The mucosa is really

The mucosa is really echogenic and thick but the submucosa muscularis and serosa are in tact. It doesnt have the complete criteria of hypertrophic pyloric gastropathy but its aspiring to and I would tx it as such if scope and sample is not an option.

Try zithomax metronidazole, pepcid liquified carafate (all cheap and easy) slurry hydrolyzed diet tiod feddings to avoid bulk and irritation and try to correct the azotemia as uremic gastritis may be the issue as well depending on how high the bun is.

Carcinoma possible but looks all mucosal here and hypertrophied instead of invasive crossing layers.