BAP37 - Gastric pathology Flashcards
4 parts of the stomach?
- Cardia
- Fundus
- Body
- Antrum
Where can mucus secreting glands be found in the stomach?
all 4 parts
Where are endocrine cells (G cells) located in the stomach? What do they secrete?
Antrum
Gastrin
Where are parietal cells located in the stomach? What do they secrete?
Body
HCl
Where are chief cells located in the stomach? What do they secrete?
Body
Pepsin
Acute gastritis means transient mucosal inflammation, which may lead to? (4 marks)
Erosion: breach in the epithelium of mucosa;
Ulcer: breach in the mucosa, with extension into submucosa or deeper
Name the possible etiologies of acute gastritis.
5
- NSAID, aspirin
- Metabolic: alcohol, chemical..
- Tramatuc: NG tube
- Severe stress, e.g. severe burns (Curling ulcer)
- CNS injury (Cushing ulcer)
Which of the following about acute gastritis is incorrect?
A. Curling ulcer occurs in proximal duodenum
B. Curling ulcer is associated with severe burns and trauma
C. Cushing ulcer occurs in stomach, duodenum and esophagus
D. Cushing ulcer is associated with stimulation of vagal nerve that causes an increase in acid secretion
E. It is always symptomatic
E
Can be asymptomatic.
Symptoms:
- epigastric pain
- bleeding: hematemesis, melena, massive blood loss
What are the 2 types of chronic gastritis? Which type is more common?
- H.pylori-associated (>80%)
2. Autoimmune (10%)
What disease is H.pylori chronic gastritis associated with?
Gastric and duodenal ulcer
What disease is autoimmune chronic gastritis associated with?
Pernicious anemia
H.pylori chronic infection is located at which part of the stomach?
Antrum
Autoimmune infection in chronic gastritis is located at which part of the stomach?
Body
Pathogenesis: features of H.pylori chronic gastritis?
4
- Flagella: motility
- Urease: generate ammonia to neutralise gastric acid
- Adhesins: enhance adherence to foveolar cells (mucous cells)
- Toxins (CagA): carcinogenesis
- Overwhelm mucosal defences»_space;> pangastritis
Pathogenesis of autoimmune chronic gastriris?
- Antibodies attack parietal cells > loss of H+/K+ ATPase
- no ATPase > achlorhydria > hypergastrinemia to produce more acid by G cell
- Lack IF, thus absorption of vitamin B12 reduced in ileum
> > Megaloblastic anemia (pernicious anemia)
Which of the following is correct?
A. HP chronic gastritis may cause gastric adenoCA
B. Autoimmune chronic gastritis may cause gastric adenoCA
C. Lymphoma is a complication of HP chronic gastritis
D. Peptic ulcer is a complication of HP chronic gastritis
All of the above
In histology of HP caused chronic gastritis, HP is concentrated in the mucous layer, __________ and ___________can be seen due to the acute and chronic inflammation.
Glandular atrophy can also be seen.
acute: neutrophils
chronic: lymphocytes
In autoimmune chronic gastritis, we can see ___________ hyperplasia.
Lymphocyte infiltration can be seen due to the chronic inflammation. Diffuse _______ atrophy too.
Endocrine G cell;
glandular
In both autoimmune and HP caused chronic gastritis, describe how it becomes adenoCA.
Intestinal metaplasia > Glandular dysplasia > Adenocarcinoma
What are the most common risk factors for peptic ulcer diseases (PUD)? (2)
- NSAID use
- HP infection
Pathogenesis: imbalances of mucosal defences and damaging forces > chronic gastritis > PUD
If the PUD is caused by HP infection, where is the MC location for the ulcer to be?
D1 of duodenum, then the antrum
PUD is common at lower esophagus if the patient has _______.
GERD