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Portal hypertension and portal gastropathy The management of bleeding gastric varices is very challeng ing. Fortunately , most bleeding from varices is oesophageal and is much more amenable to sclerotherapy , banding and balloon tamponade. Gastric varices may...

Postoperative complications of gastrectomy Radical gastrectomy is complex major surgery and predict - ably there is a large number of potential complications of the operation. Leakage of the oesophagojejunostomy can often be managed conservatively as the Ro...

Reflux gastritis This is caused by enterogastric reflux. Its histological features are distinct from other types of gastritis. Although commonly seen after gastric surgery , it is occasionally found in patients with no previous surgical intervention or those wh...

Sequelae of peptic ulcer surgery There are a number of sequelae of peptic ulcer surgery , which include recurrent ulceration, small stomach syndrome, bilious Eugen (Jeno) Alexander Pólya , 1876–1944, surgeon, St Stephen’s Hospital, Budapest, Hungary . Walthe...

Site The proximal stomach is now the most common site for gastric cancer in the West. Because the lower oesophagus is also a very common site of adenocarcinoma approximately 60% of all malignancies in the upper gastrointestinal tract occur in proximity to th...

Spread of carcinoma of the stomach Gastric cancer is an excellent example of the various distant metastases that are uncommon in the absence of lymph node metastases. The intestinal and di ff use types of gastric cancer spread di ff erently . The di ff use typ...

Staging The International Union Against Cancer (UICC) staging system is shown in Table 67.6 . Important changes have been made in the seventh and eighth editions of the TNM staging system that are worthy of discussion. In an attempt to reflect the current evi...

Stress gastritis This is a common sequel of serious illness or injury and is characterised by a reduction in the blood supply to the gastric mucosa. Although common, this is not usually recognised unless stress ulceration and bleeding supervene, in which case...

Stress ulceration This commonly occurs in patients with major injury or illness who have undergone major surgery or who have major - comorbidity . Many such patients are found in intensive care - units. The incidence has reduced in recent years owing to the wi...

Subtotal gastrectomy For tumours in the distal stomach, it is unnecessary to remove the whole stomach. However, the operation is very similar to that of a total gastrectomy except that the proximal stomach Frederick Eugene Basil Foley , 1891–1966, urologist, ...

The molecular pathology of gastric cancer Understanding of the molecular pathology of gastric cancer has been revolutionised by the application of next-generation sequencing platforms to the disease. The Cancer Genome Atlas (TCGA) group described four molec...

Treatment of peptic ulceration The vast majority of uncomplicated peptic ulcers are treated medically . Surgical treatment of uncomplicated peptic ulcer - ation has decreased markedly and is now seldom performed. Surgical treatment was aimed principally at r...

Trichobezoar and phytobezoar Trichobezoar (hair balls) ( Figure 67.34 ) are unusual and are virtually exclusively found in young psychiatric patients. It is caused by the ingestion of hair, which remains undigested in the stomach. The hair ball can lead to ul...

Tumours ly All gastric neoplasms may present with chronic or acute upper - gastrointestinal bleeding. Bleeding is not normally torrential but can be unremitting. Treatment is that of the underlying tumour as discussed in Gastric cancer . Figure 67.23 Endoscop...

Ultrasonography Standard ultrasonography can be used to investigate the stomach but used conventionally it is less sensitive than other modalities. In contrast, endoluminal ultrasonography and laparoscopic ultrasonography are probably the most sensitive techni...

Volvulus of the stomach Rotation of the stomach usually occurs around the axis and between its two fixed points, i.e. the cardia and the pylorus. In theory , rotation can occur in the horizontal (organoaxial) or vertical (mesenteroaxial) direction, but the for...

Zollinger–Ellison syndrome This syndrome is mentioned here because the gastrin - producing endocrine tumour is often found in the duodenal loop, although it also occurs in the pancreas, especially the head. It is a cause of persistent peptic ulceration. Befor...

suspected peptic ulcer Gastroduodenoscopy oper - In the stomach, any abnormal lesion should be biopsied, and in the case of a suspected benign gastric ulcer numerous biopsies must be taken in order to exclude, as far as possible, the pres - ence of a maligna...