2. Stomach Pathology Flashcards by Kortney Powell

Gastropathy

the stomach mucosa is damaged but NO INFLAMMATION is present

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gastritis

INFLAMMATION of the gastric mucosa

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What is the difference between gastropathy and gastritis?

presence of inflammation

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What is seen histologically during gastritis

neutrophils

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acute gastritis

sudden inflammation or swelling in the stomach mucosa (neutrophils are present)

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chronic gastritis

long-term stomach lining inflammation

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what is present, histologically, in chronic gastritis

lymphocytes and plasma cells

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what is the main cause of chronic gastritis

helicobacter pylori

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helicobacter pylori gastritis

helicobacter-associated gastritis. H. pylori is the primary cause of chronic gastritis

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What are the anatomic regions of the stomach

cardia
fundus
corpus
antrum/pylorus

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what is the histology of the stomach

mucosa
submucosa
muscularis externa
serosa

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What is food called entering the stomach

bolus

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chyme is made is what part of the stomach

corpus

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what are the parts of the mucosa

epithelium
lamina propria
muscularis mucosa

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what is the lamina propria

space b/t epithelium

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what is in the muscularis mucosa

muscle in mucosa

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what are the parts of the submucosa

fats
fibrous tissue
blood vessels
lymphatics

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what are the parts of the muscularis/propria/externa

inner oblique
middle circular
outer longitudinal

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what is a unique layer to the stomach

inner oblique

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what is the purpose of the muscularis/propria/externa?

it is layers of muscles/fibrous tissue to assist with churning/breaking down food into chyme

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what are parts of the serosa

epithelium
connective tissue

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gastric foveolae

mucous neck cells - contain cytoplasmic mucous globulins that protect the lining during digestion

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gastric glands

parietal cells

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muscularis mucosae

chief cells

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What is the pH of mucous neck cells

alkaline

describe the the stomach cardia?

rich in mucous cells and has gastric pits @ top of stomach made of mucous cells forms columnar epethelium

describe the stomach corpus

less coiled pits similar to the cardia mucosa is deeper have ECL

Paracrine signaling

leads to a histamine for the ECL that encompasses the mucus, parietal cells(HCl), and chief cells (pepsinogen)

describe the stomach pylorus

deeper gastric pits gastric glands are deeper in rich G and D cells (secrete somatostatin and gastrin)

What are things that cause normal damage to the stomach lining

gastric acidity peptic enzyme

What are things that can injure the stomach lining

H. pylori infection NSAID tobacco alcohol gastric hyperacidity duodenal-gastric reflux

What are protective factors against normal damage

surface mucus secretion bicarbonate secretion into mucus epithelial barrier function epithelial regenerative capacity elaboration of prostaglandins

what levels of the stomach lining are affected by injury

mucus

What are protective factors against injury

ischemia shock NSAID

what is found in ulcer

mucosal lining is completely gone when an injury is not treated properly -Necrotic debris -Nonspecific acute inflammation -Granulation tissue -Fibrosis

what is the etiology of gastritis

-frequent use NSAID (long-term use of non-steroidal anti-inflammatory drugs) -extreme stress -bile -elderly -alcohol and smoking

how do NSAIDS affect the stomach

inhibits COX-dependent synthesis of prostaglandins and mucus production

how does stress contribute to gastritis

uremia inhibits gastric bicarbonate transporters

how does bile contribute to gastritis

bile reflux into stomach bile acid's alkalinity has a higher pH causing an imbalance = acute gastritis

how does elderly contribute to gastritis

reduced mucin and bicarbonate secretion

how does alcohol and smoking contribute to gastritis

direct injury to mucosal cells and increased ROS

what is the duration of acute gastritis

few days or weeks or once the inflammation is gone

What are the symptoms of acute gastritis

loss of appetite upper abdominal discomfort (pain/bloating) nausea vomiting indigestion burning feeling

stress-related mucosal injury is also known as

stress-induced acute gastritis

what is included in stress-induced acute gastritis

increased uremea associated with an illness

curling ulcers in the proximal duodenum are associated with

severe burns or ulcers outside of the stomach

cushing ulcers: gastric, duodenal and esophageal ulcers are associated with

intracranial disease (high incidence of perforation in gastric, esophagus, and duodenum

what can you see histologically in acute gastritis?

mucus cells' surface is damaged with no mucin inflammatory defense lines within the lamina propia (feat neutrophils)

what is the etiology of gastropathy

Helicobacter pylori (most common) autoimmune (most common w/o hp) chronic bile reflux alcohol and tobacco

what is the histology of gastropathy feature

cork-skewing of the epithelium congestion of blood and epithelium

what are the symptoms of gastropathy

less severe than acute gastritis but lasts longer nausea and pain, occasional vomiting

what does the histology of chronic gastritis feature

plasma cells metaplasia cells lymphocytes in the lamina propria and epethelium

what is the gastric pH level

1.5-2

how is HELICOBACTER PYLORI GASTRITIS spread

Either oral-oral or Fecal-oral contamination

characteristics of HELICOBACTER PYLORI bacteria

gram negative rod shaped bacilli

what allows the bacteria to be motile

flagella

what does HELICOBACTER PYLORI produce in the body

Urease

Urease from h. pylori generates ammonia from urea causing what

increasing the gastric pH for survival

what does h. pylori use to attach to epethial cells

adhesins (but they do not penetrate the surface of the mucus cells

what toxins are associated in the disease progression of h pylori

cytotoxin-associated gene A (CagA)

what is h pylori mainly focused

predominantly in the antrum

h pylori can induce

metaplasia and lead to adenocarcinoma

auto immune gastritis is AKA

as autoimmune metaplastic atrophic gastritis or type A gastritis

auto immune gastritis main affects what part of the stomach

corpus

In auto immune gastritis, parietal cells are damaged by

anti-parietal cell antibodies (90%) antiintrinsic factor antibodies

Hypochlorhydria

reduced serum pepsinogen concentration and high serum gastrin levels.

Hypochlorhydria can cause

lack of vitamin 12 and acidity is affected

AUTOIMMUNE GASTRITIS is not associated with what

h pylori

AUTOIMMUNE GASTRITIS is associated with what diseases

Hasimoto's thyroiditis Addison's

AUTOIMMUNE GASTRITIS features what pathogensis

loss of parietal cells in the corpus hyperplasia of G cells in antrum Increased gastrin secretion Stimulation of ECL in the corpus Secretion of histamine to stimulate parietal cells

In AUTOIMMUNE GASTRITIS, are parietal cells missing?

YES

What secretes histamines

ECL

When chronic gastritis is left untreated it can lead to

peptic ulcer disease tumors

what causes peptic ulcer disease in chronic gastritis

an imbalance between mucosal defense mechanisms and the damaging forces, partially gastric acid and pepsin

Antral gastric PUD is caused by

h. pylori smoking NSAIDs bile pancreatic juice reflux Zollinger-Ellison disease

Treatment options for chronic gastritis

antibodies PPI Antacid

What do you need to diagnose chronic gastritis

test for h. pylori stool test breath test upper GI endoscopy Barium swallowing test

In chronic gastritis, the breath test measure for what

urea + water = ammonia and carbon dioxide