STOMACH & DUODENUM -2

DUODENAL TUMOURS Benign duodenal tumours Duodenal villous adenomas Commonly found around the ampulla of Vater Premalignant Often found in patients with familial adenomatous polyposis.

MALIGNANT DUODENAL TUMOURS Duodenal adenocarcinoma uncommon, The most common site for adenocarcinoma arising in the small bowel. Patients present with anemia (ulceration), or duodenal obstruction. Curative surgical treatment will involve a pancreaticoduodenectomy (Whipple’s procedure).

Neuroendocrine tumours Doudenal GIST Neuroendocrine tumours Non-functioning neuroendocrine tumours (Carcinoid tumors) Zollinger–Ellison syndrome (Gastrinoma): It is a cause of persistent peptic ulceration. Also occurs in the pancreas, especially the head. either sporadic or associated with the autosomal dominantly inherited multiple endocrine neoplasia (MEN) type I (in which a parathyroid adenoma is almost invariable). Diagnosis: High Basal Acid secretion High Gastrin level

Cancer of pancreatic head is the most common cause. DUODENAL OBSTRUCTION Cancer of pancreatic head is the most common cause. Metastases from colorectal and gastric cancer. Primary duodenal cancer Annular pancreas Pancreatitis Arteriomesenteric compression: fourth part of the duodenum is compressed between the superior mesenteric artery and the vertebral column

OTHER GASTRIC CONDITIONS Acute gastric dilatation Associated with pyloroduodenal disorders or postsurgery without nasogastric suction. Can result in a sudden massive vomit with aspiration into the lungs. Trichobezoar and phytobezoar Trichobezoar (hair balls) exclusively found in female psychiatric patients, often young. Hair, which remains undigested in the stomach can lead to ulceration and gastrointestinal bleeding, perforation or obstruction. Phytobezoars are made of vegetable matter and found principally in patients who have gastric stasis. Foreign bodies in the stomach e.g. needles, usually pass spontaneously, or removed endoscopically, rarely surgery required.

Volvulus of the stomach Rotation around its fixed points (cardia & pylorus): Horizontal (Oraganoaxial). Vertical (Mesenteroaxial). Usually associated with diaphragmatic hernia, eventration of diaphragm. The transverse colon moves upwards taking the stomach with it & both may enter the chest Presentation: - chronic (vomiting) - acute (ischemia) Surgery: Reduction of hernia Close diaph. Defect. Separate stomach from T. colon Anterior gastropexy (fixed to abd wall).

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