4Gastric Ulcer -CausesHelicobacter pylori infection （70% in gastric ulcer,90% in duodenal ulcer）Drugs-NSAID, steroidOthers-smoking, heredity, blood group O, hyperparathyroidism, Zollinger-Ellison syndrome, chronic renal failure, emphysema
5Causes-NSAIDNonsteroidal 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…
6Causes-blood group O Psychosomatic disease Overproduction of gastric acid(somatic disease)Character: careless; casual ; unconcerned (psychological causation)
7Causes-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.
9Causes-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.
10when 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.
11The 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.
12Causes- 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.
13RadiographyGastric 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.
20Benign ulcerMalignant ulcer1.Protrude outside the line of the lesser curvature.1.Usually there is irregular filling defect,so lie within the outline of the lesser curvature.2.Margin-regular.2.Irregular3.Overhaging mucosa at the margin of the ulcer may be seen as a line separating barium filled ulcer from barium filled stomach called Hampton’s line.3.No such.4.Associated with incisura on the opposite side in the greater curvature.
27Carcinoma of stomach -Causes Causes are unknown. Predisposing factors are-1.smoking 2.Alcohol3.Diet Gastric surgery5.Pernicious anemia 6.Adenomatous polyp7.Infection with H. pylori8.Blood group A9.Familial
28Causes-DietPreservatives 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.
29Causes- Gastric surgery Partial gastrectomy, gastrojejunostomy.This may cause intestinal metaplasia and chronic gastritis
30Causes- 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.
31Causes- 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.
32Causes-familialThere is 2 to 3 times increase incidence of carcinoma if family history is present.
33Sites50% in the antrum20 to 30% in the body (commonly lesser curverture)20% in the cardia
34Pathological TypesAdenocarcinoma 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.
35Four signals of earlier carcinoma of stomach Pain in the epigastric zone -About ¼ patients have similar pains with peptic ulcer. sense of fullnessAnorexia, symptosis, asthenia Digestive tract hemorrhage (Vomiting or positive occult blood test or melaena). Anemia
36Early 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.
37Classification of the EGCs Based upon their gross appearanceType I : Protruding type (more than 5 mm)Type II : Superficial type, further subdivided into three subtypes:a. Elevated typeb. Flat type; no elevation in the surrounding mucosac. Depressed type; the surface is slightly depressed.Type III : Excavated
38Diagram of the classification of early gastric cancer.
39About the prognosis and staging The prognosis and staging of gastric cancers are determined by wall penetration of primary disease, lymphatic metastasis and distant place metastasis.The size and location of primary cancer have not obvious contribution to judge the prognosis of the carcinoma.
40Imaging Mushroom type (polypoid type)-irregular filling defect Infiltrating type- bottle or tube like stomachUlcerative type- “Inside” niche sign
54Other investigationsHb%, TC (Total count of WBC), DC (differential count ), ESR (erythrocyte sedimentation rate )USG of whole abdomen (to see any metastasis)Stool for occult blood test (positive if cancer with bleeding)To see recurrence-CEA (carcino-embryonic antigen ) may be done