6) Gastric Neoplasms - Benign & Malignant tumours скачать в хорошем качестве

6) Gastric Neoplasms - Benign & Malignant tumours

Gastric Neoplasms - Benign Tumours-Rare in comparison to malignant tumours i)Polyps, ii)Leiomyoma, iii) Lipoma, iv) Neurofibroma & v) Ectroxic pancreas . i)Polyps – a)Hyperplastic polyp- Sessile, solitory in antrum / fundus of stomach . b) Adenomatous polyp- may be sessile or pedunculated, papillary or villous in character. -it is true neoplasm & is potentially malignant. Rx- By fibre optic gastroscope –totally exiced by snare & cautery –HPE ii)Leiomyoma –commonest tumour –Mesodernal origin –Reprerents about 80% Rx- Small lesions can be shelled out of the gastric wall. iii)Ectopic pancreas Malignant Tumour- Carcinoma of the stomach – Aetiology -1) Diet - Increased salt consumption is associated with CA of stomach -Cigarette smoking is predisposing factor. 2)Environment –varies country to country 3)Age & sex - Rare below age of 30 yrs -Between 50 to 70 -male : female ration 3:1 4)Heredity- Certain families show a strong prediction. Predisposing factors – 1)Chronic atrophic Gastritis- 2)Pernicious anaemia - 10% of such patients develop malignancy. 3)Chronic gastric ulcer- 4)New growths of the stomach 5)Hypertrophic gastropathy (Menetrier’s disease) 6)Other possible factors Pathology –Site –Adenocarcinoma mostly develops from mucous cells. -Majority develop in the pyloric & antral region. Macroscopic Types – 1) Ulcerative – 2)Proliferative or Cauliflower type – 3)Leather bottle stomach or linitis plastica –(Scirrhous Ca ) 2 varieties- a) Localied –Pyloric region b)Diffuse form –Starts at pyloric region infiltrating, the submucosa & subserosa. 4)Colloid or mucoid CA –merely a gelatinous degeneration . 5)Ulcer Cancer- 6)Carcinoid of the stomach –only 2% of all carcinoid tumours . Microscopic types – 1)Adenocarcinema –commonest variety -presence of large amount of mucin 2)Squamous cell epthelioma – situated at the lower end of oesophagus 3)Adeno canthoma – very rave variety of gastric Ca -An admixture of glandular and squamous cell. Spread 1)Direct Spread 2)Lymphatic spread- occurs by embolism or by permeation. 3)Blood spread – Malignant cells enter the blood stream & metastasis. 4)Trans-peritoneal spread – Clinical features – a) Epigastric pain & indigestion, b)Anorexia, c)Loss of weight, d)Vomitting, e)Haematemesis, f)Malaena, g)Abd. mass h)Dysphagia i) Diarrohea. Special investigations – 1)Routine Blood Examinations 2)Routine stool exam –Occult blood present in about 80% cases. 3)Gastric function test-Gross hypochlorhydria or achlorhydria. 4)Barium meal X-ray –Irregular filling defect –finding in favour of Ca. 5)Endoscopy 6)Exfoliative cytology 7)Tetra cycline flurorescence test - 8)Serum Pepsinogen – 9)CT Scan –Determination of the extent of disease may assist. Rx-Sx –Radical operations -1)Total Radical Gastrectomy or 2)Upper radical partial gastrectomy or 3)Lower radical partial gastrectomy. Palliative operations for Gastric CA- 1)Palliative resection of the Growth – 2)Antral exclusion operations- for feed adherent irremovable growth 3)Gastro jejunostomy –for irremovable malignant lesions of antrum & pylorus. 4)Jejunostomy –(Marwedel jejunostomy ) Rubber catheter. 5)Gastrostomy- Sarcoma of the stomach- -In comparison to CA it is very rare & constitutes only 1% of Gastric CA. 1)Lympho-Sarcoma –commonest variety -Respond to radiotherapy Rx – is partial Gastrectomy alongwith the tumour. 2)Leiomyosorcoma – -usually arises as malignant change of leiomyoma. 3)Neurofibrosarcoma 4)Fibrosacroma –very rare malignant tumour. Upper G.I Tract bleeding - -is a common emergency Cause –may be local for general A)Local causes, B) General causes- Diagnosis- 1)Assessment of haemorrhage- difficult to assess the degree of blood loss 2)Assessment of cause - to assess the probable cause of bleeding. INVESTIGATIONS- 1)Endoscopy- Diagnostic & Therapeutic 2)Radiology -1 )straight X-ray 2)contrast study –Ba-studies 3)Angiography- 2 main reasons for performing angiography i)To locate the source of bleeding when this is unknown ii)To stop the bleeding by selective infusion of drugs (vasopressin) / -embolic material such as sterile absorbable gelatin sponge (steri spon) -lyophilized human duramater (Lyodura) -Steel coils, -Acrylic polymers, -detachable balloons. 4)Isotope studies –Technetium –lebelled or radiochromium- lebelled red cells or -Technetium lebelled sulphur colloid can be inject I/V 5)Ultrasound & CT scaning Management –Management depends on the cause of bleeding.