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Stomach and Duodenum

ANATOMY

 

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  1. The stomach is divided into the fundus, body, and antrum
  2. Hydrochloric acid—secreting parietal cells are found in the fundus,
  3. Pepsinogen-secreting chief cells are found in the proximal stomach
  4. Gastrin-secreting G cells are found in the antrum.

image

 

The duodenum is divided into four Parts

  • 1st portion :begins at the pylorus and includes the duodenal bulb
  • 2nd portion :location of ampulla of Vater
  • 3rd portion :traversed anteriorly by the superior mesenteric vessels
  • 4th portion :terminates at the ligament of Treitz(duodenal–jejunal junction)

 

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The arterial supply to the duodenum

  • superior pancreaticoduodenal (<—gastroduodenal artery)
  • inferior pancreaticoduodenal artery (<--superior mesenteric artery)

GASTRIC AND DUODENAL ULCERATION

 

Etiology

 

  1. NSAD (alter prostaglandin synthesis)
  2. alcohol, and tobacco (restricts mucosal vascular )
  3. Helicobacter pylori

HISTORY

 

  1. epigastric pain relieved by antacids
  2. Sensations of fullness and mild nausea
  3. vomiting is rare (unless scarring-->pyloric obstruction)
  4. occasional epigastric tenderness.

 

Investigation

 

  1. barium studies (crater deformities)
  2. Serum testing :antibodies to H. pylori
  3. breath testing confirms infection.
  4. Definitive diagnosis : endoscopy
  5. biopsy : rule out gastric carcinoma

 

TREATMENT

 

Medical treatment

  1. Medications include
  2. antacids (CaCO3),
  3. H2-blockers (cimetidine, ranitidine),
  4. mucosal coating agents (sucralfate), and
  5. proton-pump inhibitors (omeprazole).

 

If H. pylori is present,

 

  1. tetracycline/metronidazole/bismuth-subsalicylate, or
  2. amoxicillin/metronidazole/ranitidine , or other combinations.

 

Surgical treatment

 

  1. reduce acid secretion by removing the entire antrum.
  2. vagotomy and distal gastrectomy (antrectomy), with Billroth I or II anastomosis,
  3. perforation are treated with closure of the defect with omental patch
Stomach and Duodenum Stomach and Duodenum Reviewed by Radiology Madeeasy on August 24, 2010 Rating: 5
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