula
communication between gastric pouch and excluded stomach; may lead to inadequate weight loss/gain
SBO from roux en y
acute post op: edema/hematoma at gastrojejunostomy/jejunojejunostomy
late post op: internal hernia (common with lap surgery) or adhesions
internal hernias from roux en y
present within 2 years of bypass
transmesocolic; peterson’s space; mesenteric defect created by the jejunojejunostomy
transmesocolic hernia
defect in mesentery of the transverse colon; associated with retrocolic Roux limb
petersons space hernia
mesentery of roux limb and transverse mesocolin
signs of internal hernia on imaging
swirling mesentery; mushroom mesentary shape; presence of bowel loops posterior to SMA
