2- pathology of stomach

Question 1

what are the inflammatory disorders of stomach?

Answer 1

1. acute gastritis
2. chronic gastritis
3. rare subtypes of gastritis

Question 2

what are causes acute gastritis?

Answer 2

• 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)

Question 3

what are types of chronic gastritis?

Answer 3

ABC
- autoimmune
- bacterial
- chemical (on the rise as can be caused by drugs + alcohol)

Question 4

what are the rare types of gastritis?

Answer 4

• lymphocytic
• eosinophilic
• granulomatous

Question 5

what is autoimmune chronic gastritis? what causes it?

Answer 5

• 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

Question 6

what does autoimmune chronic gastritis lead to overtime? and what’s a common consequence?

Answer 6

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

Question 7

what helps diagnosis of autoimmune chronic gastritis?

Answer 7

SACDC = Specific Anti-Cytoplasmic Dense Fine Speckled is a type of antibody that may help in diagnosis of condition

Question 8

what is abnormal about neutrophils in autoimmune chronic gastritis?

Answer 8

have many more - 8 or 9

Question 9

what is h.pylori associated chronic gastritis?

Answer 9

= 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

Question 10

what class of bacteria is h.pylori?

Answer 10

Gram negative curvilinear rod (microaerophilic spiral bacilli) = helicobacter

Question 11

what interleukin is crucial for h.pylori associated chronic gastritis?

Answer 11

IL8

Question 12

what causes of chemical gastritis? and what then happens

Answer 12

• 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

Question 13

is chemical gastritis common?

Answer 13

yes

Question 14

what is peptic ulceration?

Answer 14

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

Question 15

what leads to chronic peptic ulcers?

Answer 15

ulceration longstanding and often deep, if don’t reduce acid then gets worse

Question 16

what are common sites of chronic peptic ulcers?

Answer 16

• duodenum
• stomach (junction of body and antrum)
• oesophago-gastric junction
• stomal ulcers

Question 17

what is pathogenesis of chronic peptic ulcers?

Answer 17

increased attack and failure of defence = increased acid secretion and lack of mucous secretion

Question 18

what does excess acid cause in chronic peptic ulcer?

Answer 18

produces gastric metaplasia and leads to H.Pylori infection, inflammation, epithelial damage and ulceration

Question 19

what are complications of peptic ulcers?

Answer 19

• perforation
• penetration into adjacent organs
• haemorrhage
• stenosis
• intractable pain

Question 20

what are benign gastric tumour examples?

Answer 20

benign (polyps):
- hyperplastic polyps
- cystic fundic gland polyps

Question 21

what are malignant gastric tumour examples?

Answer 21

• most commonly carcinomas (adenocarcinomas mostly)
• lymphoma
• gastrointestinal stromal tumours (GISTs)

Question 22

what is major cause of chronic gastritis? and describe pathway that it can take to carcinoma?

Answer 22

h.pylori →chronic gastritis →intestinal metaplasia/atrophy →dysplasia →carcinoma

Question 23

what are other premalignant conditions of stomach other than h.pylori?

Answer 23

• Pernicious anaemia (autoimmune meaning inability to absorb b12)
• Partial gastrectomy
• HNPCC / Lynch syndrome
• Menetrier’s Disease

Question 24

what is local spread of stomach tumour?

Answer 24

directly into other organs

Question 25

what is haematogenous spread of stomach tumour?

Answer 25

to liver and beyond

Question 25

what is transcoelomic spread of stomach tumour?

Answer 25

Into peritoneal cavity and ovaries

Question 25

what are the 2 subtypes of adenocarcinomas?

Answer 25

intestinal type and diffuse type

Question 25

what are characteristics of intestinal type adenocarcinoma?

Answer 25

• glandular differentiation resembling the structure of normal intestinal glands
• exophytic = tumour grows outwards
• polypoid mass = forms polyp like structures

Question 26

what are characteristics of diffuse type adenocarcinoma?

Answer 26

• poorly differentiated type of adenocarcinoma
• spreads extensively and expands and infiltrates into stomach wall