NON NEOPLASTIC CONDITIONS OF THE STOMACH

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NON NEOPLASTIC CONDITIONS OF THE
STOMACH
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NON NEOPLASTIC CONDITIONS OF THE STOMACH

• Normal and Variations
• Congenital Conditions
• Gastritis and Gastropathy
• Ingestions including Bezoars
• Ulcer Disease
• Motility Disorders
• Mechanical Disorders
• Postoperative Evaluation

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NORMAL GASTRIC MUCOSA RUGAE, AIR CONTRAST
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NORMAL GASTRIC DIMENSIONS

• Gastric wall (CT) lt5mm
• Gastric folds
• Distended (CT) lt5mm
• Collapsed (Rad) lt10mm
• Distended (Rad) lt5mm
• Hyperrugosity gt5mm

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NORMAL GASTRIC MUCOSA RUGAE, COMPRESSION
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NORMAL GASTRIC MUCOSA AREAE GASTRICAE, AIR
CONTRAST
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CONGENITAL LESIONS OF THE STOMACH

• Situs abnormalities
• Duplications
• Diverticula
• Adenomyosis, ectopic pancreas
• Antral web, diaphragm
• Pyloric hypertrophy

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25 yo female with confusing chest film
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SITUS INVERSUS
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25 yo male with hyperphagia since birth

• Agha, 1981

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NON COMMUNICATING GASTRIC DUPLICATION
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GASTRIC DIVERTICULUM
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GASTRIC DIVERTICULUM
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GASTRIC DIVERTICULA (?)
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FOCAL ECTOPIC PANCREAS
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DIFFUSE ECTOPIC PANCREAS
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CONGENITAL ANTRAL WEB
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ADULT HYPERTROPHIC PYLORIC STENOSIS

• Definition pyloric muscle gt 9 mm
• Etiology Unknown, congenital, peptic
• Radiologic signs
• Lengthening, narrowing of canal
• Indentation of bulb
• Pyloric cleft
• Normal mucosa
• Diff. Dx.
• Carcinoma
• Peptic stricture
• Gastritis (Crohns, other)

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ADULT PYLORIC HYPERTROPHY
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ADULT PYLORIC HYPERTROPHY
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GASTRITIS AND GASTROPATHY PATHOLOGIC
DEFINITIONS

• Gastritis Mucosal injury with inflammation, e.g.
  H. pylori gastritis
• Gastropathy Mucosal injury without inflammation,
  e.g. NSAID gastropathy

Emory T, AFIP, 2000
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GASTRITIS AND GASTROPATHY Specific Causes

• Salicylates and other NSAIDs
• Other drugs, ingestants Corticosteroids,
  alcohol, nicotine
• Stress (psychologic or physical) CNS injury
  (Cushings), burns (Curlings), sepsis,
  postoperative, organ failure
• Infections Bacterial (H. pylori, strep.), viral,
  fungal, parasitic
• Direct injury Corrosives, radiation, bile
• Granulomatous
• Hypertrophic

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GASTRITIS AND GASTROPATHY CLASSIFICATION
AND EXAMPLES

• GASTRITIS
• H. Pylori
• Streptococcal
• Granulomatous
• Crohns, TB, Syphilis, Sarcoid
• Eosinophilic
• Allergic
• Parasitic
• Pernicious anemia

• GASTROPATHY
• Acute Erosive
• NSAIDS, Stress,
• Injury Alcohol, caustic, radiation,
  Chemotherapy
• Bile Reflux
• Hypertrophic
• Menetriers
• Zollinger-Ellison

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GASTRITIS AND GASTROPATHYClassification

• Acute erosive NSAIDs
• Chronic erosive (varioliform)
• Chronic nonerosive
• Type A pernicious anemia
• Type B H. pylori

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GASTRIC INFLAMMATORY DISEASEFindings by Plain
Films, CT

• Hyperrugosity, Wall thickening
• Ulcer crater visualization
• Outlet obstruction
• Penetration Gut, pancreas, biliary, pericardium,
  pulmonary
• Pneumatosis
• Perforation, Fistula
• Phlegmon, Abscess

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GASTRIC INFLAMMATORY DISEASEPlain Film Findings
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GASTRITIS and GASTROPATHYUGI Signs

• Accentuation of areae gastricae
• Fold thickening, nodularity
• Fold crenulation, scalloping (undulation)
• Mucosal erosions, ulcers
• Luminal straightening, narrowing

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EROSIVE GASTRITIS APHTHAE
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GASTRITIS INCOMPLETE EROSIONS
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GASTRITIS FOLD THICKENING
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ATROPHIC GASTRITIS PERNICIOUS ANEMIA
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53 yo female with long term dyspepsia

• Mikysa, et al, 2002

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HELICOBACTER PYLORI FACTS

• Spirochetal organism (Campylobacter)
• Most common cause of chronic gastritis
• 50 prevalence in patients with dyspepsia,
  epigastric pain
• 50 of asymptomatic individuals at age 60

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Calam J and Baron JH, BJM 2001
H. Pylori, NSAIDS and GASTRODUODENAL DISEASES
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HELICOBACTER PYLORI GASTRITISFindings by
Double Contrast UGI

• Fold enlargement (50)
• Antrum 60
• Body - 10
• Diffuse - 30
• Polypoid folds (25)
• Enlarged areae gastricae 15
• Erosions, ulcers (5-15)

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HELICOBACTER PYLORI SIGNS
Enlarged Areae Gastricae
Polypoid Folds

• Scalloped Folds

Dheer, et al, 2002
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HELICOBACTER PYLORI ULCERSSingle Contrast and
Compression
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HELICOBACTER PYLORI AND MALT LYMPHOMA
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GRANULOMATOUS GASTRITIS

• Crohns disease
• Sarcoidosis
• Tuberculosis
• Syphilis
• Fungal (Histo)
• Idiopathic

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CROHNS GASTROPATHY
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CROHNS GASTROPATHY
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GRANULOMATOUS GASTRITIS

• SYPHILIS

• SARCOIDOSIS

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EOSINOPHILIC GASTRITIS

• D. Christie, 1980

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PHLEGMONOUS (EMPHYSEMATOUS) GASTRITISGASTRIC
GANGRENE

• Rare, life threatening
• Suppurative infection
• Hemolytic streptococci (70)
• E. Coli, proteus, clostridia
• Pneumococci, staphylococci
• Anthrax, Fungi
• Clinical Acute onset pain, fever, vomiting,
  peritonitis
• Radiographic Thick wall, effaced mucosa,
  intramural gas, contrast

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PHLEGMONOUS GASTRITISGASTRIC GANGRENE
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EMPHYSEMATOUS GASTRITISMUCORMYCOSIS
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DEFINITITIONS RELATED TO GAS IN GASTRIC WALL

• Gastric Pneumatosis
• Gastric Emphysema
• Gastritis Emphysematosa
• Emphysematous Gastritis
• Gastric Gangrene
• Phlegmonous Gastritis

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GASTRIC EMPHYSEMA or PNEUMATOSIS
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HYPERTROPHIC GASTROPATHYDefinition

• Enlarged folds (hyperrugosity)
• Usually body and fundus
• Hypertrophy of gastric mucosa
• With or without protein loss

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HYPERTROPHIC GASTROPATHYClassification

• Menetriers disease
• Zollinger-Ellison syndrome
• Hypertrophic hypersecretory
• CMV-related
• Pseudolymphoma
• Allergic gastropathy

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31 yo female with anasarca
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CAUSES OF HYPERRUGOSITY

• Neoplasm
• Lymphoma
• Carcinoma
• Miscellaneous
• Amyloidosis
• Eosinophilic
• Varices
• Edema
• Normal Variant

• Gastritis
• Peptic
• Infectious
• Alcoholic
• Phlegmonous
• Granulomatous
• Gastropathy
• Injury
• Hypertrophic

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MENETRIERS GASTROPATHY
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MENETRIERS GASTROPATHY
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MENETRIERS GASTROPATHY
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ZOLLINGER-ELLISON SYNDROME

• Gastrinoma - Pancreatic, extrapancreatic
• 30 have MEN-l (multiple tumors common)
• 60 malignant - liver, nodes, bone

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ZOLLINGER-ELLISON SYNDROME ESSENTIAL FINDINGS

• Gastroduodenal and SB Ulcers Usual and
  Unusual Locations
• Excess Fluid
• Fold Thickening Stomach and SB
• Tumor Localization Pancreas, Duodenum
• Metastases
• Complications of Ulceration

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ZOLLINGER-ELLISON SYNDROME Excess Fluid
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ZOLLINGER-ELLISON SYNDROME Gastric and
Duodenal Ulceration
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ZOLLINGER-ELLISON SYNDROME Jejunal Ulcer,
Excess Fluid
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ZOLLINGER-ELLISON SYNDROME Jejunal Ulcer and
Enterocolic Fistula
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ZOLLINGER-ELLISON SYNDROME Duodenal
Gastrinoma
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ZOLLINGER-ELLISON SYNDROME METASTASES
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INJURY GASTROPATHY

• NSAIDs
• Alcohol
• Bile
• Caustics
• Radiation
• Thermal

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NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs) AND
GASTRODUODENAL INFLAMMATION

• Acute mucosal lesion
• Direct NSAID effect
• Usually asymptomatic
• Chronic mucosal lesion
• Diminished prostaglandin protective effect
• Ulcer in 10-20 of chronic users

1-2 of population uses NSAIDs daily Most
severe drug side effect in USA
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CAUSTIC INGESTION GASTROPATHY ACUTE
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CAUSTIC INGESTION GASTROPATHY SUBACUTE
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CAUSTIC INGESTION GASTROPATHY CHRONIC
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RADIATION GASTROPATHY
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25 yo female with trichophagomania
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TRICHOPHAGOMANIA
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TYPES OF BEZOARS

• Trichobezoars
• Hair
• Fiber
• Concretion Bezoars
• Antacids
• Gums, resins
• Paraffin
• Shellac
• Asphalt

• Phytobezoars
• Unripe persimmons,
• Orange, grapefruit,
• Sauerkraut, berries
• Asparagus, Greenbeans,
• Brussel sprouts, figs,
• Coconut, potato skins,
• Pineapple, artichokes,
• Cantaloupes, apples,
• Dandelion greens

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TRICHOBEZOAR
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TRICHOBEZOAR ON THE WAY

• Thapa, 2002

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GASTRIC BEZOAR
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GASTRODUODENOJEJUNAL BEZOAR
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GASTRIC FOREIGN MATERIAL
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GASTRIC FOREIGN MATERIAL
Lichtenstein, 2002
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NON NEOPLASTIC CONDITIONS OF THE STOMACH
SUMMARY

• Normal and Variations
• Congenital Conditions
• Gastritis and Gastropathy
• Ingestions

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GASTRIC FOREIGN MATERIAL
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GASTRIC FOREIGN MATERIAL
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INGESTED FOREIGN MATERIAL

• Lichtenstein, 2002