The Digestive System - stomach

Question 1

what is the stomachs macrostructure?

Answer 1

2 sphincters - cardiac & pyloric sphincter
2 curvatures - greater & lesser curvature
4 regions - cardiac, fundus, body, pylorus

Question 2

what is the microstructure lining of the stomach?

Answer 2

muscle layer, submucose & mucosa

Question 3

anatomical relations to stomach?

Answer 3

ant - left upper quadrant of abdominal wall & lft lobe of liver
post - lft kidney, spleen, IVC, pancreas, abdominal aorta
sup - diaphram & oesophagus
inf - transverse colon

Question 4

what arteries and veins supply the stomach?

Answer 4

coeliac artery into lft & rt gastric artery

lt & rt gastric veins to portal veins

Question 5

describes the lymphatic drainage of the stomach?

Answer 5

gastric nodes empty into pre-aortics & lateral aortic nodes and then into the thoracic duct

Question 6

what is the physiology of the stomach?

Answer 6

food reservoir, digestion - churns food, secretes gastric juice; 3 phases

1. cephalic phase - sigh & smell stimulation
2. gastric phase - foode in stomach
3. intestinal phase - slows down gastric juice secretion

Question 7

what are the functions of gastric juice?

Answer 7

1. water liguefies the food swalloed
2. enzyme activation & micro-organism death
3. enzyme action
4. intrinsic factor
5. mucous

Question 8

epidemiology & aetiology of stomach cancer?

Answer 8

male:female 2:1
7% of cancers
60yrs most common 
higher incidence in manual workers 
diet - high salt
smoking
industrial
stomach ulcer history 
gene mutations - p53

Question 9

types of cacners present in the stomach?

Answer 9

95% adenocarcinomas
5% lymphoma
diffuse and infiltrating

Question 10

what staging system is used for stomach cancer?

Answer 10

TNM

T1 - T4

Question 11

presenting signs and symptoms of stomach cancer?

Answer 11

loss of appetite, weight loss, abdominal pain, enlarged liver, dyshagia

Question 12

investigations used for stomach cancer?

Answer 12

FBC, chest radiograph, gastroscopy, biospy, ultrasound, MRI

Question 13

how are patients managed with stomach cancer ?

Answer 13

surgery - curative gastrectomy, subtotal resection or palliative resection
chemotherapy - epirubicin, cisplatin, 5-FU
Radiotherapy

Question 14

what RT technique and dose is used for stomach cancer?

Answer 14

parallel opposed - 45G in 25#
palliative role - 20GY in 5# or 8Gy single # - relieve symptoms - rarely used
intra=operative RT

Question 15

what is intra-operative radiothrapy?

Answer 15

electron or brachytherapy
delivery of irradiation at surgery
large fraction of 10-15Gy
residual disease or unresectable tumour

Question 16

Radiotherapy side effects for stomach cancer?

Answer 16

nausea, headache, tiredness/weakness, sickness (anti-emetics)