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Comments
Aplogies for the delayed
Aplogies for the delayed response for these images.
The stomach walls are diffusely thickened yet wall layering in maintained. This makes me think more of diffuse, possibly chronic, gastritis rather that infiltrative mural disease. However, I dont think we can rule mural infiltrative disease out.
The polyploid mass looks like it has wall layering associated with it which is kinda weird. This could be polyploid mucosal hypertrophy secondary to inflammation with potential for neoplasia. I dont see mural craters as with ulcers in the images but ulceration sound like its there with the melena.
With the melena present, this patients needs scoping with biopsies if possible…maybe this has been done. Empirically, I would cover for helicobacter with Azithromycin / Metronidazole or Amoxcicillin/ Metronidazole combo and GI protectants with sucralfate slurry and Omeprezole if not done. Bland to limited antigen or hydrolyzed protein diet as well. Recheck sonogram in several weeks, sooner if no improvement.