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GI 2 > Ch 17 Stomach > Flashcards

Ch 17 Stomach Flashcards

1
Q

Gastritis vs Gastropathy?

A
  • Gastritis is when neutrophils are present in the mucosal inflammatory process.
  • Gastropathy is when inflammatory cells are absent or rare
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2
Q

Gastropathy causes?

A

NSAIDs Alcohol Bile Stress

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3
Q

Hypertrophic gastropathy is exemplified by what two diseases?

A

Menetrier disease Zollinger-Ellison Syndrome

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4
Q

Sx of gastritis and gastropathy?

A

Epigastric pain, nausea, vomiting Severe cases may have mucosal erosion, ulceration, hemorrhage, hematemesis, melena or rarely massive blood loss

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5
Q

Who is a stress ulcer common in?

A

Individuals with shock, sepsis, or burns

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6
Q

What are curling ulcers?

A

Ulcers in the proximal duodenum associated with sever burns or trauma

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7
Q

What are cushing ulcers?

A

Gastric, duodenal, and esophageal ulcers arising in people with intracranial disease. High incidence of perforations

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8
Q

What is the pathogenesis behind cushing ulcers?

A

It is thought that head injury directly stimulates vagal nuclei which causes hypersecretion of gastric acid

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9
Q

What is a Dieulafoy lesion?

A

caused by a submucosal artery that doesn’t branch properly within the wall of the stomach. Most commonly found along lesser curvature near gastroesophageal junction. Self limited bleeding related to NSAID use and may be recurrent

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10
Q

What is GAVE?

A

Gastric Antral Vascular Ectasia Longitudinal stripes of edematous erythematous mucosa that alternates with less severely injured paler mucosa. Referred to as “watermelon” stomach

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11
Q

How do patients with GAVE present?

A

Usually idiopathic cause, but sometimes it’s assoc. with cirrhosis and systemic sclerosis Patients may have occult fecal blood or iron deficiency

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12
Q

What is the most common cause of diffuse atrophic gastritis?

A

Autoimmune gastritis

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13
Q

What is the most common cause of chronic gastritis?

A

H. pylori infection

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14
Q

When gastritis progresses to Multifocal atrophic gastritis is is associated with what appearance?

A

patchy mucosal atrophy, reduced parietal cell mass and acid secretion, increased risk of gastric adenocarcinoma

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15
Q

What toxin produced by H.pylori increases the risk of multifocal atrophic gastritis and therefore increases risk of gastric cancer?

A

CagA

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16
Q

In contrast to H. pylori associated gastritis, Autoimmune Gastritis usually spares what part of the stomach, and is associated with what?

A

Spares antrum and is associated with hypergastrinemia

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17
Q

What five things characterize Autoimmune gastritis?

A
  1. Abs to parietal cells and IF
  2. Reduced serum pepsinogen I
  3. Endocrine cell hyperplasia
  4. B12 deficiency
  5. Defective gastric acid secretion (achlorhydria)
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18
Q

Compare the possible risks of H pylori assoc. gastritis with autoimmune gastritis.

A

H. pylori:

  • PUD
  • Adenocarcinoma
  • MALToma

Autoimmune:

  • Atrophy
  • Pernicious anemia
  • Adenocarcinoma
  • Carcinoid tumor
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19
Q

Compare the associations of H pylori assoc. gastritis with autoimmune gastritis.

A

H. pylori:

  • Low socioeconomic status
  • Poverty
  • Residenced in rural areas

Autoimmune:

  • Other AI diseases
  • Thyroiditis
  • Diabetes
  • Graves
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20
Q

What is the principal agents of injury in autoimmune gastritis?

A
  • CD4 T cells directed against parietal cell componenets such as the H/K ATPase, proton pump, and intrinsic factor
21
Q

What role do autoantibodies play in autoimmune gastritis?

A
  • Auto Ab’s are present in 80% of cases but they are NOT considred to be pathogenic bc the secreted IF and the proton pumps are NOT accessible to the antibodies
  • They are a useful diagnostic tool
22
Q

What is the median onset of diagnosis for Autoimmune gastritis?

A

60

females slighlty more than males

23
Q

Where does eosinophilic gastritis occur? What are assoc. disorders?

A
  • mucosa and muscularis of the antrum or pyloric region
  • systemic sclerosis, polymyositis, parasytic infections
24
Q

Lymphocytic gastritis is idiopathic generally, but 40% of cases are associated with ____.

A

Lymphocytic gastritis is idiopathic generally, but 40% of cases are associated with celiac disease

25
Q

What area(s) of the stomach does ymphocytic gastritis impact?

A
  • Affects the entire stomach
  • referred to as varioliform gastritis due to the endoscopic appearance of thickened folds covefred by small nodules with central apthous ulceration
26
Q

What is granuomatous gastritis? What is the most common cause in the western world?

A
  • any gastritis containing well formed granulomas or aggreagates of epithelioid macrophages
  • Chrons disease followed by sarcoidosis
27
Q

Desribe the pain and HPI of a peptic ulcer.

A
  • epigastric burning or aching pain
  • some present with:
    • iron deficiency anemia
    • hemorrhage
    • perforation
  • Pain occurs 1-3 hours after a meal
  • worse at night
  • relieved by alkali or food
  • N/V bloating belching and weight loss are common
28
Q

What is Gastritis Cystica?

A
  • exuberant reactive epithelial proliferation associated with entrapment of epithelial lined cysts
  • Cound in submucosa or deeper
  • Trauma induced- associated with partial gastrectomy and chronic gastritis
  • Mimics invasive adenocarcinoma
29
Q

What is Menetrier disease?

A
  • Rare, associarted with excesssive secetion of TGF-a
  • Characterized by diffuse hyperplasia of foveolar epithelium of body and fundus
  • Also characterized by hypoproteinemia
30
Q

Symptoms of Menetrier disease?

A
  • Adults and children usually have similar sx but pediactric is self limited and follows a respiratory infection
    • hypoproteinemia, weight loss, diarrhea
  • Risk of gastric adenocarcinoma increases in adults
31
Q

Histological appearance of Menetrier disease?

A
  • Corckscrew appearance of glands and cystic dilation is common
  • Most characteristic feature is hyperplasia of foveolar mucous cells
32
Q

Hyperplastic polyps driver, median age, how common??

A
  • Make up 75% of gastric polyps
  • Chronic inflammation drives development
  • Diagnosed btw 50 and 60
33
Q

How should a hyperplastic polyp greater than 1.5 cm be treated?

A

Risk of dysplasia correlates with polyp size, so this should be resected and looked at histologically

34
Q

Gross and Histological appearancec of hyperplasatic polyps?

A
  • Multiple 1 cm polyps ovoid in shape with smooth surface
  • Histologically they ahve irregular cystically dilated anad elongated fovelar glands
  • Lamina propria is edematousand surface ulceration may be present
35
Q

What has caused the prevelance of fundic gland polyps to increase in the pasat few years?

A
  • Use of PPI as they inhibit acid production leading to increased gastin secretion which leads to gland growth
36
Q

Fundic gland polyp sx?

A
  • Nausea
  • Vomit
  • Epigastric pain
  • May be asymptomatic
37
Q

Histological and gross appearance of fundic gland polyps? Risks?

A
  • Well circumscribed lesions with smooth surface
  • SIngle or multiple and maede of cysticallydilated irregular glands lined by flattened parietal and chief cells
  • Dysplasia and cancer may occur in the familial FAP polyps
    • sporadic polyps carry no risk
38
Q

Gastric Adenocarcinoma symptoms?

A
  • Early sx mimic chronic gastritis and PUD with dyspepsia, dyspahgeia nd nausea
    • these tumors progress bc they are wrongly diagnosed
  • When diagnosed sx are usually anorexia, weight loss, early satiety, anemia, hemorrhage
39
Q

Where is gastric adenocarcinoma most common geographically?

A

Japan

40
Q

What are recognizable precursor lesion associated with gasatric aedenocarcinoma?

A
  • Gastric dysplasia
  • Adenoma
41
Q

The loss of ____ is a key step in the development of diffuse gastric cancer.

A

The loss of E-cadherin is a key step in the development of diffuse gastric cancer.

42
Q

What causes the early satiety in diffuse gastric cancers?

A
  • Infiltrative tumors cause a desmoplastic reaction that stiffens the wall
  • with large areas of infiltration diffuse rugal flattening and a thickened wall causes a “leather bottle” appearance called linitis plastica
43
Q

In the stomach MALT is induced as a result of _____, ____ is the most common bacterial inducer in the stomach.

A

In the stomach MALT is induced as a result of chronic gastritis, H.pylori is the most common bacterial inducer in the stomach.

44
Q

What translocation is associated with gastric MALToma?

A
  • t(11;18)9q21;q21)
    • causes activation of NF-KB
45
Q

What can cause remission of gastric MALToma?

A
  • eradication of H. pylori
  • unless the tumors have translocations involving BCL-10 and MLT
46
Q

What tumors tend to be a yellow tan color when bisected, and are composed of sheets of uniform cells and round oval stippled nucleus. Immunohistochemistry is positive for Synaptophysin and chromograninin A.

Submucosal mass that creates small polypoid lesions and arises within oxynitic mucosa.

A

Gastric Carcinoid Tumors

47
Q

What part of the GI tract are carcinoid tumors most common and what agae group?

A
  • Jejunum and Ileum
  • 60s
48
Q

GIST occurance and where does it arise from?

A
  • most common mesenchymal tumor of the abdomen and occurs 50% in stomach
  • arises from interstitial cells of cajal
49
Q

What mutation is common in GISTs? Treatment?

A
  • KIT
  • Imatinib

GI 2 (19 decks)

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