Anathomy. The gastrointestinal tract possess a broadly similar structure throughout its length an innermost epithelium a subepithelial lamina propria
Proceeding from the surface epithelium into the pits, the mucosal cells considered in detail in the following subsections include the following:
The acid-secreting parietal cell is located in the oxyntic gland, adjacent
A gastrointestinal ulcer is defined as a breach in the epithelium that penetrates the muscularismucosae.
- Helicobacter pylori
A 49-year-old man was admitted with sudden onset of severe pain in the epigastrium. Recently, he had taken a course of a non-steroidal anti-inflammatory drug (NSAID). This had caused indigestion, which had worsened in the two days prior to his presentation. On examination, the patient was ill and had a rigid abdomen. The operative photograph shows a perforated duodenal ulcer.
H. pylori infection
The typical pain pattern in DU occurs 90 min to 3 h after a meal and is frequently relieved by antacids or food.
Pain that awakes the patient from sleep(between midnight and 3 A.M.) is the most discriminating symptom
The mechanism for development of abdominal pain in ulcer patients is unknown. Several possible explanations include acid-induced activation of chemical receptors in the duodenum, enhanced duodenal sensitivity to bile acids and pepsin, or altered gastroduodenal motility.
False positive tests
Missed cases? – risk of transmission / disease progression
(Bardhan et al. 2004, Digestive & Liver Disease 36(9), 577-588)
Endoscope is passed through the mouth, to the stomach, examining the lining of the stomach
1. The biopsy urease test depends on the the ability of the bacterium to generate alkali.
2. H. pylori bacteria are readily detected histiologically using special stains.
3. Bacterial culture allows the antibiotic sensitivity of the patient's strain to be determined.
1. Serology is accurate and convenient but remains positive for several months after successful eradication, and is not useful for determining whether eradication has been successful.
2. The urea breath test. The patient drinks a solution of urea containing carbon atoms labelled with 13C or 14C. Labelled CO2, generated by bacterial urease, can be detected in the breath by mass spectroscopy or radioactive counting if the infection is present. This test is ideal for testing the success of eradication, if this is required.
There are several different forms of gastric cancer; this slide shows an infiltrating type. Here, malignant cells in groups or lines tend to infiltrate the wall of the stomach, causing it to become thicker, and rigid. It comes to resemble a “leather bottle” used to carry wine. It is also known as linitisplastica (linitis originally referred to linen or cloth) and this was thought to be due to inflammation (“itis”), but the inflammatory-appearing cells have been shown to be cancer cells. Mucin stains are sometimes helpful in differentiating cancer cells from chronic inflammatory cells.
H&E appearance of diffuse type gastric cancer.
anemia -iron deficiency
hypoalbuminemia- poor nutrition
abnormal liver chemistry - hepatic involvement
Nuclear Medicine 87 year old woman with neoplastic meningitis from gastric cancer.
FDG PET showed deoxyglucose uptake in the stomach and the head of the pancreas (A).
No deoxyglucose uptake was apparent in the spinal canal on FDG PET (B).