10.4 Stomach Flashcards by Kevin N

Gastroschisis

Congenital malformation of the anterior abdominal wall leading to the exposure of abdominal contents

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Omphalocele

Herniation of the bowel into the umbilical cord due to failure of the intestines to return to the body cavity during development

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What is the difference between gastroschisis and omphalocele?

In omphalocele the contents are covered in peritoneum and the amnion

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Pyloric Stenosis

Congenital hypertrophy of the the pyloric smooth muscle

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Which gender is pyloric stenosis more common in?

Males

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What are the clinical manifestations of pyloric stenosis?

Nonbilious projectile vomiting
Visible peristalsis
Olive like mass in the abdomen

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Does pyloric stenosis present at birth?

NO - classically develops after 2 weeks of birth

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Acute Gastritis

Acidic damage to the mucosa due to imbalance between mucosal defenses and the acidic environment (too much acid or too little mucin)

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What are the two types of chronic gastritis?

Autoimmune

- H. pylori

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What are the risk factors of acute gastritis?

Severe burn
NSAIDs
Alcohol
Chemotherapy
Shock
Increased intracranial pressure

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What is a Curling ulcer due to?

Severe burn

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What is a Cushing ulcer due to?

Increased intracranial pressure

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How do Cushing ulcers cause acute gastritis?

Increased vagal stimulation which increases ACh which binds the parietal receptor to increase acid production

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What are the 3 receptors on parietal cells that increase HCl production when activated?

Histamine
ACh
Gastrin

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Erosion

Loss of epithelium

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Ulcer

Loss of mucosal layer

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Chronic Gastritis

Long term inflammation of the stomach mucosa

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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

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What type of hypersensitivity reaction is chronic autoimmune gastritis?

Type IV

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What are the clinical features of chronic autoimmune gastritis?

Achorhydria
Atrophy of the mucosa
Antral G-cell hyperplasia

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What is associated with chronic autoimmune gastritis?

Megaloblastic Anemia (pernicious anemia) - loss of intrinsic factor

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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