Nguyen h, le c, nguyen. Gastric antral vascular ectasia (watermelon stomach) an enigmatic and often-overlooked cause of gastrointestinal bleeding in the elderly. 2009; 13 (4 46-9. Barnard gf, colby jm, saltzman jr, krims. Li l, banner. Endoscopic ultrasound appearance of watermelon stomach.
Treatments, in rare cases when the bleeding is can acute and massive, episodic transfusions are required. When the patient is hartkatheterisatie stable, endoscopic coagulation with an argon plasma coagulator, bipolar probe, or heater probe obliterates the vascular ectasia and reduces the bleeding.1 Additionally, laser therapy can be used.16 Another well reported safe and effective method is endoscopic band ligation.17,18 In fact, studies. Argon plasma coagulation (8.3. Notably, portal decompression with transjugular intrahepatic portosystemic shunt (tips) does not consistently reduce bleeding, accentuating the uncertain relationship of portal hypertension to gave.21,22 Additionally, another study indicated that combination estrogen/progesterone therapy may lessen bleeding, although the ectatic vessels appear to persist.23 For patients who fail. Although reserved for the most advanced cases, it is the only, reliably curative treatment for gastric antral vascular ectasia. Dulai gs, jensen dm, kovacs to, grainek im, jutabha. Endoscopic treatment outcomes in watermelon stomach patients with and without portal hypertension. Rosenfeld g, enns. Argon photocoagulation in the treatment of gastric antral vascular ectasia and radiation proctitis. Can jour of Gastroenterology. 2009; 23 (12 801-4.
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Many speculate there to be a significant association with cirrhosis and systemic sclerosis.5,7 However, a causal connection between cirrhosis or a connective tissue disease with gave has not yet been proven.8. Autoimmunity is another theory. Anti-rna polymerase iii antibodies has been documented in 25 of sclerosis patients that had gave.6 This finding demonstrates future potential to be used as a predictive and prognostic marker. In support of an immune-related hypothesis, in 2012 a case of antral vascular ectasia was induced after a treatment of Imatinib for gist.9 Further, repeat endoscopy one month after discontinuation of Imatinib showed substantial improvement in gastric inflammation. A different notion describes a more mechanical etiology. Since the 1990s there have been records of prolapses of the stomach into the small intestine prior to the development of gave.10 Yet, a final theory proposes a hormonal connection with vasoactive intestinal peptide knie and 5-hydroxy-tryptamine.11. Associated Diseases, gastric antral vascular ectasia is associated with a number of conditions, but perhaps the most frequently studied include portal hypertension, chronic renal failure, and connective tissue disorders.12 Watermelon stomach occurs especially in the connective tissue disease, scleroderma, with the subtype systemic sclerosis (5.7. Strikingly, cirrhosis has been associated with 30 of all patients with gave.8.11 Lastly, according to the genetic and Rare diseases Information Center (gard pernicious anemia is associated with gaves as an independent study showed that over three-fourths of the patients had some kind of Vitamin.
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Sections of this gut begin to differentiate into the organs of the gastrointestinal tract, and the esophagus, and stomach form from the foregut. 10 Function edit digestion edit main article: Digestion In the human digestive system, a bolus (a small rounded mass of chewed up food) enters the stomach through the oesophagus via the lower oesophageal sphincter. The stomach releases proteases (protein-digesting enzymes such as pepsin ) and hydrochloric acid, which kills or inhibits bacteria and provides the acidic pH of 2 for the proteases to work. Food is churned by the stomach through muscular contractions of the wall called peristalsis reducing the volume of the fundus, before looping around the fundus 11 and the body of stomach as the boluses are converted into chyme (partially digested food). Chyme slowly passes through the pyloric sphincter and into the duodenum of the small intestine, where the extraction of nutrients begins. Depending on the quantity and contents of the meal, the stomach will digest the food into chyme within anywhere between forty minutes and a few hours. The average human stomach can comfortably hold about a litre of food. Gastric juice in the stomach also contains pepsinogen.
It is syndrome the only layer of the three which is not seen in other parts of the digestive system. The antrum has thicker skin cells in its walls and performs more forceful contractions than the fundus. The middle circular layer: At this layer, the pylorus is surrounded by a thick circular muscular wall which is normally tonically constricted forming a functional (if not anatomically discrete) pyloric sphincter, which controls the movement of chyme into the duodenum. This layer is concentric to the longitudinal axis of the stomach. Auerbach's plexus (aka myenteric plexus) is found between the outer longitudinal and the middle circular layer and is responsible for the innervation of both (causing peristalsis and mixing) The outer longitudinal layer is responsible for moving the bolus towards the pylorus of the stomach through. The stomach also possesses a serosa, consisting of layers of connective tissue continuous with the peritoneum. Gastric glands edit main article: Gastric glands In humans, different types of cells are reaction found at the different layers of the gastric glands : layer of stomach Name secretion Region of stomach Staining Isthmus of gland foveolar cells Mucus gel layer Fundic, cardiac, pyloric Clear.
During the second week of development, as the embryo grows, it begins to surround parts of the sac. The enveloped portions form the basis for the adult gastrointestinal tract. 10 The sac is surrounded by a network of vitelline arteries. Over time, these arteries consolidate into the three main arteries that supply the developing gastrointestinal tract: the celiac artery, superior mesenteric artery, and inferior mesenteric artery. The areas supplied by these arteries are used to define the foregut, midgut, and hindgut. 10 The surrounded sac becomes the primitive gut.
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Near the cardia is the lower oesophageal sphincter. 7 Recent research has shown that the cardia is not an anatomically distinct region of the stomach but a region of the oesophageal lining damaged by reflux. 8 The fundus (from Latin, "bottom is formed by the upper curvature of the organ. The body is the main, central region. The pylorus (from Greek, "gatekeeper is the lower section of the organ that facilitates emptying the contents into the small intestine.
Blood supply edit The lesser curvature of the human stomach is supplied by the right gastric artery inferiorly, and the left gastric artery superiorly, which also supplies the cardiac region. The greater curvature is supplied by the right gastroepiploic artery inferiorly and the left gastroepiploic artery superiorly. The fundus of the stomach, and also the upper portion of the greater curvature, is supplied by the short gastric artery which arises from the splenic artery. Histology edit micrograph showing a cross section of the human stomach wall, in the body portion of the stomach. Main article: Gastrointestinal wall like the other parts of the gastrointestinal tract, the human stomach walls consist of an outer mucosa, inner submucosa, muscularis externa, and serosa. The gastric mucosa of the stomach consists of the epithelium and the lamina propria (composed of loose connective tissue with a thin layer of smooth muscle called the muscularis mucosae separating it from the submucosa beneath. The submucosa lies under the mucosa and consists of fibrous connective tissue, separating the mucosa from the next layer. Meissner's plexus is in this layer. The muscularis externa lies beneath the submucosa and is unique from other organs of the gastrointestinal tract, consisting of three layers: The inner oblique layer: This layer is responsible for creating the motion that churns and physically breaks down the food.
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A large double fold of visceral peritoneum called the css greater omentum hangs down from the greater curvature of the stomach. Two sphincters keep the contents of the stomach contained; the lower oesophageal sphincter (found in the cardiac region at the junction of the oesophagus and stomach, and the pyloric sphincter at the junction of the stomach with the duodenum. The stomach is surrounded by parasympathetic (stimulant) and sympathetic (inhibitor) plexuses (networks of blood vessels and nerves in the anterior gastric, posterior, superior and inferior, celiac and myenteric which regulate both the secretory activity of the stomach and the motor (motion) activity of its muscles. In adult humans, the stomach has a relaxed, near empty volume of about 75 millilitres. 4 Because it is a distensible organ, it normally expands to hold about one litre of food. 5 The stomach of a newborn human baby will only be able to retain about 30 millilitres. Sections boldocynara edit In classical anatomy, the human stomach is divided into four sections, beginning at the gastric cardia, 6 each of which has different cells and functions. The cardia is where the contents of the oesophagus empty into the stomach. The cardia is defined as the region following the "z-line" of the gastroesophageal junction, the point at which the epithelium changes from stratified squamous to columnar.
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In humans and many other animals, the stomach is located between the oesophagus and the small intestine. It secretes digestive enzymes and gastric acid to aid in food digestion. The pyloric sphincter controls the passage of partially digested food ( chyme ) from the stomach into the duodenum where peristalsis takes over to move this through the rest of the intestines. Contents, structure edit, sections of the human stomach, in humans, the stomach lies between the oesophagus and the duodenum (the first part boomkorf of the small intestine ). It is in the left upper part of the abdominal cavity. The top of the stomach lies against the diaphragm. Lying behind the stomach is the pancreas.
This article is about the internal organ. For the middle part of the body, see. For other uses, see, stomach (disambiguation). For the ancient Greek colony, see. For the sauce flavoring, see. The stomach (from ancient Greek στόμαχος, stomachos, stoma means mouth) is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital digestive organ. In the digestive system the stomach is involved in the second phase of digestion, following mastication (chewing).
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The classic watermelon stripes are visualized during an endoscopy. These appear as longitudinal rows of flat, erythematous stripes radiating from the pylorus into the antrum. Another presentation exists in patients with co-existing portal hypertension. These individuals may have diffuse antral angiomas in lieu of the classic radiating pattern.1 In any case, the diagnosis may be confirmed with endoscopic ultrasound, ct scan, or tagged red blood cell scan.4 Moreover, vascular ectasia, spindle cell proliferation, and fibrohyanlinosis characterizes the histopathological features. Women represent 71 of all cases of gave making the incidence roughly twice that of males.2 The average age at diagnosis is also slightly elevated for females at 73 years of age. 68 for men.3 Patients as early as their late twenties have been treated van for gave; however, it is much more prevalent in those in their eighties. Ultimately in the most affected patient population, gave is responsible for 4 of nonvariceal upper gi bleeding.1. Pathogenesis, since its discovery in 1952 (describe in 1953 there has been much postulation as to the etiology of watermelon stomach. Even now gave is thought to occur in an idiopathic manner.
render the affected areas more susceptible to bleeding. Even though the etiology is still being speculated upon, and the occurrence is rare (4 of non-variceal upper gi bleeds)1, gave has become a distinct entity with established co-morbid conditions. Signs and Symptoms, like most cases of chronic upper gastrointestinal bleeding, many patients will complain of anemia and other symptoms of blood loss.2 More uncommon is the case that presents with acute blood loss requiring revival. Occasionally, a patient may notice melena and/or hematochezia. The chronicity of the anemia also plays a role in whether the patient protests of subsequent symptoms. Typically a patient that is chronically anemic is able to tolerate a lower hemoglobin and hematocrit. Differential diagnosis, because many diagnoses can present in this manner, it is imperative to construct an adequate differential, as the treatments for these conditions can be vastly diverse. An adequate differential would include, but is not limited to, more common causes, like a duodenal/gastric ulcer and portal hypertension3, and more intermittent causes, like: upper gastrointestinal tumors, dieulafoy lesions, gastric antral vascular ectasia, portal hypertensive gastropathy, hemobilia, hemosuccus pancreaticus, aortoenteric fistulas, and Cameron lesions. Diagnosis, the only way to conclusively diagnose gave is by means of endoscopic biopsy.