This document provides information about the anatomy, blood supply, drainage, layers and cancer of the stomach. It describes the five parts of the stomach and their functions. It also discusses the predisposing factors, clinical presentation, investigations, staging, spread, management including surgery, chemotherapy and radiotherapy, postoperative orders and complications of gastric cancer. Nursing diagnoses and management of a patient post-gastrectomy are also outlined.

1. Presented by:
Ms. Elizabeth M.Sc (N)
Asst. Professor,
Dept of MSN,
NNC, GNSU

2. Anatomy
The stomach has 5 parts
• Cardia: The first portion (closest to the esophagus)
• Fundus: The upper part of the stomach next to the cardia.
• Body (corpus): The main part of the stomach, between the
upper and lower parts.
• Antrum: The lower portion (near the intestine), where the
food is mixed with gastric juice.
• Pylorus : The last part of the stomach, which acts as a valve
to control emptying of the stomach contents into the small
intestine.

3. • The first 3 parts of the stomach (cardia, fundus, and body) are
sometimes called the
• Some cells in these parts of the stomach make acid and pepsin (a
digestive enzyme), the parts of the gastric juice that help digest food.
• They also make a protein called intrinsic factor, which the body needs
to absorb vitamin B12.
• The lower 2 parts (antrum and pylorus) are called the
• The stomach has 2 curves, which form its inner and outer borders.
They are called the ,
respectively.

4. Blood supply
Most of the blood supply to the stomach is from Four main arteries
• Left gasrtic artery
• Right gastric artery
• Right gastroepiploic artery

5. Venous drainage
• Left and right gastric vein
• Right gastroepiploic vein
• Left gastroepiploic vein

6. Lymphatic drainage
It has into four zones:
• Superior gastric
• Suprapyloric
• Pancreaticolienal
• Inferior gastric/subpyloric

7. Stomach has five layers:
• Mucosa
• Sub mucosa
• Smooth muscle layer
• Sub serosa
• Serosa

8. Stomach cancer begins when cancer cells form
in the inner lining of stomach. These cells can
grow into a tumor. Also called gastric cancer, the
disease usually grows slowly over many years.

11. Predisposing
factor
• Pernicious anaemia
• Atrophic gastritis
• Previous gastric resection
• Chronic peptic ulcer
• Smoking
• Alcohol.
Environmental
Factor
• H.pylori infection
• Diet
• Low socioeconomic Status
• Nationality (JAPAN)
Genetic Factor
• .Blood group A
• Hereditary non- polyposis
colon cancer (HNPCC).

12. Clinical Presentation
Common clinical Presentation: 3A”s:
1.Anaemia(due to bleeding from tumour)
2.Asthenia(septic absorption from the tumour)
3.Anorexia
• onset of early satiety, dyspepsia, epigastric discomfort

13. Specific symptoms depending on the site of tumour.
- gastric outlet obstruction.
- dysphagia, hamaetemesis.
- mass per abdomen(silent variety).
- jaundice, ascites

14. • Grossly Anemic,
• Cachexia,
• Epigastric mass,
• Virchows node
• Sister mary joseph node
• Krukenberg tumor
• Irish node

16. Stages of gastric cancer

17. Staging of Gastric Cancer
T1 - lamina propria & sub - mucosa
T2 - muscularis & sub - serosa
T3 - serosa
T4 - Adjacent organs
N0 - no lymph node
N1 - Epigastric node
N2 - main arterial trunk
Mo - distal metastasis
M1 - distal metastasis

18. Spread of Gastric Cancer
• Direct Spread
• Blood-borne metastasis
• Lymphatic spread
• Transperitoneal spread

19. INVESTIGATIONS
• Full blood count
• LFT, RFT
• Stool examination for occult blood
• CXR
• Serum tumor markers (CA 72-4,CEA,CA19- 9)

20. • Diagnostic study of choice - USG, CT, biopsy
• UGI endoscopy with biopsy, CT, MRI & USG Laparoscopy
• Upper gastro intestinal endoscopy - Diagnostic accuracy is 98% if
upto 7 biopsies is taken.
• Laparoscopy: Help in assessment of wall thickness, metastases
(peritoneum ,liver & LNs) Help in assessment of wall thickness,
metastases (peritoneum ,liver & LNs) Detection of peritoneal
metastases

22. Management
Surgery Chemotherapy Radiotherapy

23. Initial treatment
1.Improve nutrition if needed by parentral or enteral feeding.
2.Correct fluid &electrolyte & anemia if they are present.

24. Though some superficial cancers can be treated endoscopically,
gastrectomy is the most widely used approach
1. Total gastrectomy - usually performed for lesions in the upper third
(proximal) stomach
2. Distal subtotal gastrectomy - performed for tumors in the distal (lower two-
thirds) of the stomach

25. RADICAL GASTRECTOMY
• Remove the stomach +distal part of
esophagus+ proximal part of duodenum +
greater & lesser omentum + Lymph Nodes
• Oesophagojejunostomy with roux-en-y
gastric bypass surgery

27. SUBTOTAL GASTRECTOMY
• Similar to total one except that the
PROXIMAL PART of the stomach is
preserved
• Followed by reconstruction &
creating anastomosis ( by
gastrojejunostomy, billroth II )

28. Billroth - II

29. PALLIATIVE SURGERY
• For pts with advanced (inoperable) disease & suffering significant
symptoms e.g. obstruction, bleeding.
• Palliative gastrectomy not necessarily to be radical, remove resectable
masses & reconstruct (anastomosis/intubation/stenting/
recanalisation)

30. POSTOPERATIVE ORDERS
• Admit to PACU
• Detailed nutritional advise (small frequent meals)

31. Post-Operative Complications
• Leakage from duodenal stump.
• Secondary hemorrhage.
• Nutritional deficiency in long term.

32. Chemotherapy
Responds well, but there is no effect on survival.
- Epirubicin, cisplatin &5-flurouracil (3 wks) 6 cycles
40% .

33. Radiotherapy
may decrease the recurrence.

34. Nursing Diagnosis
• Acute Pain
• Altered Nutrition: Less Than Body Requirements
• Risk for Fluid Volume Deficit
• Fatigue
• Risk for Infection
• Risk for Altered Oral Mucous Membranes
• Risk for Impaired Skin Integrity

35. • Anticipatory Grieving
• Situational Low Self-Esteem
• Risk for Altered Sexuality Patterns
• Risk for Altered Family Process
• Fear/Anxiety
• Risk for Constipation/Diarrhea

36. Nursing Management
• Monitor nutritional intake and weigh patient regularly.
• Monitor CBC and serum vitamin B12 levels to detect anemia, and monitor
albumin and prealbumin levels to determine if protein supplementation is needed.
• Provide comfort measures and administer analgesics as ordered.
• Frequently turn the patient and encourage deep breathing to prevent pulmonary
complications, to protect skin, and to promote comfort.
• Maintain nasogastric suction to remove fluids and gas in the stomach and prevent
painful distention.

37. • Provide oral care to prevent dryness and ulceration.
• Keep the patient nothing by mouth as directed to promote gastric wound healing.
Administer parenteral nutrition, if ordered.
• When nasogastric drainage has decreased and bowel sounds have returned, begin
oral fluids and progress slowly.
• Avoid giving the patient high-carbohydrate foods and fluids with meals, which
may trigger dumping syndrome because of excessively rapid emptying of gastric
contents.
• Administer protein and vitamin supplements to foster wound repair and tissue
building.

38. • Eat small, frequent meals rather than three large meals.
• Reduce fluids with meals, but take them between meals.
• Stress the importance of long term vitamin B12 injections after gastrectomy to
prevent surgically induced pernicious anemia.
• Encourage follow-up visits with the health care provider and routine blood studies
and other testing to detect complications or recurrence.