STOMACH

Dr. Aulia Janer

Tutor :
Dr. Anbiar Manjas, Sp.B KBD
anatomy
vascularization
innervation
lymph
hystology
PHYSIOLOGY
 Importantsecretory functions include the
production of acid, pepsin, intrinsic factor,
mucus, and a variety of GI hormones.

 Important motor functions include food

storage (receptive relaxation and
accommodation), grinding and mixing,
controlled emptying of ingested food,
and periodic interprandial “housekeeping
 Acid Secretion
 For ingested food and protect
again pathogens
 Product parietal cells  stimulated
by acetylcholine (from vagal
nerve fibers), gastrin (from D cells),
or histamine (from ECL cells).
 The enzyme H+/K+-ATPase is the
proton pump
 The
acid secretory described in three
phases:
 cephalic,
 gastric,
 and intestinal
 Pepsinogen Secretion
 From chief cells (P1) and SEC (P2)
 Somatostatin inhibits pepsinogen secretion
 Function as food ingestion catalyzes the
hydrolysis of proteins
 pH 2.5, and inactive at pH >5

 Intrinsic Factor
 Intrinsic factor binds to luminal vitamin B12,
and the complex is absorbed in the
terminal ileum via mucosal receptors
Gastric Mucosal Barrier
Gastric Hormones
 Gastrin
 produced by antral G cells
 Major hormonal stimulant of acid secretion
 Stimulate by histamin 2

 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
 a satiety signal hormone
 Ghrelin
 small peptide described in 1999
 primarily in the stomach
 is a potent secretagogue of pituitary
growth hormone
 regulator of appetite
 Elevated appetite is stimulated
 suppressed, appetite is suppressed
Gastric Motility and Emptying
 by coordinated smooth muscle relaxation
and contraction of the various gastric
segments (proximal, distal, and pyloric)
 modulated by extrinsic and intrinsic
innervation and hormones
 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
Gastric Motility and Emptying
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
PEPTIC ULCER DISEASE
 focal
defects in the gastric or duodenal
mucosa that extend into the submucosa
or deeper, caused by H. pylori infection
and/or NSAID use
 Chronicuse of NSAIDs (including aspirin)
increases the risk of peptic ulcer disease
about 5-fold and upper GI bleeding
about 4-fold
Clinical Manifestations
 More than 90% of patients with PUD
complain of abdominal pain. The pain is
typically nonradiating, burning in quality,
and located in the epigastrium. The
mechanism of the pain is unclear.
 Patients with duodenal ulcer often
experience pain 2 to 3 hours after a meal
and at night
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)
 Truncal vagotomy and pyloroplasty
 truncal vagotomy and gastrojejunostomy
 vagotomy and distal gastrectomy
Zollinger-Ellison Syndrome
 caused by the uncontrolled secretion of
abnormal amounts of gastrin by a
duodenal or pancreatic neuroendocrin
tumor (i.e., gastrinoma).
 The most common symptoms of ZES are
epigastric pain, GERD, and diarrhea
MALIGNANT NEOPLASMS OF
THE STOMACH
Radical
gastrectomy
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
Thank you