Stomach

Question 1

What is S1 chemotherapy.

Answer 1

It is an oral chemotherapy for metastatic gastric cancers.
Includes:
1) Tegafur- Oral fluropyrimidine derivative
2) Oteracil & Gimeracil- Enzyme inhibitors

Question 2

Chemo for gastric cancer: drugs used and indications for chemo?

Answer 2

• Cisplatin and 5-FU

Indications:
- LN involvement
- Muscle invasion
- Advanced cancer

Question 3

GIST
-Facts about it
- C/F
- Investigation
- Classification
- HPE, IHC

Answer 3

Most common mesenchymal tumor of stomach and abdomen in general
Arises from : Interstitial cells of Cajal (pacemaker cells)
Most are sporadic, some familial.

Sporadic associated with Carneys triad.
Familial associated with Carney Stratakis syndrome.

Behaves like sarcoma- hematogenous spread —> routine LN clearance not needed.

C/F:
UG Hemorrhage
Pain
Perforation
Mass

Investigations;
-IOC: CECT (diagnosis is radiological, BIOPSY NOT NEEDED)
- For monitoring: PET-CT

Classification: Fletchers classification

HPE:
2 types - Epithelioid type and Spindle type

IHC :
CD117/ c-Kit (most common in GIST)
CD34
DOG1 (Most specific for GIST)

Question 4

Management of GIST

Answer 4

1) Surgery
- If gastric GIST- only wedge resection (gastrectomy not needed)
- Intestinal GIST - Resection & anastomosis
- Routine LN Clearance not needed
- Adhesions may be present to surrounding structures, should be removed to prevent recurrence

In malignant/metastatic GIST: IMATINIB used (Tyr kinase -)

If resistant to imatinib—> Sunitinib, Sorafenib

Question 5

Treatment of gastric lymphoma

Answer 5

1) 1st line treatment is chemotherapy- RCHOP regimen

Rituximab
Cyclophosphamide
Hydroxydaunorubicin
Oncovin/Vincristin
Prednisolome

2) Surgery is used for residual or recurrent disease - Gastric resection

Question 6

MALToma

Site
Cause
C/F
Treatment

Answer 6

Most common site is stomach
H pylori maybe causative

Clinical features: Behaves like lymphoma

Treatment:
-Low grade- H pylori eradication
-Hugh grade- RCHOP regimen followed by surgery

Question 7

Gastric volvulus- Types, Clinical features, Investigations, Management

Answer 7

Types
1) Organoaxial- more common, associated with Rolling diaphragmatic hernia
2) Mesenteroaxial

Clinical features:
BORCHARDT’S triad

1) upper abdominal pain
2) Retching
3) Inability to insert Ryle’s tube

Investigation:
IOC: CECT
Contrast study: Cascade sign

Management:
1) If stomach is viable : Derotate, Gastropexy, Fix diaphragm defect
2) If stomach not viable: Resect stomach, fix diaphragm defect

Question 8

Name the method used to visualise a posterior duodenal ulcer

Answer 8

Kocherization
(Mobilisation of duodenum)

Question 9

Management of giant duodenal perforation.

Answer 9

Triple tube method + Graham patch repair

Triple tube: Duodenostomy tube + Ryles tube (decompression) + Jejunostomy tube (nutrition)