67 T_h e stomach and duodenum

ANATOMY OF THE STOMACH AND DUODENUM Blood supply Arteries The stomach has an arterial supply on b...

Aetiology Gastric cancer is a multifactorial disease. Epidemiological studies point to a role for...

Angiography Angiography is used most commonly in the investigation of upper gastrointestinal blee...

Aortic enteric fistula This diagnosis should be considered in any patient with haematemesis and me...

Autoimmune gastritis This is an autoimmune condition in which there are circulating antibodies to...

Bleeding peptic ulcers The epidemiology of bleeding peptic ulcers mirrors that of perforated ulc...

Chief cells These lie proximally in the gastric crypts and produce pepsino gen. Two forms of pep...

Clinical examination Examination of the patient may reveal epigastric tenderness but, except in ...

Clinical features of peptic ulcers The clinical features of gastric and duodenal ulceration cann...

Clinical features In benign gastric outlet obstruction, there is usually a long history of pepti...

Complications of peptic ulceration The common complications of peptic ulcer are perforation, ble...

Computed tomography/positron emission tomography Positron emission tomography (PET) is increasing...

Computed tomography scanning and magnetic resonance imaging CT is increasingly used in the invest...

Contrast radiology Upper gastrointestinal radiology is not used as much as in previous years, as ...

DUODENAL OBSTRUCTION Duodenal obstruction in adults is usually due to malignancy , and cancer of ...

DUODENAL TUMOURS Benign duodenal tumours Duodenal villous adenomas occur principally in the peria...

Dieulafoy lesion This is essentially a gastric arterial venous malformation that has a characteri...

Duodenal adenocarcinoma Most duodenal tumours originate in the periampullary region and commonly ...

Duodenal ulceration Incidence There have been marked changes in the demography of patients prese...

Duodenum The duodenum is lined by a mucus-secreting columnar epithe lium. In addition, Brunner’s ...

Endocrine cells The stomach has numerous endocrine cells that are critical to its function. In th...

Erosive gastritis This is caused by agents that disturb the gastric mucosal barrier; NSAIDs and a...

FURTHER READING Al-Batran S-E, Homann N, Schmalenberg H et al . Perioperative che - motherapy wit...

Flexible endoscopy Flexible endoscopy is more sensitive than conventional radiology in the assess...

Foreign bodies in the stomach A variety of ingested foreign bodies reach the stomach, and very o...

GASTRIC CANCER Carcinoma of the stomach is a major cause of mortality world - wide. Its prognosis...

GASTRIC OUTLET OBSTRUCTION The two common causes of gastric outlet obstruction are gastric cance...

GASTRITIS The great variety of names and classification systems used in gastritis is confusing. T...

GASTROINTESTINAL STROMAL TUMOURS Gastrointestinal stromal tumours (GISTs) may arise in any part o...

Gastric acid secretion Secretion of gastric acid and pepsin tends to run in parallel, although t...

Gastric emptying studies These are useful in the study of gastric dysmotility problems, particula...

Gastric erosions Erosive gastritis has a variety of causes, especially NSAIDs. Fortunately , mos...

Gastric mucus and the gastric mucosal barrier The gastric mucous layer is essential to the integr...

Gastric ulcers Incidence As with duodenal ulceration, H. pylori and NSAIDs are the important aeti...

Gastroduodenal motor activity The motility of the gastrointestinal tract is modulated by its int...

HAEMATEMESIS AND MELAENA Upper gastrointestinal haemorrhage remains a major medi - cal problem wi...

HELICOBACTER PYLORI H. pylori is involved in the aetiology of a number of common gastroduodenal...

Helicobacter pylori gastritis H. pylori gastritis, previously described as type B gastritis, a ff ...

Histopathology Microscopically , the base of the ulcer is covered with granula tion tissue and t...

INVESTIGATION OF THE STOMACH AND DUODENUM

Incidence There are marked variations in the incidence of gastric cancer worldwide. In the UK, i...

INTRODUCTION The stomach acts as a reservoir for ingested food, where it is mechanically broken d...

Investigation of the patient with

Laparoscopy Laparoscopy is routine in the assessment of patients with gastric cancer. Its particu...

Learning objectives To understand: The gross and microscopic anatomy and pathophysiology • of the...

Long-term complications of surgery There is very little functional di ff erence between patients w...

Lymphatic drainage of the stomach Understanding the lymphatic drainage of the stomach is the key...

Lymphatics The lymphatics of the stomach are of considerable importance in surgery for gastric ...

Lymphocytic gastritis This type of gastritis is rare. It is characterised by the infiltration of ...

MICROSCOPIC ANATOMY OF THE STOMACH AND DUODENUM The gastric surface epithelial cells are mucus pr...

Malignancy in gastric ulcers In contrast to chronic duodenal ulcers, gastric ulcers are associate...

Mallory–Weiss tear This is a longitudinal tear at the GOJ, which is induced by repetitive and str...

Management Treating the patient involves correcting the metabolic abnormalities and dealing with ...

Metabolic effects V omiting hydrochloric acid results in hypochloraemic alkalosis. Initially the ...

Ménétrier’s disease This is an unusual condition characterised by gross hypertro - phy of the ga...

Neoadjuvant chemotherapy Most operable patients should have neoadjuvant chemother - apy as there ...

Nerves The stomach and duodenum possess both intrinsic and extrinsic nerve supplies. The intrinsi...

Neuroendocrine tumours A number of neuroendocrine neoplasms occur in the duode - num. It is a c...

OTHER GASTRIC CONDITIONS Acute gastric dilatation This condition usually occurs in association wi...

Operations for duodenal ulceration Procedures for the treatment of duodenal ulcers have the comm...

Operations for gastric ulcer In contrast to surgery for duodenal ulcer, where the princi pal obje...

Other forms of gastritis Eosinophilic gastritis appears to have an allergic basis and is treated ...

Other peptic ulcers A prepyloric gastric ulcer was in the past di ffi cult to treat, a problem over...

Other treatment modalities Because of the failure of radical surgery to cure advanced gastric c...

Outlook after surgical treatment The outlook after surgical treatment varies considerably between...

PHYSIOLOGY OF THE STOMACH AND DUODENUM The stomach mechanically breaks down ingested food and, to...

Palliative surgery In patients with significant symptoms of either obstruction or bleeding, palli...

Parietal cells These are found in the body (acid-secreting portion) of the stomach and line the ...

Pathology Gastric ulcers have similar features to duodenal ulcers but tend to be larger. Fibrosis...

Pattern of relapse following surgical treatment The most common site of relapse following radica...

Peptides and neuropeptides in the stomach and duodenum As with most of the gastrointestinal trac...

Portal gastropathy Portal gastropathy refers to changes in the gastric mucosa as a result of por...

Portal hypertension and portal gastropathy The management of bleeding gastric varices is very ch...

Postoperative complications of gastrectomy Radical gastrectomy is complex major surgery and predi...

Reflux gastritis This is caused by enterogastric reflux. Its histological features are distinct fro...

Sequelae of peptic ulcer surgery There are a number of sequelae of peptic ulcer surgery , which...

Site The proximal stomach is now the most common site for gastric cancer in the West. Because the...

Spread of carcinoma of the stomach Gastric cancer is an excellent example of the various distant...

Staging The International Union Against Cancer (UICC) staging system is shown in Table 67.6 . Imp...

Stress gastritis This is a common sequel of serious illness or injury and is characterised by a ...

Stress ulceration This commonly occurs in patients with major injury or illness who have undergon...

Subtotal gastrectomy For tumours in the distal stomach, it is unnecessary to remove the whole sto...

The molecular pathology of gastric cancer Understanding of the molecular pathology of gastric c...

Treatment of peptic ulceration The vast majority of uncomplicated peptic ulcers are treated medi...

Trichobezoar and phytobezoar Trichobezoar (hair balls) ( Figure 67.34 ) are unusual and are virtu...

Tumours ly All gastric neoplasms may present with chronic or acute upper - gastrointestinal bleed...

Ultrasonography Standard ultrasonography can be used to investigate the stomach but used conventi...

Volvulus of the stomach Rotation of the stomach usually occurs around the axis and between its t...

Zollinger–Ellison syndrome This syndrome is mentioned here because the gastrin - producing endocr...

suspected peptic ulcer Gastroduodenoscopy oper - In the stomach, any abnormal lesion should be bi...