STOMACH

Dr. Aulia Janer

Tutor :
Dr. Anbiar Manjas, Sp.B KBD

anatomy

vascularization

innervation

lymph

hystology

PHYSIOLOGY

Important secretory 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

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

Secretion

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

 Chronic

use 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
gastrectom
y

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