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PHYSIOLOGY
Acid Secretion
For
The
cephalic,
gastric,
and intestinal
Pepsinogen
Intrinsic
Secretion
Factor
Gastric Hormones
Gastrin
Somatostatin
produced by D cells
The major stimulus for somatostatin release is antral
acidification; acetylcholine from vagal nerve fibers inhibits
itsRelease
Somatostatin inhibits acid secretion from parietal cells and
gastrin release from G cells
Leptin
Ghrelin
Intrinsic Gastric
Innervation
Excitatory
neurotransmitters include
acetylcholine, the
tachykinins, substance P,
and neurokinin A
inhibitory
neurotransmitters: NO,
vasoactive intestinal
peptide (VIP)
Seretonin can be both
DIAGNOSIS OF GASTRIC
DISEASE
Signs and Symptoms
The most are pain, weight loss, early satiety,
and anorexia. Nausea, vomiting, bloating,
and anemia also are frequent complaints.
Several of these symptoms (pain, bloating,
nausea, and early satiety) are often
described by physicians as dyspepsia,
synonymous with the common nonmedical
term indigestion
Diagnostic
Tests
Esophagogastroduodenoscopy
Radiologic Tests Double-contrast
upper GI
Computed Tomographic Scanning and
Magnetic Resonance Imaging.
Endoscopic Ultrasound
Gastric Secretory Analysis
Scintigraphy
Tests for Helicobacter pylori
Antroduodenal Motility Testing and
Electrogastrography
Chronic
Clinical Manifestations
More
complication
Bleeding
Perforation
Obstruction
Surgical treatment
Traditionally, the vast majority of peptic ulcers
were treated by a variant of one of the three
basic operations:
Parietal cell vagotomy also called highly
selective vagotomy or proximal gastric
vagotomy (HSV)
vagotomy and drainage (V+D)
vagotomy
Zollinger-Ellison
Syndrome
caused
MALIGNANT NEOPLASMS
OF THE STOMACH
Radical
gastrectom
y
BENIGN GASTRIC
NEOPLASMS
Leiomyoma
The typical leiomyoma is submucosal
and firm. If ulcerated, it has an
umbilicated appearance and may bleed
Lesions <2 cm are usually asymptomatic
and benign. Larger lesions have greater
malignant potential and a greater
likelihood to cause symptoms such as
bleeding, obstruction, or pain
Lipoma
Lipomas are benign submucosal fatty
tumors that are usually asymptomatic,
found incidentally on upper GI series or
EGD.
Endoscopically, they have a
characteristic appearance; there also is
a characteristic appearance on EUS.
Excision is unnecessary unless the
patient is symptomatic
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