Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

604 Gallstone Disease Gastric Adenocarcinoma

■Mirizzi’s syndrome: edema and swelling (inflammation) secondary

to the impacted stone in the cystic duct leads to the compression of

common hepatic duct or CBD

Prognosis

■excellent after cholecystectomy, except for small minority with

residual symptoms due to retained CBD stones (1 to 8% post-

cholecystectomy), biliary strictures, and postcholecystectomy syn-

drome

Gastric Adenocarcinoma...............................

LYN SUE KAHNG, MD and ROY SOETIKNO, MD, MS

history & physical

History

■uncommon in western countries. decreasing incidence

■older age; male: female=2:1.

■increased risk in H.pyloriinfection, post-gastrectomy state, gastric

adenomas, chronic atrophic gastritis, intestinal metaplasia, perni-

cious anemia, FAP, HNPCC, diet containing high nitrates

Signs & Symptoms

■asymptomatic until advanced

■nonspecific: anorexia, epigastric pain, early satiety, nausea and vom-

iting, weight loss, anemia, or overt GI bleeding.

■palpable mass, hepatomegaly, ascites, succussion splash, and

adenopathy in advanced disease

tests

■CBC: anemia. LFT: abnormalities suggesting liver metastasis

■endoscopy

➣localize and biopsy for pathology (intestinal versus diffuse

(signet-ring)-type).

■double-contrast UGI is useful in more advanced disease

differential diagnosis

■Menetrier’s disease, hypertrophic gastropathy, thickened gastric

folds due to infections, lymphoid hyperplasia, lymphoma, and

metastatic cancer