1 / 54

G astric Diseases

G astric Diseases. Pay attention. G astric U lcer Carcinoma of stomach. G astric U lcer ( belongs to peptic ulcers) . G astric U lcer -Causes . Helicobacter pylori infection （ 70% in gastric ulcer,90% in duodenal ulcer ） Drugs-NSAID, steroid

ordell
Download Presentation

G astric Diseases

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. GastricDiseases

  2. Pay attention • GastricUlcer • Carcinoma of stomach

  3. GastricUlcer( belongs to peptic ulcers)

  4. GastricUlcer -Causes • Helicobacter pylori infection （70% in gastric ulcer,90% in duodenal ulcer） • Drugs-NSAID, steroid • Others-smoking, heredity, blood group O, hyperparathyroidism, Zollinger-Ellison syndrome, chronic renal failure, emphysema

  5. Causes-NSAID • Nonsteroidal anti-inflammatory drugs are medications such as aspirin and ibuprofen that decrease pain and inflammation. • Many can now be obtained without a doctor's prescription. • NSAID may provoke peptic ulcer ,prevent healing…

  6. Causes-blood group O • Psychosomatic disease • Overproduction of gastric acid(somatic disease) • Character: careless; casual ; unconcerned (psychological causation)

  7. Causes-H. pylori infection • Helicobacter pylori --a species of spiral or straight gram-negative bacteria with multiple sheathed（具鞘的）flagella（鞭毛）found in the gastric mucosa of humans and other animals and associated with gastric ulcers as well as gastric cancers.

  8. Heliobacter pylori

  9. Causes-Hyperparathyroidism • Parathyroid glands are four pea-sized glands located just behind the thyroid gland in the front of the neck. • The function of parathyroid glands is to produce a hormone called parathyroid hormone (parathormone), which helps regulate calcium and phosphate in the body. Hyperparathyroidism is the overproduction of this hormone.

  10. when one or more parathyroid glands malfunctions, it can lead to overproduction of the hormone and elevated calcium level in the blood. Therefore, a common result of hyperparathyroidism is hypercalcemia, or an abnormally high level of calcium in the blood.

  11. The abnormal condition may include development of gastric ulcers or pancreatitis because high calcium levels can cause inflammation and pain in the linings of the stomach and pancreas.

  12. Causes-Zollinger-Ellison syndrome • A condition characterized by severe peptic ulceration, gastric hypersecretion, elevated serum gastrin, and gastrinoma of the pancreas or the duodenum. • It may occur in early childhood but is seen more commonly in people between 20 and 50 years of age. • Two thirds of the tumors are malignant. Total gastrectomy may be necessary, but the administration of cimetidine in large doses may control gastric hypersecretion and allow the ulcers to heal.

  13. Radiography • Gastric ulcers appear as round or oval collections of barium. They may also be linear, rectangular or serpiginous. • Ulcers may vary in size from very small lesions (termed erosions) to entities several cm in diameter. • Large ulcers are more likely to cause complications such as bleeding and perforation. Most gastric ulcers are located on the lesser curvature or in the antrum of the stomach.

  14. GastricUlcer (Benign )

  15. GastricUlcer (Benign )

  16. GastricUlcer (Benign ) tangential projection

  17. GastricUlcer (Benign ) collar sign

  18. GastricUlcer (Benign ) axial view

  19. GastricUlcer (Benign )

  20. Benign Malignant

  21. GastricUlcer (Malignant )

  22. GastricUlcer (Malignant ) 1.Agger/dike 2.Fissure 3.digital impression

  23. GastricUlcer (Malignant )

  24. GastricUlcer (Malignant )

  25. Carcinoma of stomach（gastric cancer）

  26. Carcinoma of stomach-Causes Causes are unknown. Predisposing factors are- 1.smoking 2.Alcohol 3.Diet 4.Gastric surgery 5.Pernicious anemia 6.Adenomatous polyp 7.Infection with H. pylori 8.Blood group A 9.Familial

  27. Causes-Diet • Preservatives in diet such as nitrates(eg:NaNO3) converted to nitrosamines(NH4NO2 ) which is carcinogenic. • Excess spicy food, salted, smoked and prickled food. • Diets lacking fresh fruits and vegetables as well as Vit-C and Vit-A may also contribute.

  28. Causes- Gastric surgery • Partial gastrectomy, gastrojejunostomy. • This may cause intestinal metaplasia and chronic gastritis

  29. Causes- Pernicious anemia • Progressive megaloblastic macrocytic anemia that results from a lack of intrinsic factor essential for the absorption of cyanocobalamin (vitamin B12). • Extreme weakness, numbness and tingling in the extremities, fever, pallor, anorexia, and loss of weight may occur. The condition is usually treated with cyanocobalamin injection and with folic acid and iron therapy.

  30. Causes- Infection with H. pylori • It can cause chronic atrophic gastritis, intestinal metaplasia and dysplasia which is precancerous. • H. pylori may be responsible for 60% to 70% of all carcinomas, specially those patients who become hypo- or achlorhydric are at greater risk. • Chronic inflammation with generation of reactive oxygen species and depletion of antioxidant ascorbic are also important.

  31. Causes-familial • There is 2 to 3 times increase incidence of carcinoma if family history is present.

  32. Sites • 50% in the antrum • 20 to 30% in the body (commonly lesser curverture) • 20% in the cardia

  33. Pathological Types • Adenocarcinoma accounts for 95% of gastric malignancies, the remaining 5% being composed of sarcomas. • In general, carcinoma of stomach belongs to adenocarcinoma, which may be ulcerating, polypoid, diffuse, and fibrous, or superficial spreading lesions.

  34. Four signals of earlier carcinoma of stomach • Pain in the epigastric zone -About ¼patients have similar pains with peptic ulcer. • sense of fullness • Anorexia, symptosis, asthenia • Digestive tract hemorrhage (Vomitingor positive occult blood test or melaena). Anemia

  35. Early gastric cancer (EGC) • A carcinoma limited to the mucosa and submucosa, with or without lymph node involvement. • This form of gastric carcinoma is reported less often in Europe and the USA than in Japan.

  36. Classification of the EGCs Based upon their gross appearance • Type I : Protruding type (more than 5 mm) • Type II : Superficial type, further subdivided into three subtypes: a. Elevated type b. Flat type; no elevation in the surrounding mucosa c. Depressed type; the surface is slightly depressed. • Type III : Excavated

  37. Diagram of the classification of early gastric cancer.

  38. About the prognosis and staging • The prognosis and staging of gastric cancers are determined by wall penetration of primary disease, lymphatic metastasisanddistant place metastasis. • The size and location of primary cancer have not obvious contribution to judge the prognosis of the carcinoma.

  39. Imaging • Mushroom type (polypoid type)-irregular filling defect • Infiltrating type- bottle or tube like stomach • Ulcerative type- “Inside” niche sign

  40. mushroom type • Filling fefect • sublobes • Irregular surface • Small niche sign

  41. mushroom type

  42. infiltrating type

  43. Leather bottle stomach

  44. Ulcerative type • “Half a month ” syndrome • Intracavitary Ulcer • Circlingagger • Fissure sign • digital impression • rigid wall • Crude borderline

  45. Ulcerative type

  46. Ulcerative type

  47. carcinoma of gastric cardia • Distortion of gastric fundus, rigid wall • Stricture lumen，inability of dilation • Dilation in the proximal end • Irregular outline • Barium flows hard (Fluoroscopy)

  48. Carcinoma of sinus ventriculi (antrum)

More Related