Diseases of the Stomach
Congenital Pyloric Stenosis
Example: male, 3 weeks old and started vomiting non bile stained fluid at 3 wks; palpated the
abdomen and felt a knot in RUQ and see hyperperistalsis. This is NON bile stain fluid at 3 weeks.
Congenital Pyloric Stenosis
What if it is duodenal atresia in a down’s kid? That would be at birth vomiting of bile stained
fluid. And double bubble sign – atresia (lack of development of the lumen) is distal to where the
bile duct comes in, so bile can still enter the proximal portion of the duodenum – this is why it is
bile staining – b/c there is no movement, there will be air trapped in there, and air is trapped in
the stomach, therefore there is air in the stomach and prox duodenum – a double bubble sign.
Also, mom will have polyhydramnios. So, do not confuse congenital pyloric stenosis (which has
no relationship to down’s) with duodenal atresia.
It does have multifactorial inheritance; therefore it can be increased in future children. Can see
pyloric stenosis, as it has thickened. To Rx, split the muscle (called pyloroplasty).
Non steroidal will block PGE2, which is responsible for the mucous barrier of the stomach, and
vasodilatation of the vessels, mucous secretion, and secretion of bicarb into the mucous barrier.
So, when you take NSAIDS for a period of time, the whole thing is destroyed. Leads to multiple
ulcers and significant blood loss over time. They are punched out.
Silver stain (as is PCP, Legionella, bartenella hensilai). Comma shaped organisms (like
campylobacter), but found out that they have different cell walls and etc. Nasty bug b/c it make
lots of cytokines and urease which converts urea to ammonia, and is one of the reasons why
they can burrow through the mucous layer – ammonia is very toxic – this is the test we use –
when we take bx of gastric mucosa, we do a urease test on it and if its positive, know H pylori is
in it. Can also use serological tests – Ab’s against it. It’s only good for the first time. Why? B/c
the Ab’s do not go away and, therefore cannot dx reactivation or recurrent. After that it is
useless b/c won’t tell anything b/c will always be positive b/c Ab’s stick around.
Where does pernicious anemia hit? Body and fundus. That is where the parietal cells have
autoAb’s destroying them, and IF leading to atrophic gastritis.
This is NOT where H pylori exerts its affect. H pylori affects the pylorus and antrum. It destroys
the mucosa, leading to atrophic gastritis of the pylorus and antrum. This is where cancers are.
Most cancers are along the lesser curvature of the pylorus and antrum (exact same place
where gastric ulcers are). The H pylori live in a mucous barrier and therefore is protected. MCC
stomach cancer = H pylori. H pylori can also cause malignant lymphomas of the stomach (low
Why don’t we ever bx a duodenal ulcer? B/c they are never malignant. But gastric ulcers have a
chance of becoming malignant therefore need to biopsy gastric and not duodenal ulcers. Only