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Understanding Stomach Diseases: Diagnosis, Treatment & Management by Prof. Dr. Öge Taşcılar

Explore the spectrum of benign and malignant stomach diseases, from acute gastritis to peptic ulcers, and learn about their diagnosis and treatment with in-depth insights from Prof. Dr. Öge Taşcılar. Delve into topics such as Helicobacter pylori infection, peptic ulcer disease complications, neoplasms of the stomach, and more.

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Understanding Stomach Diseases: Diagnosis, Treatment & Management by Prof. Dr. Öge Taşcılar

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  1. Benignandmaligndiseases of Stomach Prof. Dr. Öge TAŞCILAR

  2. MİDE • Mukoza • Submukoza • MuskularisPropria • Seroza • Mukoza İntraepitelyal Mukoza Epitel Bazal Membran LaminaPropria Muskularis Mukoza

  3. MİDE • Fonksiyon: • Alınan gıdaların sindirimi ve emilimi • Reseptifrelaksasyon ve gastrik adaptasyon • İntragastrik basınç düşer. • 100cc-------------1500cc

  4. MİDE • Mallory-Weiss Sendromu • Kusma ile ÖG bileşke mukoza submukoza yırtık ve kanama • Endoskopi • Alkol,diyabet,gebelik, üremi, • Tam kat olursa Booerhaave sendromu

  5. MİDE • Bezoarlar • Midede oluşan yabancı cisimler. • Trikobezoar-fitobezoar • Mide operasyonu sonrası • Antrumun öğütücü işlevinin kaybolması • HCL azalmasına bağlı CandidaAlbicansbezoar • Tanı: Radyoloji-endoskopi • Tedavi:Endoskopik-Cerrahi

  6. MİDE • Menetrier Hastalığı • Hipertrofikmukozalgastropati • Fundus ve korpusta dev rugalar • Foveolarhiperplazi • Hipoklorhidri ve Hipoalbüminemi • 50> erkekler • Epigastrik ağrı, kilo kaybı, (özellikle protein) , kanama, diare, ödem • Medikal tedavi PPI • Destek tedavisi • Çok ciddi olgularda rezeksiyon

  7. Acute gastritis • Drugs (non-steroidal anti-inflammatory drugs NSAID), alcohol cause acute erosion (loss of mucosa superficial to muscularis mucosae). Can result in severe haemorrhage

  8. Chronic gastritis ABC • A – autoimmune(associated with vitamin B12 malabsorption (pernicious anaemia) • B – bacterial (helicobacter) • C – chemical(bile reflux, drugs)

  9. Autoimmune chronic gastritis • Autoantibodies to gastric parietal cells • Hypochlorhydria/achlorhydria • Loss of gastric intrinsic factor leads to malabsorption of vitamin B12 with macrocytic,megaloblastic anaemia

  10. Helicobacter pylori • Adapted to live in association with surface epithelium beneath mucus barrier • Causes cell damage and inflammatory cell infiltration • In most countries the majority of adults are infected

  11. Peptic ulcer disease • A surface breach of mucosal lining of GI tract occurring as a result of acid and pepsin attack • Sites: • Duodenum (DU) • Stomach (GU) • Oesophagus • Gastro-enterostomy stoma • Related to ectopic gastric mucosa (e.g. in Meckel’s diverticulum)

  12. Pathogenesis • In normal acid/pepsin attack is balanced by mucosal defences • Increased attack by hyperacidity • Weakened mucosal defence – the major factor (H. pylori related)

  13. MİDE • Duodenal Ülser: • Duodenal HCO3 sekresyonu azalmış • Gece asit sekresyonu artmış • Duodenal asit yükü artmış • Bazal ve postprandial gastrin artmış • Tamamına yakın HP gastrit saptanmıştır.

  14. Morphology of peptic ulcers • Clean, non-elevated edge • Granulation tissue base (floor) • Underlying fibrosis

  15. MİDE • Klinik: • Yanıcı, kemirici, açlık ağrısı. • Epigastrium • Antiasit ve gıda ile hafifler. • Mevsimsel bir ağrı. • İlkbahar, sonbahar, stress dönemleri • Penetre olursa ağrı özellikleri değişir.

  16. MİDE • Anamnez, • Radyoloji • Endoskopi, biyopsi • Tedavi: • Medikal tedavi Antiasit Sükralfat H2 blokör PPI Prostoglandin analogları

  17. MİDE • DÜ Cerrahi Tedavi: • BTV-PP • BTV-Distal gastrektomi+GJ • PGV

  18. MİDE • Mide Ülseri

  19. Complications of peptic ulcer • Perforation leading to peritonitis • Haemorrhage by erosion of vessel in base • Penetration of surrounding organ (liver/pancreas) • Obstruction (by scarring) – pyloric stenosis • (Cancer – rare event in true peptic ulcer)

  20. NEOPLASMS OF STOMACH BENIGN__ 10% MALIGNANT__90% BENIGN Polyps Lipomas Leiomyomas

  21. NEOPLASMS OF STOMACH MALIGNANT Adenocarcinoma95% Lymphoma4% Others1% (sq.cellca, angiosarcoma,carcinosarcoma, Gist)

  22. Less common gastric neoplasms • Gastrointestinal stromal tumour (GIST) • Lymphoma • Neuroendocrine (carcinoid) tumours

  23. GIST • Risk categories were assigned according to current recommended NIH criteria. • Tumors <2 cm and<5 mitosis per 50 high-power fields (HPF) were classified as very low risk. • Tumors ranging from 2 to 5 cm and having <5 mitoses/50 HPF were classified as low risk.

  24. Tumors <5 cm but having 6 to 10 mitoses/50 HPF were intermediate risk, as were tumors from 5 to 10 cm with <5 mitoses/50 HPF. • Tumors >5 cm with >5 mitoses/50 HPF was defined as high risk, as was any tumor >10 cm or any tumor with >10 mitoses/50 HPF.

  25. GASTRIC STROMAL TUMOURS PRESENTATION; Mass abdomen Upper GI bleeding Obstruction PATHOLOGY; Difficult to ascertain benign or malignant nature Size & Histology is the criteria TREATMENT; Surgical resection Lymph node resection not necessary.

  26. MİDE LENFOMA • Non-HodgkinLenfoma(NHL) klasik olarak lenf nodlarından gelişir. • Ama NHL %30 olguda ekstranodal(Solid organ kaynaklı) olarak gelişebilir. • GI sistem tüm NHL %20

  27. MİDE LENFOMA • GI lenfoma; oral kaviteden rektuma • En sık; Mide • Sonra ince barsak • Kolon • Pankreas

  28. MİDE LENFOMA • NHL, ekstranodal lenfoma ve GI lenfomanın en sık görülen tipi diffüz B hücre lenfoması. • MALT lenfoma • Burkitt lenfoma • T- hücre lenfoma

  29. Gastric lymphoma • Malignant neoplasm of mucosa associated lymphoid tissue (MALT) • A (usually) low grade B-cell (marginal cell) lymphoma

  30. MİDE LENFOMA • Antrum ve distal mide • Proksimal yerleşebilir. • Karın ağrısı, erken doyma • Bulantı, kusma, halsizlik • Abdominal dolgunluk • Kronik kan kaybı, anemi melena

  31. Gastric lymphoma (maltoma) • Neoplastic cells infiltrate the epithelium (lymphoepithelial lesions) • Strongly associated with chronic H. pylori and can be cured by eliminating infection.

  32. MİDE LENFOMA • Tedavi • HP tedavi edilmeli. • Bir zamanlar cerrahi • Şimdi Konservatif, bazı olgularda cerrahi • Low grade lenfoma(MALT) • HP eradikasyonu, KRT, • High Grade: • Antihelikobakter tedaviye cevap vermeyen erken evre PGL, ileri evre lenfoma, diffüz büyük hücreli lenfoma ise cerrahi tedavi • KT-RT • Residual hastalık: KT-cerrahi

  33. Neuroendocrine tumours • Carcinoids are tumours of resident neuroendocrine cells in gastric glands • Usually seen in context of chronic atrophic gastritis (driven by gastrin) • Clinical behaviour variable

  34. GASTRIC CANCER

  35. ETIOLOGY 1.HELICOBACTER PYLORI CA of body & distal stomach Gastritis Gastric atrophy Intestinal metaplasia 2.PERNICIOUS ANEMIA 3.GASTRIC POLYPS 4.Pt. with surgery of peptic ulcer disease Billroth II gastrectomy Gastroenterostomy Pyloroplasty 4 times increased risk

  36. 5.Cigarette smoking &dust ingestion 6.Diet Consumption of potatoes,pickledvegetables,dried/salted fish & less milk Alcohol ingestion Excessive salt intake Deficiencies of anti oxidants Exposure to N- Nitrosocompounds 7.Familial predisposition Relatives of CA stomach pt. are 4 times more at risk Genetically H-ras, C-erb B2 & APC gene mutations have some role in pathogenesis of CA stomach Blood group A 8.Gastric ulcer 3-5% of cases?? 9. İntestinalmetaplazi Tip1,2 ve 3 En tehlikeli olanı Tip 3

  37. PATHOLOGY MACROSCOPIC CLASSIFICATION Schirrous (lintis plastica) Ulcerative Polypoid Superficial spreading HISTOLOGICALLY (W.H.O) Papillary Tubular Mucin secreting Signet ring cell

  38. Clinical Features GASTRIC CANCER Early feeling of fullness after meal Bloating , distention Vomiting Pallor – iron deficiency anemia due to tumour bleed Dysphygia –epigastric fullness or vomiting due to obstrution of gastric outlet Epigastric mass – ¼ of cases Non metastatic effects ; thrombophlebitis Deep venous thrombosis ( by affecting thrombotic & haemostatic mechanism)

  39. Ascites Jaundice Trosier sign(virchows node) Sister mary joseph nodule krukenbergtumour Blummer Shelf

  40. INVESTIGATIONS BLOOD COMPLETE EXAM. ------ Anemia STOOL EXAM. --- for occult blood in ½ of pts. CARCINOEMBRYONIC (CEA) LEVEL--- elevated in 65% of cases GASTRIC JUICE ANALYSIS--- 20% are achlorhydric after maximal stimulation DOUBLE CONTRAST BARIUM MEAL--- mucosal irregularities and to assess the size , shape, margins of lesions GASTROSCOPY & BIOPSY---minimum of 6 biopsies for accuracy --- brush cytology C.T. SCAN ENDOSCOPIC USG LAPAROSCOPY

  41. Advanced Gastric CA

  42. Advanced Gastric CA

  43. Advanced Gastric CA

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