Gastric Cancer and Pyloric Obstruction Quiz

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.