Medical iw

• Increased rate of gastric emptying

• Multiple endocrine neoplasia (MEN) type I and Zollinger-Ellison syndromes

• Cirrhosis and COPD

iii. Location: anterior wall of the proximal duodenum iv. Classic presentation: burning epigastric pain 1-3 hours after eating, which is relieved by food c. Gastric peptic ulcer i. Associated with H. pylori (75%)

ii. Location: lesser curvature of the antrum iii. Gross

• Sharply demarcated, "punched-out" ulcers

• Overhanging margins

• Radiating mucosal folds iv. Classic presentation: burning epigastric pain, which worsens with eating 6. Gastric carcinoma (malignant ulcer)

a. Gastric carcinoma i. Epidemiology

■ Decreasing incidence in the United States

■ Japan > United States ii. Risk factors

• Dietary factors

Smoked fish and meats Pickled vegetables Nitrosamines Benzpyrene

Decreased intake of fruits and vegetables

■ Chronic atrophic gastritis

■ Bacterial overgrowth in the stomach

• Prior subtotal gastrectomy

• Ménétrier disease iii. Presentation

• Often (90%) asymptomatic until late in the course

• Weight loss and anorexia

• Epigastric abdominal pain mimicking a peptic ulcer

• Early satiety

■ Occult bleeding and iron deficiency anemia iv. Location: lesser curvature of the antrum v. Gross

• Heaped-up margins and a necrotic ulcer base

■ May also occur as a flat or polypoid mass vi. Intestinal type—micro: gland-forming adenocarcinoma vii. Diffuse type

■ Diffuse infiltration of stomach by poorly differentiated tumor cells

■ Signet-ring ceils: nucleus is displaced to the periphery by intracellular mucin

• Linitis plastica: thickened "leather bottler-like stomach viii. Metastasis

• Virchow (sentinel) node: left supraclavicular lymph node

• Krukenberg tumor: spread to the ovary ix. Diagnosis: endoscopy and biopsy x. Treatment: gastrectomy xi. Prognosis: poor; overall 5-year survival 20% C. Small and Large Intestine

1. Mechanical obstruction a. Volvulus i. Definition: twisting of a segment of bowel on its vascular mesentery, resulting in intestinal obstruction and infarction ii. Often associated with congenital abnormalities such as intestinal malrotation iii. Locations: sigmoid colon, cecum, and small bowel iv. Complication: infarction and peritonitis b. Intussusception i. Definition: telescoping of a proximal segment of the bowel into the distal segment ii. Most common in infants and children iii. In adults it may be associated with a mass or tumor iv. Presentation: intestinal obstruction, abdominal pain, and "currant-jelly" stools v. Complication: infarction of the intussuscepted segment c. Incarcerated hernia i. Definition: segment of bowel becomes imprisoned witliin a hernia ii. Complications: intestinal obstruction and infarction d. Hirschsprung disease i. Synonym: congenital aganglionic megacolon ii. Definition: congenital absence of ganglion cells in the rectum and sigmoid colon resulting in intestinal obstruction iii. Presentation

• Delayed passage of meconium

• Constipation, abdominal distention, and vomiting

■ Associated with Down syndrome iv. Gross

• Affected segment is narrowed

• Proximal dilatation (megacolon)

Note

Acquired megacolon may be caused by Chagas disease or ulcerative colitis (toxic megacolon).

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