Engidaw Ambelu

1. Stomach and duodenum
Dr solomon H.( dept. of surgery)

2. Course out line
• Introduction on anatomy and physiology of
stomach and duodenum
• PUD
• Gastric ca
• GOO( gastric out let obstruction)

3. Anatomy of stomach and duodenum
• Blood supply < right and Left gastric artery
,Right and Left gastro epiplioc artery, short
gastric arteries, superior and inferior
pancreatico duodenal arteries
• Veins > follow the same pattern of arteries
• Innervations< stomach mainly innervated by
parasympathetic and sympathetic branch

4. continued
• Lymphatics < drain to celiac node to adjacent
hepatic and splenic node
• The main function of stomach is storage and
digestion
• Parietal cell ….important for hydrogen ion
production and secretion of intrinsic factor
• Chief cell…..mainly for secretion of
pepsinogen

5. Continued
Parietal cells
G cell
vagus ECL cell

6. Physiologic barrier of stomach
• Mucus layer
• Tight epithelial junction
• Bicarbonate
• Adequate vascular supply plus rapid
regeneration of cells
• Disruption of these physiologic barriers leads
to different pathologic disorders

7. Investigation modality
• Imaging : endoscopy ,us ,CT
• Barrium studies
• H.pylori test such as stool AG ,urea breath
test, culture ,serology

8. Gastritis
• Is an inflamatory change characterized by
mucosal injury
• Type A……. Autoimmune mediated parietal
cell destruction associated with hypochloro
hydra ,vit B12 def, hyper gastrinemia and
micro adenoma of ECLcells

9. continued
• Type B…….. Mainly associated with H.pyelori
infection risk for PUD and malignancy
• Erosive gastritis……. Secondary to drugs
,stress and back flow of intestinal content

10. Peptic ulcer disease
• PUD is defect at stomach or duodenal mucosa
that extend up to sub mucosa or deeper due
to imbalance between defense mechanism
and acid/peptic injury
• H.pyelori infection, drugs such as NSAIDS,ASA
,gastritis are some of the most common
causes of PUD

11. continued
• Duodenal ulcer is more common than gastric
ulcer but risk for malignancy transformation is
vice versa
• Generally PUD manifest as epigastric
dicomfort( dyspepsia), epigastric
tenderness,upper GI bleeding ,post prandial
fullness ,early sateity…

12. continued
• Modified johnson classification of PUD:
• Type 1…..ulcer occur at lesser curve
• Type 2…..ulcer occur at incisura and duodenum
• Type 3……pre pyloric ulcer
• Type 4 ……ulcer near to gastro esophageal
junction
• Type 5 ….any where in the stomach related to
drug

13. Complications of PUD
• Bleeding
• Perforation
• obstruction

14. Treatment of PUD
• Medical : triple or quadriple therapy
• Surgical: indicated if medical therapy fails
,presence of complications like bleeding
perforation or obstruction

15. Neoplasm of stomach
• Malignant neoplasia of stomach include the
three most common like adeno ca (95
pecent),lymphoma(4 percent) ,GIST(1percent)
and rare like carcinoid and squamous cell ca
• Benign tumour of stomach includes some
inflamatory condition ,polyp,leiomyoma…

16. Alarm feature of dyspepsia needs
further evaluation
• Age > 55 with new onset dyspepsia
• Family history of gastric ca
• GI bleeding
• Dysphagia odynophagia
• Unexplained wt loss and iron def. anemia
• Persistent vomiting
• jaundice

17. Risk factors of gastric ca
• Family history of gastric ca
• H .pylori infection
• Smoking
• Gastritis both type A and B
• Nitrite rich food
• vitB12 def ,blood group A, and family history
of polyposis

18. Continued
• Vitamin c ,ASA ,vegetable diet and fruits have
protective effect

19. Physical findings of gastric ca
• Palpable mass at epigastric region
• LAP especially virchow lymph node
• sign and symptom of anemia
• Organo megally due to metastasis
• Palpable umblical nodule ( sister josef nodule)
• Blumer shelf
• Kruken burg tumor
• Ascites etc.

20. Treatment of gastric ca
• Surgical
• Radiation or chemotheapy

21. GOO
• Is defined as epigastric pain and post
prandial vomiting secondary to mechanical
obstruction
• Mainly caused by gastric ca but others
including gastric lymphoma, tumor of
proximal duodenum ,local extension of
adjacent gall bladder tumor, PUD, crohns
disease etc. are also related to GOO.

22. READING ASSIGNMENT
• Staging and histologic classification of gastric
ca
• Complicatons of operative management of
PUD and malignancies

23. Thanks