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Hypertrophic Gastropathies

  

•      All have hyperrugosity or enlarged folds, usually in the body and fundus of stomach

•      Coarse duodenal folds are usually associated with large folds in the stomach

•      Most often, enlarged gastric folds are normal

•      Factors which suggest large folds are pathologic

                • Nodularity or induration of the fold

                • Asymmetry or segmental distribution

                • Wall rigidity

                • Ulceration

Types of Hypertrophic Gastropathies

•      Zollinger-Ellison Syndrome

            • Hypersecretion of gastric acid 2° gastrinoma non-b islet cell tumor

                                • Pancreas (87%), medial wall of duodenum (13%)

                • Most are malignant (60%)

                • Clinical tetrad of

                            1) Gastric Hypersecretion

2) Diarrhea or steatorrhea

                    3) Hyperacidity-elevated serum gastrin levels

                    4) Recurrent peptic ulcer disease

                • X-ray suggested by         

                        1) Multiple ulcers (10%), most in bulb, but also post-bulbar, jejunum

                        2) Recurrent ulcers

                        3) Marginal ulcers in post-gastrectomy patients

                                a) On gastric side

                                b) Mesenteric border of efferent loop

 •      Hypertrophic hypersecretory gastropathy

            • Hypersecretion of gastric acid

 •      Hypertrophic hypersecretory gastropathy with protein loss

            • Hypersecretion of gastric acid

 •      Menetrier’s Disease-fundus and body, esp. greater curvature

            • Low acid output-hypochlorhydria

                • Hypoproteinemia 2° GI protein loss

                                • Peripheral edema

                • Mostly middle-aged men

                • Associated with benign gastric ulcer (13-72%)

                                • GI bleeding

                • Carcinoma occurs in 10%, the same number as those patients who have atrophic gastritis and carcinoma

                • DDx: Lymphoma (involves antrum which Menetrier’s does not), gastric carcinoma, gastritis, gastric varices

 

WH/93

 

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