2- pathology of stomach Flashcards
what are the inflammatory disorders of stomach?
- acute gastritis
- chronic gastritis
- rare subtypes of gastritis
what are causes acute gastritis?
- irritant chemical injury
- severe burns (systemic inflammation)
- shock
- severe trauma (Stress hormones released = increase gastric acid secretion)
- head injury (interfering with ANS = potential ischaemia to GI tract)
what are types of chronic gastritis?
ABC
- autoimmune
- bacterial
- chemical (on the rise as can be caused by drugs + alcohol)
what are the rare types of gastritis?
- lymphocytic
- eosinophilic
- granulomatous
what is autoimmune chronic gastritis? what causes it?
- rarest but very serious
anti-parietal and anti-intrinsic antibodies = mistakenly attacks parietal cells, antibodies that attack parietal cells and a necessary intrinsic factor for absorption of B12
what does autoimmune chronic gastritis lead to overtime? and what’s a common consequence?
over time this leads to Atrophy and intestinal metaplasia in body of stomach
common consequence = Pernicious anaemia, macrocytic, due to B12 deficiency
also have increased chance if malignancy
what helps diagnosis of autoimmune chronic gastritis?
SACDC = Specific Anti-Cytoplasmic Dense Fine Speckled is a type of antibody that may help in diagnosis of condition
what is abnormal about neutrophils in autoimmune chronic gastritis?
have many more - 8 or 9
what is h.pylori associated chronic gastritis?
= most common type
Bacteria inhabits a niche between the epithelial cell surface and mucous barrier, this excited early acute inflammatory response and if not cleared then chronic active inflammation ensures
what class of bacteria is h.pylori?
Gram negative curvilinear rod (microaerophilic spiral bacilli) = helicobacter
what interleukin is crucial for h.pylori associated chronic gastritis?
IL8
what causes of chemical gastritis? and what then happens
- Due to NSAIDs, alcohol, bile reflux that cause Direct injury to mucus layer by fat solvents
- there is then marked epithelial regeneration, hyperplasia, congestion and little inflammation
= may produce erosions or ulcers
is chemical gastritis common?
yes
what is peptic ulceration?
a breach in the gastrointestinal mucosa as a result of acid and pepsin attack
→stomach is hostile environment and things like pepsinogen that break down proteins all slow rate of healing = means difficult to heal →becomes chronic
what leads to chronic peptic ulcers?
ulceration longstanding and often deep, if don’t reduce acid then gets worse
what are common sites of chronic peptic ulcers?
- duodenum
- stomach (junction of body and antrum)
- oesophago-gastric junction
- stomal ulcers
what is pathogenesis of chronic peptic ulcers?
increased attack and failure of defence = increased acid secretion and lack of mucous secretion
what does excess acid cause in chronic peptic ulcer?
produces gastric metaplasia and leads to H.Pylori infection, inflammation, epithelial damage and ulceration
what are complications of peptic ulcers?
- perforation
- penetration into adjacent organs
- haemorrhage
- stenosis
- intractable pain
what are benign gastric tumour examples?
benign (polyps):
- hyperplastic polyps
- cystic fundic gland polyps
what are malignant gastric tumour examples?
- most commonly carcinomas (adenocarcinomas mostly)
- lymphoma
- gastrointestinal stromal tumours (GISTs)
what is major cause of chronic gastritis? and describe pathway that it can take to carcinoma?
h.pylori →chronic gastritis →intestinal metaplasia/atrophy →dysplasia →carcinoma
what are other premalignant conditions of stomach other than h.pylori?
- Pernicious anaemia (autoimmune meaning inability to absorb b12)
- Partial gastrectomy
- HNPCC / Lynch syndrome
- Menetrier’s Disease
what is local spread of stomach tumour?
directly into other organs
what is haematogenous spread of stomach tumour?
to liver and beyond
what is transcoelomic spread of stomach tumour?
Into peritoneal cavity and ovaries
what are the 2 subtypes of adenocarcinomas?
intestinal type and diffuse type
what are characteristics of intestinal type adenocarcinoma?
- glandular differentiation resembling the structure of normal intestinal glands
- exophytic = tumour grows outwards
- polypoid mass = forms polyp like structures
what are characteristics of diffuse type adenocarcinoma?
- poorly differentiated type of adenocarcinoma
- spreads extensively and expands and infiltrates into stomach wall
