Gastric Cancer and Pyloric Obstruction Quiz
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Questions and Answers

Which of the following is a finding on examination indicative of pyloric obstruction?

  • Decreased serum electrolytes
  • Soup dish appearance on barium meal
  • Absence of abdominal distension
  • Visible peristalsis (left to right) (correct)

    • Multiple adenomatous polyps in the stomach are considered premalignant.

    True (A)

    What percentage of gastric cancers are adenocarcinomas?

    95%

    A dilated stomach reaching the pelvis and a '____ ____' appearance are findings in barium meal studies of pyloric obstruction.

    <p>soup dish</p> Signup and view all the answers

    Match the following characteristics with the type of gastric cancer:

    <p>Adenocarcinoma = Most common type of gastric cancer Colloid carcinoma = Associated with a bad prognosis Early gastric cancer = Infiltration limited to mucosa or submucosa</p> Signup and view all the answers

    A patient with a confirmed H. pylori infection is at risk for:

    <p>Increased risk of gastric cancer (D)</p> Signup and view all the answers

    Truncal vagotomy + gastrojejunostomy is the treatment of gastric tumours?

    <p>False (B)</p> Signup and view all the answers

    Which of the following is NOT a predisposing factor for gastric cancer?

    <p>High socioeconomic status (A)</p> Signup and view all the answers

    Which type of spread can lead to Krukenberg's tumor or Blumer's shelf in advanced gastric cancer?

    <p>Trans-celomic spread (C)</p> Signup and view all the answers

    Squamous cell carcinoma is the most common type of gastric cancer.

    <p>False (B)</p> Signup and view all the answers

    What is the test of choice for diagnostic confirmation of gastric cancer?

    <p>EGD with biopsy</p> Signup and view all the answers

    Enlarged Virchow's lymph nodes are also known as ________ sign.

    <p>Troisier's</p> Signup and view all the answers

    Match the following clinical presentations with the likely location/type of mass in gastric cancer:

    <p>Dysphagia = Mass in the cardia Vomiting = Mass in the pylorus Jaundice = Liver secondaries Epigastric mass = Advanced stage</p> Signup and view all the answers

    A male patient over 40 years old presents with dyspepsia, anorexia, and abdominal pain after meals that does not respond to treatment. Which clinical group does this patient most likely belong to?

    <p>Dyspepsia group (D)</p> Signup and view all the answers

    Blood spread of gastric cancer commonly metastasizes to the bones.

    <p>False (B)</p> Signup and view all the answers

    What staging method is the most accurate for assessment of invasion?

    <p>Endoscopic ultrasound (EUS)</p> Signup and view all the answers

    Which of the following lymph nodes does the antrum of the stomach primarily drain to?

    <p>Right gastric and subpyloric LNs (C)</p> Signup and view all the answers

    A thickened stomach wall with intact mucosa, indicative of advanced gastric cancer, is known as ________ ________.

    <p>linitis plastica</p> Signup and view all the answers

    What is the main genetic mutation associated with Gastrointestinal Stromal Tumors (GIST)?

    <p>c-KIT (C)</p> Signup and view all the answers

    Small tumors (< 2 cm) in GISTs are often symptomatic.

    <p>False (B)</p> Signup and view all the answers

    What is the primary treatment for Gastrointestinal Stromal Tumors?

    <p>Surgical removal and treatment with tyrosine kinase inhibitors such as imatinib.</p> Signup and view all the answers

    A ____ is an opening of the stomach on the skin, which may be temporary or permanent.

    <p>gastrostomy</p> Signup and view all the answers

    Match the type of vagotomy with its description:

    <p>Truncal vagotomy = Involves cutting the trunk of the vagus nerve, often requiring drainage operation Selective vagotomy = Targets specific areas of the vagus nerve, preserving gastric motility Highly selective vagotomy = Focuses on specific branches to minimize side effects Seromyotomy = A procedure to manage complications related to vagotomy</p> Signup and view all the answers

    What is a trichobezoar primarily caused by?

    <p>Pathological ingestion of hair (C)</p> Signup and view all the answers

    Phytobezoars are usually found in patients who have a history of psychiatric disorders.

    <p>False (B)</p> Signup and view all the answers

    What are the two types of stomach volvulus?

    <p>Horizontal (organoaxial) and Vertical (mesenteroaxial)</p> Signup and view all the answers

    Trichobezoars can lead to __________ and gastrointestinal bleeding.

    <p>ulceration</p> Signup and view all the answers

    Which of the following statements about foreign bodies in the stomach is true?

    <p>Most foreign bodies will pass spontaneously if they leave the stomach. (D)</p> Signup and view all the answers

    Vertical volvulus is more common than horizontal volvulus.

    <p>False (B)</p> Signup and view all the answers

    What is the most common symptom of acute stomach volvulus?

    <p>Severe epigastric pain</p> Signup and view all the answers

    The treatment for trichobezoars may require __________ surgical treatment.

    <p>open</p> Signup and view all the answers

    Match the conditions with their associated characteristics:

    <p>Trichobezoar = Pathological ingestion of hair Phytobezoar = Made of vegetable matter Volvulus (Horizontal) = Associated with diaphragmatic defects Volvulus (Vertical) = Idiopathic in nature</p> Signup and view all the answers

    What is the most common clinical picture seen in chronic stomach volvulus?

    <p>Distress or bloating after meals (D)</p> Signup and view all the answers

    Flashcards

    Dehydration Signs

    Clinical signs include upper abdominal distension and visible peristalsis with succussion splash.

    Barium Meal Appearance

    Shows dilated stomach and 'soup dish' appearance in imaging studies.

    Truncal Vagotomy

    Surgical procedure to cut vagus nerve, often paired with gastrojejunostomy.

    Gastric Tumors Types

    Can be benign (like GIST and adenomatous polyps) or malignant (like gastric cancer).

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    Adenocarcinoma Prevalence

    Accounts for 95% of gastric cancer cases and arises from glandular stomach cells.

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    Predisposing Factors for Gastric Cancer

    Includes diet, H. pylori infection, smoking, obesity, and genetic factors.

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    5-Year Survival Rate

    Overall survival rate for gastric cancer is about 5%.

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    Hereditary Nonpolyposis Colorectal Cancer

    Genetic condition that increases risk of gastric cancer, often linked with blood type A.

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    Gastrointestinal Stromal Tumor (GIST)

    Tumors originating from interstitial cells of Cajal, primarily in the stomach and intestines.

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    c-KIT Gene Mutations

    Genetic alterations associated with GIST, affecting a tyrosine kinase receptor.

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    Vagotomy Complications

    Post-surgery issues include distention, diarrhea, dysphagia, and ulcer recurrence.

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    Gastrectomy Types

    Includes total, subtotal, and partial gastrectomy based on how much of the stomach is removed.

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    Treatment for GIST

    Involves surgical removal and tyrosine kinase inhibitors like imatinib (Gleevec).

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    Advanced Gastric Cancer Types

    Includes squamous cell carcinoma (4%), anaplastic carcinoma (1%), and colloid carcinoma.

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    Fungating Mass

    A growth resembling a cauliflower found in the body and fundus of the stomach.

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    Spread of Cancer

    Cancer spreads via direct invasion, blood, lymphatic routes, and trans-celomic spread.

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    Dyspepsia Group Symptoms

    Symptoms include dyspepsia, abdominal pain, and anorexia in males over 40.

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    Cachexia Group Symptoms

    Anemia, unexplained weight loss, and asthenia.

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    Obstructive Group Symptoms

    Includes dysphagia from a mass in the cardia and vomiting from pyloric obstruction.

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    Mass Group Symptoms

    About 30% of patients present with an epigastric mass.

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    Diagnostic Confirmation

    EGD with biopsy is the test of choice for diagnosing gastric cancer.

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    CT in Staging

    CT scans of the abdomen, pelvis, and thorax evaluate for lymph node and metastatic diseases.

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    Treatment Options

    Inoperable cases may undergo palliative gastrectomy; operable tumors may be resected.

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    Trichobezoar

    A hair ball formed from ingested hair, often in psychiatric patients.

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    Phytobezoar

    A bezoar made of vegetable matter, commonly found in patients with gastric stasis.

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    Diagnosis of bezoars

    Diagnosis can be made via endoscopy or radiograph.

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    Treatment of trichobezoars

    Involves removal, sometimes requiring open surgery.

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    Foreign bodies in stomach

    Various ingested objects, often visible on radiographs, typically pass without harm.

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    Volvulus of the stomach

    Twisting of the stomach around its axis, leading to obstruction.

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    Horizontal volvulus

    A type of volvulus, usually associated with diaphragmatic defects.

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    Vertical volvulus

    An idiopathic type of volvulus around the center of the greater curvature.

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    Acute volvulus symptoms

    Symptoms include severe epigastric pain and vomiting.

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    Chronic volvulus symptoms

    Often asymptomatic, may present with bloating or distress after meals.

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    Study Notes

    Surgical Diseases of the Stomach

    • Gastric Conditions:

      • Acute Gastric Dilatation: A condition where the stomach loses tone and rapidly expands to a large size, often filled with air and dark, foul-smelling fluid. Caused by conditions like post-operative procedures, splenectomy, cholecystectomy, and rarely, labor or plaster casts.
      • Foreign Body Ingestion: Objects like needles or other ingested items usually pass without harming the patient, but those that cause symptoms or blockages may require intervention.
      • Gastric Volvulus: Twisting of the stomach around its axis, resulting in a blockage or severe pain. This can be horizontal or vertical. Often associated with a large diaphragmatic defect. Treatment depends if the patient is in acute or chronic stage.
      • Trichobezoar: Hairballs formed from undigested hair, predominantly present in psychiatric patients .Can lead to ulceration and other complications.
      • Phytobezoar: Stomach bezoars composed of vegetable matter, commonly occurring following gastric surgery due to stomach stasis.

    • Peptic Ulcer Disease: A common condition in the past causing stomach ulcerations, but now more often treated with medication to reduce stomach acid.

      • Indications for Surgery: Treatment with medical intervention is usually sufficient. Surgery is only needed in refractory cases, continuing use of NSAIDs, or if medical treatment is not tolerated.Complicated cases might also require surgery.

    • Gastric Neoplasms:

      • Benign: Gastrointestinal stromal tumors (GISTs), neurofibromas, and schwannomas are examples.
      • Malignant: Adenocarcinoma is one of the more common types of gastric cancer. 95% of cases are adenocarcinoma. Predisposing factors like high-nitrate diets, H. pylori, and certain hereditary conditions can increase risk.

    • Gastric Operations:

      • Vagotomy: Surgical division of the vagus nerve to reduce stomach acid production. This is sometimes combined with other procedures to improve results (e.g., pyloroplasty or antrectomy).
      • Partial Gastrectomy: Resection of a portion of the stomach. This can include a number of procedures such as Billroth I or Billroth II.
      • Total Gastrectomy: Surgical removal of the entire stomach, usually performed for advanced cases.
      • Gastrostomy: Surgical creation of a connection between the stomach and the skin to provide access to the stomach for feeding, nutrition, etc. Could be temporary or permanent.

    • Innervation of the Stomach:

      • Sympathetic: Innervated by T5 to T10.
      • Parasympathetic: Anterior part innervated by the left vagus nerve (giving a hepatic branch) and the posterior by the right vagus nerve (giving a celiac branch).

    • Blood Supply of the Stomach:

      • Lesser Curvature: Supplied by the right and left gastric arteries originating from the hepatic and celiac trunk respectively.
      • Greater Curvature: Supplied by the right and left gastroepiploic arteries, originating from the gastroduodenal and splenic artery respectively.
      • Pylorus: Supplied by the gastroduodenal artery.
      • Fundus: Supplied by the short gastric arteries.

    • Anatomy, Histology & Physiology of Stomach:

      • Stomach is composed of  five parts: cardia, fundus, body, antrum, and pylorus.

    Acute Gastric Distention

    • This is a condition where the stomach loses its tone and rapidly enlarges to an enormous size, filled with air and foul-smelling fluid.
    • It's commonly experienced postoperatively following procedures like pelvic operations, splenectomies, and cholecystectomies
    • The fluid is typically from the intravascular compartment which has been depleted, leading to hypovolemic shock.

    Complications of Peptic Ulcer

    • Bleeding
    • Perforation
    • Penetration and Fistula
    • Malignant Transformation
    • Gastric Outlet Obstruction (hourglass stomach)
    • Recurrence after treatment

    Perforated Peptic Ulcer

    • This complication typically involves the anterior wall of the first part of the duodenum.
    • It's more prevalent in men.
    • Risk factors include the use of NSAIDs and heavy meals.

    Gastric Outlet Obstruction

    • Characterized by compensatory hypertrophy of the muscular layers.
    • Often presents with long-standing symptoms of dyspepsia, reduced weight and loss of appetite.
    • Commonly involves long-standing history of dyspepsia and weight loss.
    • Diagnosis can be aided by laboratory tests (electrolyte levels), barium meals, and upper endoscopy examinations.

    Gastric Tumors (Benign and Malignant)

    • Benign: Gastrointestinal stromal tumors
    • Malignant: Adenocarcinomas is the most frequent gastric cancer type.

    Staging of Gastric Cancer

    • TNM staging system (tumor, node, metastasis) is used to grade the disease.

    Treatment of Gastric Conditions

    • Typically includes conservative methods (medications) and surgical intervention in severe cases or complications.
    • Treatment of complications and pre-existing conditions (e.g., anemia or electrolyte imbalance ) are crucial components of the approach.

    Foreign Bodies in the Stomach

    • A variety of ingested foreign bodies end up in the stomach, and they frequently appear on radiographic images.
    • They are usually safely passed by the body and don't require intervention, unless they are problematic.

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    Description

    Test your knowledge on gastric cancer, its types, and pyloric obstruction findings. This quiz covers key clinical presentations, examination findings, and treatment options for gastric tumors. Brush up on your understanding of H. pylori's role in gastric cancers and related diagnostic methods.

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