6. Case studies

Question 1

8 Causes of gastritis

Answer 1

Oxygen deprivation
Chemical agents = drugs
Infectious agents = helicobacter
Immunological reactions = autoimmune
Genetic defects
Nutritional imbalances
Physical agents
Aging

Question 2

What are the 3 effects of helicobacter infection on the stomach?

Answer 2

Inflammation: acute and chronic (including ulcers)
Cell damage: atrophy, metaplasia, dysplasia
Neoplasia: carcinoma and lymphoma

Question 3

Range of clinical outcomes of Helicobacter pylori infections

Answer 3

Asymptomatic or chronic gastritis
Chronic atrophic gastritis 
Intestinal metaplasia
Gastric or Duodenal ulcer
Gastric cancer
MALT Lymphoma

Question 4

What is an Ulcer and what is it caused by?

Answer 4

An open sore on an external or internal surface of the body

Caused by a break in skin or mucous membrane which fails to heal

Question 5

Granulomatous gastritis

Answer 5

subset of chronic inflammation
collection of activated macrophages (granuloma)
involves specific immune reaction T-Cells

Question 6

Causes of granulomatous gastritis

Answer 6

Infection: TB, fungi, helicobacter
Foreign material
Reaction to tumours
Immune diseases (sarcoid, Crohn’s)

Question 7

What is the difference between acute and chronic ulcers?

Answer 7

Pattern of inflammation is different

Chronic ulcers have fibrosis, scarring associated with chronic ulcers. Repair but no regeneration.

Question 8

Healing of acute gastric ulcer

Answer 8

Parenchymal cell regeneration

RESOLUTION

Question 9

Healing of chronic gastric ulcer

Answer 9

Repair by connective tissue

SCAR TISSUE FORMATION

Question 10

What cellular adaptations are seen with helicobacter gastritis?

Answer 10

Hyperplasia- increase in cell number
Hypertrophy- increase in cell size
Atrophy- shrinkage in size of cells
Metaplasia- reversible, 1 cell type replaced by another
Dysplasia- precancerous cells show genetic and cytological features/ malignancy but not invasion

Question 11

How are neoplasms classified?

Answer 11

According to cell of origin and whether they are benign or malignant

Question 12

What are benign and malignant tumours from glandular epithelium called?

Answer 12

Benign: Adenomas
Malignant: Adenocarcinomas

Question 13

What is the grading of cancer based on?

Answer 13

degree of histological differentiation

Question 14

What is staging of cancer based on?

Answer 14

How far tumour has spread

Question 15

What is the main staging system?

Answer 15

TNM
Size and spread of tumour
Spread to regional lymph nodes
Presence of metastases

Question 16

Atherosclerosis

Answer 16

Plaques form in the arteries
Loss of normal endothelium
Thrombosis and emboli can occur

Question 17

Clinically important sites of atheroma

Answer 17

Coronary arteries
Carotid arteries
Aorta and/or iliac arteries

Question 18

Why are stable atherosclerotic plaques a concern?

Answer 18

They just get bigger and bigger
Cause increasingly narrow arteries
Associated with angina, dementia, chronic lower limb ischaemia

Question 19

What may thrombosis of atherosclerotic plaques lead to?

Answer 19

Unstable angina
Myocardial infarction
Cerebral infarction
Acute lower limb ischaemia

Question 20

Why is weakening of arterial walls a concern?

Answer 20

Leads to aneurysm formation

Question 21

What is an aneurysm?

Answer 21

An abnormal blood-filled bulge of a blood vessel, especially arteries
Result from weakening of the vessel wall