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GASTRIC ULCER

SHAPE
Round or oval Linear,rod,rectangular,serpiginous,flame shaped Linear may be also seen in healing ulcers

SIZE
Ba studies can detect ulcers more than 5mm Gaint ulcers are called when size more than 3cm..they are usualy benign.but complications are more

LOCATION
Benign lesser curvature,posterior wall of antrum,body of stomach,distal half of greater curvature[sump ulcer] Posterior wall than anterior wall Least in fundus Malignant-proximal half of greater curvature

Young-antrum Old-body,lesser curvaturegeriartric ulcer Gastric ulcers associated with a hiatus hernia tend todevelop high on the lesser curve where mucosa prolapses throughthe diaphragmatic hiatus and may result from ischaemic mucosalinjury.

ULCER CHARACTERISTICS
Smooth round or ovoid that project beyond adjacent gastric wall malignantulcer -at the apex of a protruding tumour mass will lie within theoutline of the stomach HAMPTONS LINE-Sometimes overhanging preserved mucosa[underneath submucosa is vulnerable] at the margins of a benign ulcer will be seen as a thin lineseparating a barium-filled ulcer from barium in the stomach

ULCER COLLAR-rim of undermined mucosa may be oedematous producing a wide radiolucent band ULCER MOUND-as a smooth bilobed hemispheric mass projecting into the lumen on both side of ulcer forming a obtuse gently slopping angle with adjacent gastric wall

Area gastrica pattern may be coarse and prominent When seen en face, an ulcer onthe dependent wall of the stomach fills with barium, whereas an ulcer on the non-dependent wall is seen as a ring. Smooth folds radiate from the edge of a benign ulcer

MULTIPLE ULCERS
Benign gastric ulcers are multiple in 25% of patients but a benign ulcer can be associated with a malignant one, so each ulcer has to be assessed individually

HEALING ULCER
ulcers decrease in size and change from being round to linear interval of 8 weeks of medical treatment Healing may be complete or there can be scaring Enface scars are seen as punctate or linear grooves from which smooth folds radiate evenly Ulcer splitting

In profile, scars cause a localised flattening of the mucosa On occasions the mucosa heals over an ulcer crater but a depression persists,in which case the radiologist may believe the ulcer to be still active and it is only with endoscopy that healing is confirmed.

Healing gastric ulcer with radiating folds

If scarring has been pronounced orrecurrent ulceration at the same site can lead to gastric deformity..hour glass deformity

COMPLICATIONS
Obstruction Penetration perforation

Benign posterior wall ulcer

Greater curve -sump ulcer nsaid,kcl,steroids

Lesser curve gastric ulcer

Lesser gastric ulcer with hamptons line