- Burning epigastric pain - Exacerbated by eating spicy foods & recumbent position - Relieved by antacids
Increased abdominal pressure: Obesity, pregnancy Hiatal hernia - Sliding, rolling (para-oesophageal) 1. Prolonged recurrent GE reflux 2. Inflammation and ulceration of squamous epithelial lining of the lower segment of the oesophagus. (distal oesophagus) 3. Reepithelialization and in growth of pluripotent stem cells ( squamous epithelium replaced by metaplastic columnar epithelium of the intestinal type - shows a greater resistance to acid injury than squamous epithelium. ) 4. In an environment of sustained low pH , these cells undergo dysplasia
SQUAMOUS CELL CARCINOMA ADENOCARCINOMA upper and middle thirds of the oesophagus lower third of the oesophagus
Peptic ulcer Common sites : 1. 1 st portion of the duodenum 2. Lesser curvature of the stomach 3. Antral region of stomach (98% of the peptic ulcers present in duodenum or stomach ; ration of duodenal and gastric ulcers is about 4 : 1 ) 4. Distal oesophagus / gastroesophageal junction - due to GERD / Barretts 5. Margins of gastrojejunostomy 6. Meckels diverticulum
Gastric ulcers Duodenal Ulcers Lesser curvature of stomach Pyloric antrum Anterior / Posterior wall of proximal duodenum Bleeding from left gastric artery Perforation Obstruction Risk of malignancy !!! Bleeding from gastroduodenal artery Perforation Obstruction Almost never malignant !!! - Burning epigastric pain soon after eating. - Pain increases with food intake - Pain is relieved by antacids - Patient is afraid to eat and loses weight. - No night pain - Melena : Less common - Vomiting and haematemesis : More common
- Burning epigastric pain 1-3 hours after eating - Pain decreases with food intake - Pain is relieved by antacids - Patient does not lose weight - Patient wakes at night due to pain. (night pain) - Melena : More common - Vomiting and haematemesis : Less common
Features Benign ulcer Malignant ulcer Age Comparatively younger age Older age Sex Clear cut male predominance Slight male predominance Site Usually along lesser curvature of pylorus and antrum Along greater curvature of stomach Size Benign ulcers are generally less than 4 cm Generally more than 4 cm Ulcer base Clear , rarely haemorrhagic Necrotic debris may be present Mucosal folds Radiating from the ulcer crater Interrupted , flattening of the rugae around the ulcer due to infiltration by malignant cells Margins No or minimal heaping Heaping prominent Barium meal Sharply , punched out lesion Irregular lesion