10.4 Stomach Flashcards
Gastroschisis
Congenital malformation of the anterior abdominal wall leading to the exposure of abdominal contents
Omphalocele
Herniation of the bowel into the umbilical cord due to failure of the intestines to return to the body cavity during development
What is the difference between gastroschisis and omphalocele?
In omphalocele the contents are covered in peritoneum and the amnion
Pyloric Stenosis
Congenital hypertrophy of the the pyloric smooth muscle
Which gender is pyloric stenosis more common in?
Males
What are the clinical manifestations of pyloric stenosis?
- Nonbilious projectile vomiting
- Visible peristalsis
- Olive like mass in the abdomen
Does pyloric stenosis present at birth?
NO - classically develops after 2 weeks of birth
Acute Gastritis
Acidic damage to the mucosa due to imbalance between mucosal defenses and the acidic environment (too much acid or too little mucin)
What are the two types of chronic gastritis?
- Autoimmune
- H. pylori
What are the risk factors of acute gastritis?
- Severe burn
- NSAIDs
- Alcohol
- Chemotherapy
- Shock
- Increased intracranial pressure
What is a Curling ulcer due to?
Severe burn
What is a Cushing ulcer due to?
Increased intracranial pressure
How do Cushing ulcers cause acute gastritis?
Increased vagal stimulation which increases ACh which binds the parietal receptor to increase acid production
What are the 3 receptors on parietal cells that increase HCl production when activated?
- Histamine
- ACh
- Gastrin
Erosion
Loss of epithelium
Ulcer
Loss of mucosal layer
Chronic Gastritis
Long term inflammation of the stomach mucosa
Chronic Autoimmune Gastritis
Ab are made against the parietal cells or intrinsic factor as a result of the damage in the fundus and the body of the stomach
What type of hypersensitivity reaction is chronic autoimmune gastritis?
Type IV
What are the clinical features of chronic autoimmune gastritis?
- Achorhydria
- Atrophy of the mucosa
- Antral G-cell hyperplasia
What is associated with chronic autoimmune gastritis?
Megaloblastic Anemia (pernicious anemia) - loss of intrinsic factor
What are people with chronic autoimmune gastritis at increased risk for?
Gastric Adenocarcinoma - chronic inflammation will induce intestinal metaplasia
Chronic H. pylori Gastritis
Due to H. pylori infection
What is the common site of H. pylori gastritis?
Antrum
How does H. pylori survive in the stomach?
Urease converts urea to NH3 to neutralize the local acid
Does H. pylori invade into the stomach cells?
No - they sit on the epithelium
What are the clinical findings of H. pylori?
Epigastric abdominal pain
What does H. pylori infection increase the risk for?
- Gastric Adenocarcinoma
- MALT Lymphoma
What is the treatment for H. pylori?
Triple Therapy
Peptic Ulcer Disease
Solitary ulcer in the duodenum or in the stomach
Where is the most common site for ulcers in PUD?
Duodenum
What can be a rare cause of a duodenal ulcer?
Zollinger-Ellison Syndrome
What will happen to the pain in duodenal ulcer with meals?
The pain will decrease
What will be seen on biopsy of the duodenum if there are ulcers present?
Ulcer with hypertrophy of the Brunner glands
What is a complication of duodenal ulcers?
Rupture which leads to bleeding from the gastroduodenal ulcer - complications of posterior ulcers
What are the main causes of gastric ulcers?
H. pylori and NSAIDs
What is the main cause of duodenal ulcers?
H. pylori
Where will a ruptured gastric ulcer bleed from?
Left Gastric Artery
Are duodenal ulcers related to cancer?
No - rarely malignant
Are gastric ulcers related to cancer?
Yes - gastric carcinoma can cause ulcers
What are the signs of a benign ulcer?
Small and punched out
What are the signs of malignant ulcers?
Large and irregular with folding of the tissue
Gastric Carcinoma
Malignant proliferation of columnar cells - adenocarcinoma
What are the 2 types of gastric carcinoma?
- Intestinal
- Diffuse
Intestinal Gastric Carcinoma
Large irregular ulcer with heaped up margins
Where is Intestinal Gastric Carcinoma generally located?
Lesser curvature of the antrum
What are risk factors of Intestinal Gastric Carcinoma?
- Intestinal metaplasia
- Nitrosamines in smoked foods
- Blood Type A
Diffuse Gastric Carcinoma
Signey ring cells diffusely infiltrate the gastric wall with desmoplasia that results in a thickening of the stomach wall
Linitis Plastica
Thickening of the stomach wall
What are the risk factors of Diffuse Gastric Carcinoma?
Not associated with H. pylori, intestinal metaplasia or nitrosamines
Leser-Trelat Sign
Dozens of keratoses all over the skin
Where does gastric carcinoma spread to?
Virchow’s Node (Left Supraclavicular)
What is periumbilical metastasis of Gastric Carcinoma known as?
Sister Mary Joseph Nodule - intestinal
What is bilateral ovary metastasis of Gastric Carcinoma known as?
Krukenberg Tumor - diffuse
