SU28.{7,9} | Stomach Anatomy and Clinical Examination — Summary & Reflection

KEY TAKEAWAYS

Stomach disease presents with non-specific symptoms — epigastric pain/dyspepsia, vomiting, weight loss, haematemesis/melaena — so the alarm ('ALARMS') features and a disciplined examination do the work of stratification. The surgical anatomy turns on the two curvatures and their named arteries: left and right gastric on the lesser curve, left and right gastro-epiploic and short gastric on the greater curve, with lymphatics following the arteries to coeliac nodes (the basis of cancer lymphadenectomy) and portal venous drainage. Acid physiology — parietal cells (acid + intrinsic factor), chief cells (pepsinogen), G cells (gastrin), vagal stimulation — underlies peptic ulcer disease. The examination runs general survey then inspect–palpate–percuss–auscultate, eliciting an epigastric mass (moves with respiration, not on swallowing) and a succussion splash (gastric outlet obstruction), and always seeking the metastatic signs: Virchow's node (Troisier's sign), Sister Mary Joseph nodule, Blumer's shelf, Krukenberg tumour and ascites, any of which signals advanced, incurable disease and shifts the plan from curative gastrectomy to palliation.

REFLECT

Recall a patient you have examined with abdominal symptoms, or imagine clerking the man in the hook. Did you examine the supraclavicular fossae, the umbilicus and (where appropriate) perform a rectal and pelvic examination — or did you stop at the abdomen and risk missing the one sign that changes everything? Consider how confidently you could elicit a succussion splash and explain to a colleague what it means. Reflect on how knowing that the gastric lymphatics drain along the arteries to the coeliac nodes changes the way you understand why cancer surgery is so extensive, and how the bedside metastatic signs can spare a patient a futile operation. Finally, think about how you would communicate a likely incurable finding to a patient with honesty and compassion.