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ANATOMY OF THE STOMACH AND DUODENUM Blood supply Arteries The stomach has an arterial supply on both the lesser and greater curves ( Figure 67.1 ). On the lesser curve, the left gastric artery , a branch of the coeliac axis, forms an anastomotic arcade with t...

Aetiology Gastric cancer is a multifactorial disease. Epidemiological studies point to a role for H. pylori ; however, there is insu ffi cient evidence to support eradication programmes in asymptomatic patients . H. pylori seems to be principally associated with...

Angiography Angiography is used most commonly in the investigation of upper gastrointestinal bleeding not identified using endoscopy . Giulio Bizzozero , 1846–1901, pathologist, University of Turin, Italy . John Robin Warren , b. 1937, pathologist, Royal Perth...

Aortic enteric fistula This diagnosis should be considered in any patient with haematemesis and melaena that cannot be otherwise explained. Contrary to expectation, the bleeding from such patients is not always massive. V ery often there is nothing much to dist...

Autoimmune gastritis This is an autoimmune condition in which there are circulating antibodies to parietal cells that results in atrophy of the parietal cell mass, hence hypochlorhydria and ultimately achlorhydria. As intrinsic factor is also produced by pari...

Bleeding peptic ulcers The epidemiology of bleeding peptic ulcers mirrors that of perforated ulcers. In recent years, the population a ff ected has become older and bleeding is commonly associated with the ingestion of NSAIDs. Diagnosis can normally be made e...

Chief cells These lie proximally in the gastric crypts and produce pepsino gen. Two forms of pepsinogen are described: pepsinogen I and pepsinogen II. The ratio between pepsinogens I and II in the serum decreases with gastric atrophy . Pepsinogen is activated...

Clinical examination Examination of the patient may reveal epigastric tenderness but, except in gastric outlet obstruction, there is unlikely to be much else to find (see Chapter 63 ).

Clinical features of peptic ulcers The clinical features of gastric and duodenal ulceration cannot be di ff erentiated on the basis of symptoms. The demographic characteristics of groups of patients with gastric and duodenal ulceration do di ff er but this doe...

Clinical features In benign gastric outlet obstruction, there is usually a long history of peptic ulcer disease. The vomitus is characteristically of undigested food and is totally lacking in bile. Weight loss is a feature, and the patient appears unwell and...

Complications of peptic ulceration The common complications of peptic ulcer are perforation, bleeding and stenosis. Bleeding and stenosis are considered below in the relevant sections. y Perforated peptic ulcer Epidemiology Despite the widespread use of gast...

Computed tomography/positron emission tomography Positron emission tomography (PET) is increasingly being used in the preoperative staging of gastro-oesophageal cancer as it will detect otherwise occult tumour spread in up to 10% of patients who might otherw...

Computed tomography scanning and magnetic resonance imaging CT is increasingly used in the investigation of the stomach, especially in the context of gastric malignancies. Although it is much less accurate in ‘T’ staging than endoluminal can be easily detecte...

Contrast radiology Upper gastrointestinal radiology is not used as much as in previous years, as endoscopy is a more sensitive investigation. Computed tomography (CT) imaging with oral contrast has replaced contrast radiology in many of the areas where anatom...

DUODENAL OBSTRUCTION Duodenal obstruction in adults is usually due to malignancy , and cancer of the pancreas is the most common cause. Treat ment is usually by gastroenterostomy , but duodenal stenting is increasingly being used. In patients having a surgica...

DUODENAL TUMOURS Benign duodenal tumours Duodenal villous adenomas occur principally in the periamp ullary region. Although generally uncommon, they are often found in patients with FAP . The appearances are similar to those adenomas arising in the colon and, ...

Dieulafoy lesion This is essentially a gastric arterial venous malformation that has a characteristic histological appearance. Bleeding due to - this malformation is one of the most di ffi cult causes of upper - gastrointestinal bleeding to treat. The lesion i...

Duodenal adenocarcinoma Most duodenal tumours originate in the periampullary region and commonly arise in pre-existing villous adenomas. Patients present with anaemia due to ulceration of the tumour or obstruction. Direct involvement in the ampulla leads to o...