Changes

* Leiomyosarcoma

* Leiomyosarcoma

* Mast cell

* Mast cell

Benign tumours include:

Benign tumours include:

* Polyps

* Polyps

* [[Stomach and Abomasum Proliferative - Pathology #Leiomyoma|Leiomyoma]]

* [[Stomach and Abomasum Proliferative - Pathology #Leiomyoma|Leiomyoma]]

* Regerative anaemia - on account of gastric haemorrhage

* Regerative anaemia - on account of gastric haemorrhage

* Electrolyte disturbances - secondary to vomiting

* Electrolyte disturbances - secondary to vomiting

* Elevted BUN and creatinine - due to dehydration

* Elevated BUN and creatinine - due to dehydration

===Positive Contrast Radiography===

===Positive Contrast Radiography===

The following abnormalities may be observed:

The following abnormalities may be observed:

* Delayed gastric emptying

* Delayed gastric emptying

* Changes in motility in certain areas of the stomach

* Changes in motility in certain areas of the stomach

===Ultrasonography===

===Ultrasonography===

Characteristic features of gastric neoplasia are a thickened gastric wall along with disruption of the wall layers. Enlarged lymph nodes may be observed. The rest of the abdominal organs should be checked for metastases. Ulceration appears as a focal outpouching of the luminal (inner) surface with trapped gas bubbles.

Characteristic features of gastric neoplasia are a thickened gastric wall along with disruption of the wall layers. Enlarged lymph nodes may be observed. The rest of the abdominal organs should be checked for metastases. Ulceration appears as a focal outpouching of the luminal (inner) surface with trapped gas bubbles. guided fine-neelde or core biopsies may be taken at this time.

===Endoscopy and Biopsy===

===Endoscopy and Biopsy===

This allows direct visualisation of the lesion. Definitive diagnosis requires histolpathology. Biopsies can be taken via grab biopsy, however the sample may be unrepresentative. Alternatively, biopsies can be taken via gastrotomy at the time of surgical treatment (see below).

This allows direct visualisation of the lesion. Definitive diagnosis requires histolpathology. Several biopsies can be taken via grab biopsy, however the samples may be unrepresentative.  

 

Alternatively, biopsies can be taken via gastrotomy at the time of surgical treatment (see below). If a GIST is susptected a CD117 immunohistochemical stain can be used for diagnosis.

 

==Treatment==

==Treatment==

===Surgery===

===Surgery===

Prior to any surgical intervention thoracic radiography should be performed for evidence of metastasis. Regional lymph nodes should also be examined along with the rest of the abdominal cavity. For tumours that have not metastasised, resection is the treatment of choice. However, excision with large margins whilst maintaining the ability to sucessfully reconstruct the stomach without post-operative complications can be problematic. Futhermore, pylorectomy and gastroduodenostomy or gastrojejunostomy for antral tumours risk iatrogenic injury to the local blood supply as well as the pancreas and extrahepatic biliary system. Post-operative complications are more frequent with resections associated with the pylorus. Neoplasia associated with the lesser curvature is generally unresectable.

Prior to any surgical intervention thoracic radiography should be performed for evidence of metastasis. Regional lymph nodes should also be examined along with the rest of the abdominal cavity. For tumours that have not metastasised, resection is the treatment of choice (wide partial gastrectomy or antrectomy with gastroduodenostomy (Billroth 1). However, there are often difficulties as tumours are often in an advanced stage on time of presentation. Excision with large margins whilst maintaining the ability to sucessfully reconstruct the stomach without post-operative complications can be problematic. Futhermore, pylorectomy and gastroduodenostomy or gastrojejunostomy for antral tumours risk iatrogenic injury to the local blood supply as well as the pancreas and extrahepatic biliary system. Post-operative complications are more frequent with resections associated with the pylorus. Neoplasia associated with the lesser curvature is generally unresectable.

===Chemotherapy===

===Chemotherapy===

Unreported

Unreported

===Medical Management===

===Other Medical Management===

Symptomatic therapy of for example vomiting may improve quality of life in the short term - treatment options include anti-emetics such as metocolpramide and H2 blockers including ranitidine and cimetidine.

Symptomatic therapy of for example vomiting may improve quality of life in the short term - treatment options include anti-emetics such as metocolpramide and H2 blockers including ranitidine and cimetidine.