Radiation diagnosis of stomach ulcers

a) Visualization of gastric ulcer :

• Benign gastric ulcer:
o Is a well-defined mucosal defect, with even, smooth folds converging to the center of the ulcer posterior wall or antrum o CT may show leakage of gas or oral contrast into the
lesser sac or main peritoneal cavity

• Malignant ulcer:
o Has an irregular shape, uneven, asymmetric edges; radial folds are unevenly thickened, lose their continuity

• Methods of radiation diagnostics:
o X-ray (-graphy) of the upper gastrointestinal tract in order to visualize the ulcer; CT to detect complications; in some cases, CT can also detect an ulcer directly CT gastroscopy (virtual endoscopy) performed by an experienced specialist can compete with fibrogastroscopy

• Deep ulcers, located along the greater curvature in the distal sections (1/2), due to the use of NSAIDs

• Pointing finger sign: smooth, narrow retraction of the stomach wall on the opposite side of the ulcer resulting from sustained muscle contraction

(Left) Gastric ulcer with smooth folds converging to the edge of the ulcer. Note the retraction of the stomach wall in the direction of the ulcer – a symptom of “pointing finger”.
(Right) An upper GI fluoroscopy shows an ulcerative “niche” B in the lesser curvature of the gastric antrum . Note the smooth folds of the stomach, converging radially to the edge of the “niche”.

b) Differential diagnosis :
• Gastritis • GIST of the stomach • Metastases in the stomach wall and lymphoma • Artifacts

c) Pathology :
• Two main risk factors: H. pylori (60-80%) and NSAIDs (20%)

d) Clinical features :
• Benign ulcers (95%), malignant (5%) • Often gastric ulcers are multiple (20-30%) • Complications: bleeding, perforation, gastric outlet obstruction, fistula formation.

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