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Barium Meal
Benign tumours
Malignant tumours
Miscellaneous causes
Hyperplastic
Polyps
Dependant part of stomach__filling defect Anterior wall polyp__ring Small, sessile,smooth polyps__always benign Polyp>1cm OR irregular surface__further workup needed
Majority dysplastic_may undergo malignant change -Tubular -Tubulovillous -Villous >1cm ,larger than hyperplastic Solitary with nodular surface Commonest site__Gastric antrum May pedunculate,prolapse in pylorus
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Include
Stromal tumours Neurofibroma Lipoma Hemangioma Lymphangioma Glomus tumour Neural tumour Brunner gland hemartoma Duplication cyst Ectopic pancreatic rest
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Difficult to diagnose by endoscopy because overlying mucosa may be intact Large tumours tend to ulcerate
Smooth bulge into bowel lumen , margins forming a right angle/obtuse angle with normal bowel wall.
Complications :
Necrosis Ulceration Gastric outflow obstruction Intussusception Large abdominal mass
Barium Meal: -clearly defined margins -if central ulcer present__bulls eye/target appearance
CT: -well defined, homogenous mass -larger tumours__ulceration, necrosis -glomus tumour, pancreatic, carcinoid __ hypervascular -stromal, glomus tumour, hemangioma __calcifications
EUS diagnostic modality of choice -mass arising from mucularis propria or muscularis mucosa -smaller,echo-poor ,well-defined >3cm tumors surgically removed
Soft , may change shape with peristalsis or palpation May ulcerate , bleed , intussuscept Diagnosed by : -EUS__echogenic tumour Confirmed by: - CT
Greater curve of antrum OR anteromedialy in 1st or 2nd part of duodenum Congenital failure of bowel recanalization Gastric duplication present in early childhood Filled with clear mucinous fluid
Small __ 1-3 cm Distal end of greater curve OR proximal duodenum Incidental finding If tissue well-diffrentiated,barium study may show a central niche or fill a short ductal system.
Complications : Pancreatitis Pseudocyst Adenocarcinoma CT variable appearance -homogenous , strongly enhancing tumours OR -avascular cystic lesions
Include : 1. Gastric carcinoma 2. Lymphoma 3. Malignant stromal tumours (GIST) 4. Kaposi sarcoma 5. Carcinoid tumour 6. Metastatic tumours
Risk factors: Atrophic gastritis intestinal metaplasia dysplasia neoplasia Pernicious anemia H. Pylori infection Partial gastrectomy Nitrates intake
Symptoms:
Mucosa and submucosa 90% 5 yr survival rate Diffrentiate benign ulcers from ulcerating malignancy __nodularity, clubbing, interrupted or fused mucosal folds
Muscularis propria invasion May be Polypoid Fungating Ulcerated Infiltrating (linitis plastica)
Stippled calcification in mucin producing Ca Ulcerated early Ca resembles benign ulcer (meniscus sign) Large tumours__obvious filling defects on barium studies
Most common mets in stomach from: Malignant melanoma Ca breast Kidney, lung, thyroid, testes
Most common site of GI lymphoma H.Pylori __MALT lymphoma Coeliac disease __T-cell lymphoma Middle aged men Doesnt cause obstruction commonly
Radiological appearance o Often identical to gastric Ca, benign ulcers, suspect lymphoma if: Giant cavitating lesions Pronounced gastric folds thickening
CT
-Bulky homogenous tumour
-gastric wall thickness -perigastric fat plane preserved -transpyloric spread -splenomegally -multicentricity __CT used for staging
1% of gastric malignancies Fundus and body involved Middle age / elderly __ males > females Large tumours, might pedunculate Central necrosis and ulceration
CT
Exophytic growth Low density necrotic centre Dystrophic calcification Mets to peritoneal cavity, liver, lung ,bone
Tumour of blood vessels 1/3rd of homosexual male patients with AIDS Multifocal tumours throughout GIT
Diagnosed by
Endoscopy
-hemorhagic patches on gastric mucosa
Barium meal
- large polypoid tumors OR -submucosal nodule,later ulcerates_bulls eye lesion -linitis plastica
CT
-retroperitoneal LN enlargement -splenomegaly
Rare in stomach/duodenum Slow-growing__distal antrum,lesser curvature Submucosal nodules__may ulcerate/pedunculate Hypervascular__both pri. n liver mets ___assess in both arterial and venous phase on CT
Intragastric prolapse of sliding hiatus hernia -mucosal folds form the mass -disappears in recumbent position
Mass of ingested material Dragging sensation/ fullness 2 types: Trichobezoar -mass of matted hair -young girls , psychiatric patients Phytobezoars -vegetables/ fruit pith -unripe persimons, gastric surgery
Diagnosis: -Barium meal __filling defect __outlines the mass __may penetrate __mottled appearance
Rapunzels syndrome: -severe case of trichobezoar -extend into small bowel, even caecum
Plain radiograph of the abdomen showing multiple air fluid levels with dilated small intestinal loops and a sizable soft tissue density within the stomach
Congenital anomaly - Infantile - adult Stasis causes __ antral gastritis + ulceration Antrum tapers into >2cm long pyloric canal
To differentiate from annular Ca: Antral tapering Absence of mucosal destruction Intact mucosal folds passing through pyloric canal