SU28.5-9 | Upper Gastrointestinal Surgery — Glossary

A primary motility disorder with failure of relaxation of the LES and loss of peristalsis, causing dysphagia to both solids and liquids and nocturnal regurgitation.

The cancer typical of the lower third, arising in Barrett's metaplasia driven by chronic GERD and obesity.

Columnar (intestinal) metaplasia of the lower oesophageal lining driven by chronic GERD; a premalignant change predisposing to adenocarcinoma.

The smooth, tapering narrowing at the cardia with a dilated oesophagus above, seen on barium swallow in achalasia.

A hard rectovesical/rectouterine pouch deposit palpable on rectal examination, indicating transcoelomic metastatic spread.

Gastric cell secreting pepsinogen, the precursor of the digestive enzyme pepsin.

The terminal nodal group draining the stomach along its arteries; the target of lymphadenectomy in gastric cancer surgery.

A benign fibrous cicatricial narrowing of the oesophagus following acid or alkali ingestion, treated by dilatation and, if refractory, reconstruction.

The extended lymph-node dissection accompanying gastrectomy for gastric cancer, removing the second tier of nodes along the named arteries.

Difficulty in swallowing; the cardinal symptom of oesophageal disease, whose pattern (solids-then-liquids vs both together) points to the cause.

Endoscopic imaging that assesses depth of tumour invasion (T) and local lymph nodes (N) in oesophageal carcinoma staging.

A mass palpable in the epigastrium that moves with respiration and not on swallowing; in stomach disease it suggests gastric carcinoma.

Antral endocrine cell secreting gastrin, which stimulates gastric acid secretion.

Surgical removal of part (partial/subtotal) or all (total) of the stomach, the curative operation for resectable gastric carcinoma.

The malignant tumour of the stomach, classified into an intestinal (gland-forming) type and a diffuse (signet-ring) type.

Obstruction of gastric emptying, from a scarred pyloric ulcer or antral cancer, causing large-volume vomiting and a succussion splash.

Symptomatic reflux of gastric contents due to an incompetent LES, causing heartburn and oesophagitis and predisposing to Barrett's oesophagus.

Artery behind the first part of the duodenum that gives the right gastro-epiploic artery; a posterior peptic ulcer eroding it causes major haemorrhage.

The classic operative repair of a perforated peptic ulcer, plugging the perforation with a tongue of omentum, with peritoneal lavage.

The long, convex left border of the stomach, supplied by the left and right gastro-epiploic and short gastric arteries.

A gastric bacterium that is a major cause of peptic ulcer disease and a risk factor for intestinal-type gastric carcinoma; treated by eradication therapy.

Surgical division of the muscle of the lower oesophageal sphincter to relieve achalasia, usually laparoscopic and combined with a partial fundoplication.

The acid-base and electrolyte disturbance of pyloric stenosis from loss of gastric hydrochloric acid; must be corrected before surgery.

Hypertrophy of the circular pyloric muscle in a neonate (typically 3–6 weeks, often first-born male) causing non-bilious projectile vomiting and gastric outlet obstruction.

Bilateral ovarian metastases (classically with signet-ring cells) from transcoelomic spread of gastric carcinoma.

A direct branch of the coeliac trunk supplying the lesser curvature; an important vessel ligated in gastric surgery.

The short, concave right border of the stomach, supplied by the left and right gastric arteries.

A diffusely infiltrating gastric carcinoma producing a rigid, contracted 'leather-bottle' stomach.

The physiological high-pressure zone at the cardia that relaxes to admit a bolus and stays closed to prevent reflux; its incompetence causes GERD and its failure to relax causes achalasia.

An antireflux operation wrapping the gastric fundus around the lower oesophagus, used for GERD refractory to medical therapy.

Vomiting free of bile, indicating obstruction proximal to the entry of bile (the ampulla) — characteristic of pyloric stenosis.

Pain on swallowing, suggesting mucosal ulceration, oesophagitis or infection such as candidiasis.

Pressure study of the oesophagus; the gold standard for diagnosing achalasia, showing absent peristalsis with incomplete LES relaxation.

The firm, olive-shaped hypertrophied pylorus felt in the right upper quadrant in infantile hypertrophic pyloric stenosis.

Gastric cell secreting hydrochloric acid (via the H+/K+ ATPase proton pump) and intrinsic factor for vitamin B12 absorption.

Ulceration of the gastric or duodenal mucosa caused chiefly by Helicobacter pylori and NSAIDs, with complications of perforation, bleeding and obstruction.

An endoscopic myotomy of the LES performed through a submucosal tunnel, used to treat achalasia.

Free gas in the peritoneal cavity, seen as gas under the diaphragm on an erect chest X-ray; in this context it indicates a perforated peptic ulcer.

The operation for infantile hypertrophic pyloric stenosis in which the hypertrophied pyloric muscle is split down to the mucosa, performed after resuscitation.

An expandable stent placed across an obstructing oesophageal tumour to relieve dysphagia as palliation.

A mucin-filled tumour cell displacing the nucleus to the periphery, characteristic of diffuse-type gastric adenocarcinoma.

A metastatic deposit at the umbilicus, a sign of advanced intra-abdominal (often gastric) malignancy.

The cancer typical of the upper and middle thirds of the oesophagus, linked to smoking, alcohol, hot beverages and corrosive strictures.

An audible splash on rocking the abdomen, heard hours after a meal, indicating gastric outlet obstruction with retained gastric contents.

The clinical finding of a palpable, enlarged Virchow's (left supraclavicular) node, indicating metastatic spread.

An enlarged LEFT supraclavicular lymph node infiltrated by metastatic gastric (or other GI) carcinoma.