8 - Pathology of the Stomach Flashcards
What is dyspepsia?
A complex of upper GI tract symptoms that are typically present for four or more weeks including upper abdominal pain, discomforta, heart burn, acid reflux, nausea and/or vomiting
What are some common gastric diseases and why are they caused?
- GORD
- Gatritis
- Peptic Ulcers
- Cancer
All due to an inability of the stomach to protect itself from acid contents
What are the common triggers of GORD?
- Smoking and food triggers less important
- Pregnancy due to increased intrabdominal pressure
What are the symptoms of GORD, how is it treated, and what can be some consequences of not treating it?
Symptoms: chest pain, acid taste in mouth, cough
Consequences: nothing, strictures, oesophagitis, Barrett’s oesophagus
Lifestyle: prop up in bed, eat slow, eat smaller meals more often, lose weight
What is a hiatal hernia and what can it lead to?
- Stomach LOS herniates into thorax
- Lose angle of the oesophagus
- Leads to GORD and oesophagitis
What is the structure of the lower oesophageal sphincter?
What is gastritis?
- Inflammatory process in the stomach’s mucosal layer that can be acute or chronic
- Pain, nausea, vomiting, bleeding
What can acute gastritis be caused by, what are the symptoms and how is it treated?
Causes: heavy NSAID use (lowers prostaglandins so lowers mucus blood flow), lots of alcohol, chemotherapy, bile reflux
Symptoms: asymptomatic or ab pain, nausea, vomiting, bleeding
Treatment: remove irritant
How does chronic gastritis appear macro/microscopically and why?
What can chronic gastritis be caused by and what are the differences in symptoms between the two main causes?
- H Pylori
- Autoimmune pernicious anaemia against parietal cells
- Chronic alcohol, NSAID abuse
- Chronic reflux or bile
What is the structure of helicobacter pylori and how does this help it to survive?
Why does helicobacter pylori causes issues in the stomach?
- Releases cytotoxins to injure epithelia
- Expresses urease that forms ammonia which is toxic to epithelia
- Degrades mucus layer
- Promotes inflammatory response so self damage
How does helicobacter pylori infection present when in different locations of the stomach?
How can you diagnose and treat H.Pylori infection?
What are some changes you would see histologically in chronic and acute gastritis?
What is peptic ulcer disease?
- Breach in the gastric or duodenal mucosa that extends through the muscularis mucosa.
- Most common in duodenum and common in lesser curve/antrum
What are the differences between duodenal and gastric ulcers?
Duodenal more common
What are the causes of peptic ulcer disease?
- Due to there being a breakdown in normal defence mechanisms e.g mucus or bicarbonate
- Breakdown of normal defences more important than excessive acid
Where in the peptic area do ulcers tend to occur?
What are some symptoms of peptic ulcer disease?
What can be some clinical consequences leading on from a peptic ulcer?
- Scar tissue can narrow stomach or cause pyloric stenosis
- Could perforate and cause peirotnitis
- Erosion into adjacent structure, e.g pancrease
- Haemorraghe from vessel into base of ulcer
- Malignancy
What is the macroscopic appearance of a gastric ulcer?
- Less than 2cm but up to 10cm
- Base of ulcer necrotic or granulation tissue
- Muscularis propria replaced by scar tissue
How can we treat peptic ulcer disease?
- Remove exacerbating factors
- Lifestyle modification
- Check for H.Pylori
- PPIs
- Endoscopy and inject bleeding ulcer
- H2 antagonists
What is the diagnosis of someone with symptoms of peptic ulcer disease but no physical evidence?
Functional dyspepsia
What is Zollinger-Ellison syndrome?
- Non beta islet cell gastrin secreting tumour of the pancreas
- Proliferation of parietal cells so lots of acid production and severe ulceration of stomach and bowel
- Ab pain and diarrhoea
How can we diagnose any gastric pathology?
- Upper GI endoscopy for biopsies (malignancy and H.Pylori)
- Urease breath test
- Erect chest x-ray for perforation
- FBC for anaemia
What are some examples of drugs that can be used for gastric pathology?
Used as both decrease the amount of acid secreted
What are some conditions that can cause stress related mucosal damage?
What are some risk factors of stomach cancer?
- Male
- H.Pylori
- Dietary factors
- Smoking
What are some symptoms of stomach cancer?
Has to be large before symptoms:
- Dysphagia
- Loss of appetite
- Malaena
- Weight loss
- Nausea/vomiting
- Virchow’s Node
