SU28.8 | Pyloric Stenosis, Peptic Ulcer Disease and Carcinoma Stomach — Summary & Reflection

KEY TAKEAWAYS

Three diseases of one organ demand three different strategies. Infantile hypertrophic pyloric stenosis — a first-born male at ~3–6 weeks with non-bilious projectile vomiting who stays hungry; the muscle of the pylorus is hypertrophied, the biochemistry is a hypochloraemic hypokalaemic metabolic alkalosis, the confirmatory test is ultrasound, and the rule is correct the alkalosis first, then Ramstedt pyloromyotomy (resuscitate before operating). Peptic ulcer disease — caused chiefly by H. pylori and NSAIDs, diagnosed by endoscopy with biopsy (gastric ulcers must be biopsied) and H. pylori testing, and treated medically by eradication + PPI, with surgery reserved for complications: perforation (free gas under the diaphragm → Graham omental patch), bleeding (endoscopic haemostasis first), and outlet obstruction. Gastric carcinoma — an adenocarcinoma (intestinal vs diffuse/signet-ring/linitis plastica) presenting late with weight loss, mass and anaemia, spreading by lymphatics (Virchow's node), blood and transcoelomically (Sister Mary Joseph nodule, Krukenberg tumour); diagnosed by endoscopy+biopsy and staged by CT, with gastrectomy + D2 lymphadenectomy ± chemotherapy for resectable disease and palliation for the rest.

REFLECT

Recall the three kinds of patient in this module — the projectile-vomiting baby, the adult with an acute abdomen or ulcer-type pain, and the older patient with weight loss — and ask yourself whether you could keep them firmly apart at the bedside. Would you remember to correct the baby's alkalosis before sending him to theatre, rather than treating the vomiting as a reason to rush? Would you recognise the free gas under the diaphragm and act on it? And would you resist the temptation to treat an older patient's 'dyspepsia' with tablets alone, instead arranging the endoscopy that could catch a curable cancer? Reflect on how the metastatic signs you learned to examine for translate, here, into the decision between curative gastrectomy and palliation — and how you would explain each of these very different plans to the patient or parent in front of you.