Stomach

Thickened Gastric Wall

  • Gastric wall thickening = wall thickness > 5mm

  • DDx

    • Gastritis

      • Common with many causes

      • Emphysematous gastritis

        • Life threatening

        • Invasion of gastric wall by E. coli or staph aureus

        • Will see air in gastric wall

    • Malignancy (gastric carcinoma, lymphoma)

Menetrier Disease

  • Idiopathic gastropathy resulting in rugal thickening of the fundus and spares the antrum

  • May be related to CMV in kids

  • Results in albumin loss

Gastric Ulcers

Malignant

  • Carmen meniscus sign

  • Occur anywhere in stomach

  • Wider than deep

Fundoplication

  • Take gastric fundus and wrap it around the distal esophagus

  • Nissen = 360 deg wrap

  • Indications = reflux & hiatal hernia

  • The esophagus that is “purposely narrowed” by the wrap should be <2 cm in length

    • If > 2cm in length —> consider slipped nissen

  • Early complication = esophageal obstruction/narrowing

    • From edema or wrap is too tight

  • Later complications/failure

    • GE junction telescopes through the wrap

      • Get recurrent reflux

        • Most common cause for a slipped Nissen = short esophagus

    • Now the treatment for a short esophagus is a Collis gastroplasty where there is lengthening + fundoplication

Billroth Procedure

  • Done for gastric cancer, ulcers

  • Both have part of stomach/pylorus removed, difference is what it is attached back to and complications

  • Billroth 1

    • Residual stomach attached back to dudoenum

  • Billroth 2

    • Residual stomach attached back to jejunum

GISTs

  • Arise from Cajal cells

  • Stomach & Small bowel, rare elsewhere

  • 10% malignant

    • ↑ risk if arise outside of stomach

  • > 40 yo

  • Stain positive for KIT (CD117)

    • Differentiates from leiomyoma/sarcoma

  • Grow away from lumen extending to abdominal cavity

  • Carney Triad

    • Pulmonary chondroma

    • Extra-adrenal pheochromocytoma

    • GIST

Malignancy

Zollinger-Ellison Syndrome

  • Gastrin producing islet cells of pancreas (gastrinoma)

  • Multiple stomach and duodenal ulcers

  • Findings

    • Hypervascular pancreatic mass

      • Arterially enhancing

References:

Ram Horn Deformity

  • Tapered antrum (distal stomach)

  • DDx

    • Scarring from ulcers

    • Granulomatous disease (Crohns, sarcoid, TB, syphilis)

    • Scirrhous carcinoma

Benign

  • Hampton’s line

  • Typically lesser curvature

  • Deeper than wide

Chronic Aspirin Use

  • Multiple gastric ulcers

  • For test taking purposes, no duodenal ulcers

Gastric Adenocarcinoma

  • 95% of gastric cancers

  • RF

    • Pernicious anemia

    • Mentrier disease

    • FAP

    • Chronic gastritis

  • Spreads to celiac and gastrohepatic nodes

  • Spreads to liver > lungs > adrenal glands

  • Linitis plastica (scirrhous carcinoma)

    • Diffuse gastric thickening with resultant small gastric lumen

  • Met to ovary = Kruckenberg tumor

Gastric Lymphoma

  • Most commonly NHL-B cell type

  • Findings favoring Lymphoma > carcinoma

    • Wall thickening > 3 cm

    • Involvement of other parts of GI tract

    • Sub-renal adenopathy

  • Classically described as crossing the pylorus

  • Rarely has gastric luminal obstruction

  • Can rupture with chemo

Mets to Stomach

  • Rare

  • Melanoma & Lobular breast carcinoma

Gastric Surgery

Gastric Band

  • Put band around upper stomach

  • Complications

    • Stenosis - band too tight

    • Band erosion

      • Pressure too high and band erodes into stomach lumen

    • Band slippage

      • Phi angle of 5-60 is normal

      • Band should be angled to 2 o’clock position