Ch. 13: Stomach Flashcards
2 week old presents in ED because he keeps projectile vomiting. The vomit is nonbilious. Upon exam, you notice that his bowel activity is pretty visible and you palpate a small abdominal mass.
Pyloric stenosis, an enlargement of the pyloric sphincter and narrowing of the pyloric canal.
Most common indication for abdominal surgery in first 6 months of life
What are the risk factors for acute gastritis? What are the gross findings?
Results from increased acid production or decreased mucosa protection
Risk factors: Severe burn (Curling ulcer), NSAIDs, alcohol, chemotherapy, increased intracranial pressure (Cushing ulcer), shock
Results: superficial inflammation, erosion, or ulcer
A nice gentleman presents with a 5mo history of fatigue and “feeling off.” He notices vague abdominal pain from time to time, but nothing that he seems is very important. Upon workup, you find pernicious anemia and elevated antibodies in the blood. What are the antibodies to and what are hallmarks of his disease?
Chronic autoimmune gastritis, with antibodies against parietal cells or intrinsic factor. Pathogenesis is actually mediated by T cells!
Absence of acid secretion, G cell hyperplasia, diffuse atrophy of mucosa
This gastritis tends to occur in the fundus and body
This is the most common form of gastritis, tends to occur in the antrum, and presents with epigastric abdominal pain. Disease is often cured after a course of antibiotics. What other GI items does this disease increase the risk of?
Helicobacter pylori gastritis
Increased risk of ulceration, gastric adenocarcinoma, and MALT lymphoma
Patient with history of NSAID use presents with pain immediately after eating.
Next patient presents with abdominal pain that gets better after meals.
What is at the top of your differential for each and how do these two disease states differ?
Peptic ulcer disease is first on the list for each, but the first patient probably has a gastric ulcer while the second patient has a duodenal one.
Gastric ulcer carries risk of rupture and bleeding from left gastric artery
Duodenal ulcer will show hypertrophy of Brunner glands, and rupture carries risk of bleeding from gastroduodenal artery or acute pancreatitis
Patient presents with persistent epigastric pain over the last few months, which isn’t made better by antacids. She also notices that she has lost weight and states its because her appetite just isn’t what it used to be. You take a look and see a crater-like ulcerated lesion with raised irregular and indurated (“heaped up”) margins. What is the most likely diagnosis?
Intestinal type adenocarcinoma
Associations with H. pylori, smoking, nitrosamines, HNPCC, low SES, and blood type A
You look at a stomach specimen and see signet ring cells, desmoplasia, and a fibrotic thickening of the entire stomach wall.
Diffuse type adenocarcinoma
- leather bottle appearance on xray
- thickening of wall = linitis plastica
Patient presents with postprandial pain that is relieved by antacids. He notices that he has lost some weight, and his ankles seem to be a bit edematous. You perform endoscopy and notice that his gastric rugae are quite large. What is the most common cause in children vs adults?
Menetrier Disease, usually causing severe loss of plasma proteins from the altered gastric mucosa
In children, due to CMV infection
In adults, due to overexpression of TGF-alpha
What chronic disease are associated with peptic ulcers?
cirrhosis, chronic renal failure, MEN 1, Zollinger-Ellison syndrome, alpha 1 antitrypsin deficiency, chronic lung disease
How does the placement of a peptic ulcer relate to its cause?
If on greater curvature, probably related to NSAIDs
If on lesser curvature, probably related to chronic gastritis
Spindle cells with vacuolated cytoplasm and positive staining for c-kit
Gastrointestinal Stromal Tumors (GIST)
- derived from pacemaker cells of Cajal
- most are nonaggressive
How likely are hyperplastic polyps in the stomach to transform and have malignant potential?
Not at all
Patient presents with weight loss, dyspepsia, and abdominal pain. She has a palpable lymph node on her neck. What is most likely?
Lymphoma (specifically MALToma) - stomach is most common extranodal site and can clinically mimic gastric adenocarcimona but there is no obvious tumor. May be arise in setting of chronic H. pylori infection.
