Diseases Of The Stomach Flashcards
What is the definition of acute gastritis?
Short term inflammatory process that involves walls of stomach, especially mucosa
What is the aetiology of acute gastritis?
Exogenous factors - alcohol
Ingestion of corrosive substances eg acetone
Drugs such as NSAID’s, antibiotics or corticosteroids
Diet of spicy food, coffee,
Endogenous factors - urea
Infectious diseases
Allergies
Ischaemia
What is the morphopathology of acute gastritis>
Edematous mucosa
Erosions
Purulent exudates
Necrotic epithelium
What are the different anatomo-pathological forms of acute gastritis?
Cathatral acute gastritis - endoscopy reveals intense red mucosa, oedema and little bleeding
Erosive acute gastritis (ulcerative acute gastritis) - more severe than first form
Phlegmonous acute gastritis - discovered beside gastric cancer or at alcohol abusers
Emphysematous acute gastritis - produced by infection of gastric wall with anaerobic bacteria
What are the clinical symptoms of acute gastritis?
Epigastric pain that is increased by ingesting food
NBA’s yea
Vomiting which relieves the pain
Anorexia
Headache
Diarrhoea
What are the clinical for a self acute gastritis?
Alcoholic acute gastritis
Corrosive acute gastritis
Medicamentous acute gastritis
Infectious acute gastritis
Allergic acute gastritis
What are the symptoms of alcoholic acute gastritis
Epigastralgia
Vomiting containing large amounts of mucous and bile
Anorexia
Digestive intolerance
Altered general status
what is the treatment for alcoholic acute gastritis?
Stopping alcohol intake and following same dietary and medical recommendations as for all gastritis
What are the symptoms of corrosive acute gastritis?
Dysphagia
Sialorrhea (drooling or excessive salivation)
Retrosternal pain
Epigastric pain
Vomiting with haemorrhaging aspect
Altered general status
what is the treatment for corrosive acute gastritis?
Gastric and oesophageal mucosal lovage
Parenteral nutrition for 3-4 weeks
What causes medicamentous acute gastritis?
Produced by any kind of drug which ingested in large quantities produces gastric irritation
What is infectious acute gastritis associated with?
Pneumonia
Flyer
Typhoid fever
Dysentery
What is characteristic of allergic acute gastritis?
Lesions appearing and disappearing
How do you diagnose allergic acute gastritis?
Skin test and specific serological tests
What is found at the physical examination for acute gastritis?
Sensibility at palpation of Epigastrium
Dry, red tongue
Tachycardia
Oliguria (low urine output)
What is the paraclinical investigation for acute gastritis?
Gastric X-ray
Endoscopy
Biopsy
How do you determine a positive diagnosis for acute gastritis?
Anamnesis, physical examination and paraclinical examination
what is the treatment plan for acute gastritis?
Dietary management
Rich in soft liquids for 1-2 days (1-2 litres of tea a day)
Next 3-5 days eat vegetable soups, boiled rice, potatoes, cow cheese and finally boiled meat
What is the medical treatment for acute gastritis?
Gastric protective (sucralfate, sodium bicarbonate)
Anticholinergics (atropine derivatives)
Sedative solutions (codeine phosphate)
Correction of hydroelectrolythic and protein imbalance
What is the definition of chronic non erosive gastritis?
Refers to inflammatory changes in the mucosa or submucosa leading to atrophy of glands that are replaced by metaplasia
what is chronic non erosive gastritis characterised by?
Grossly visible erosions
What are the underlying aetiological agents that can cause chronic gastritis?
Helicobacter pylori
Bile reflux
NSAID’s
Autoimmunity
Allergic response
What is a complication of h pylori gastritis?
Peptic ulcer
Gastric malignancy
What is a complication of chronic strophic gastritis?
Gastric carcinoma
What is a complication of autoimmune gastritis?
Achlorhydria (absence of HCL in secretion)
Hypergastrinemia
Loss of pepsin and pepsinoegn
Anemia
Increased risk of gastric neoplasm
Which race is h pylori gastritis more common in?
Asians
Hispanics
high race is autoimmune gastritis more common in?
Northern Europe and black people
Less common in south Europe and Asian people
Which sex is chronic h pylori gastritis common in?
Both sexes with similar frequency
which sex is affected more by autoimmune gastritis?
Females 3:1 male
Which age group is more likely to suffer from all forms of chronic gastritis?
People aged 40-60 years of age
What is the classification order chronic gastritis?
Sydney system, updated to Houston system
Alphabetical classification
Aetiological classification
What is the Sydney system based on?
Aetiology
Pathogenical mechanisms
Location of lesions
Severityt of inflammatory process
Atrophy or metaplasia degree
Wha is needed for classification ion the Sydney’s system?
2 biopsies from each gastric area, gastric corpus or antropyloric area, from anterior band posterior gastric wall
What does inflammation mean for the Sydney system?
Increase in the number of lymphocytes and plasmocytes in the lamina propria
What does atrophy mean in the Sydney classification?
Decreased number off specialised glands Fromm the gastric corpus and from the antropyloric area
What does h pylori bacteria do to lesions of the gastric mucosa?
Colonises the lesions
What is the alphabetical classification of chronic gastritis?
Type A - autoimmune
Type B - bacterial
Type C - chemical (duodenal or biliary reflux)
What are the etiological classifications for chronic gastritis?
Infectious chronic gastritis
Non infectious chronic gastritis
Which infections can cause infectious chronic gastritis?
H pylori (most common)
Mycobacteriosis
Parasitic infections
Viral infections
What can cause non infectious gastritis?
Autoimmune gastritis
Chemical gastropathy - related to chronic bile reflux or NSAID
Uraemia gastropathy
Lymphocytic gastritis
Eosinophilia gastritis
Radiation injury to the stomach
Ischemic gastritis
Which infection of h pylori is more likely to develop peptic ulcer?
H pylori strain that secretes vacuolating toxin A
Which h pylori strain has a higher risk of developing gastric carcinoma?
Strains that produce CagA protein
What are the 2 common progressions of hpylori associated chronic gastritis?
Antral inflammation predominant gastritis - usually in patients with peptic ulcers
Multi focal astrophic gastritis involves corpus and gastric antrum with progressive development of gastric atrophy (usually leads to gastric carcinoma)
Wheat are the clinical features of h pylori associated chronic gastritis?
Typically asymptomatic but can manifest -
Gastric pain
Nausea
Vomiting
Anorexia
Significant weight loss
What are the complications of h pylori associated gastritis?
Peptic ulcers
Gastric adenocarcinoma
MALT lymphoma
What is found on the physical examination for h pylori associated chronic gastritis?
In uncomplicated h pylori - epigastric tenderness may exist
If gastric ulcers coexist - guaiac positive stool may result from occult blood loss (hidden blood loss)
Halitosis and abdominal pain or discomfort may occur with bloating associated with bacterial overgrowth syndrome
How do you diagnose h pylori associated chronic gastritis?
Upper GI endoscopy essential to establish diagnosis of gastritis
Endoscopy for chronic h pylori infection may show areas of intestinal metaplasia
Tissue sampling from gastric antrum, incisura and corpus is essential to establish topography of gastritis and to identify atrophy and intestinal metaplasia
Can do specific stain tests (giemsa) to identify h pylori infection
Late stages can do urea breath test and serological tests for evidence of infection
Bacterial culture of gastric biopsy
What histological findings are present in h pylori associated chronic gastritis?
Polymorphonuclear leukocytes present in lamina propria, glands, surface epithelium and foveolar cells
Lymphoid aggregates expanding the lamina propria of the mucosa
Significant loss of gastric glands produces gastric atrophy
What is the treatment for h pylori associated chronic gastritis?
Eliminate the h pylori infection - first line triple therapies
Quadruple therapies are recommended as second line treatment when triple therapies fail to eradicate h pylori
Administered for 10-14 days
What is triple therapy for h pylori infection?
PPI - Lansoprazole
ATB - clarithromycin
ATB - amoxicillin
What is involved in quadruple therapy for h pylori infection?
PPI twice daily - lansoprazole
Tetracycline
Bismuth sucralfate
Metronidazole
What are some other causes of infectious gastritis?
Tuberculosis
Fungi
Both Cavan cause caseating granulomas
Which diseases can cause gastritis in immunosuppressed patients?
Cytomegalovirus - infection of stomach observed in immunosuppressed patients
Herpes simplex causes basophil infection intranuclear inclusions in epithelial cells
Mycobacterium avium can infiltrate lamina propria by histocytes (type of immune cell that destroys foreign substances)
What are the clinical features form infectious granulomatous gastritis?
Caseating granulomasd secondary to TB may be found in the absence of lung disease in patients who are malnourished, immunosuppressed or alcoholic
Patients may report gastric pain, nausea and vomiting
What are the histological findings for infectious granulomatous gastritis?
Early stages - isolated granulomas in the mucosa and submucosa
Later stages - inflammation extends too muscularis propria and fibrosis may be prominent
Granuloma normally caseating if associated with TB
If syphilis is involved can show poorly formed granulomas
CMV shows - intranuclear eosinophilic inclusions. Patchy mild inflammatory infiltrate is observed in lamina propria.
Herpes simplex causes basophil infection intranuclear inclusions in epithelial cells
What is autoimmune gastritis typically associated with?
Antiparietal and anti intrinsic factor antibodies
what may patients develop in autoimmune gastritis if deficiency occurs?
Pernicious anemia
What characterises autoimmune gastritis?
Atrophic gastritis limited to corpus fundus mucosa and marked diffuse atrophy of parietal and chief cells
Which vitamin deficiency can autoimmune gastritis lead to?
Vitamin b12 deficiency (Cobalamin)
What causes Cobalamin deficiency in autoimmune gastritis?
Due to intrinsic factor deficiency leading to inadequate absorption of B12
What are the clinical features of Cobalamin deficiency?
Haematological manifestations - Megalobastic anaemia
Purpura (rare) due to thrombocytopenia
Symptoms of anemia eg weakness, light headedness, vertigo, tinnitus, palpitations, angina
GI manifestations - megaloblastosis - sore tongue. Anorexia with moderate weight loss and diarrhoea due to malabsorption
Neurological manifestations - due to demyelination and thus atonal degeneration and neuronal death.
Affected nerves are the peripheral nerves, posterior and lateral columns of spinal cord and cerebrum. Signs and symptoms include numbness and parasthesias in the extremities, weakness and ataxia lack of coordination)
How do you diagnose autoimmune gastritis?
Antiparietal and anti IF antibodies in the serum
Achlorhydria, both basal and stimulated and hypergastrinema
Low serum cobalamin (<100pg/ml)
what are the early histological findings for autoimmune gastritis?
Early phase - multifocal diffuse infiltration of lamina propria by mononuclear cells and eosinophils and focal T cell infiltration of oxyntic glands with glandular destruction occur. Focal mucous neck cell hyperplasia and hypertonic changes of parietal cells are also observed
what are the florid histological findings for autoimmune gastritis?
Increased lymphocytic inflammation, oxyntic gland atrophy and focal intestinal metaplasia occur
what are the end histological findings for autoimmune gastritis?
Diffuse involvement of gastric corpus and fundus by chronic atrophic gastritis associated with little intestinal metaplasia
What is the treatment for autoimmune gastritis?
No specific treatment, just b12 supplement for pernicious anaemia
Elated gastric emptying treated with metoclopramide
What is chronic reactive chemical gastropathy associated with?
Long term intake of aspirin or NSAID’s
What is another cause of chronic reactive chemical gastropathy
Bile containing intestinal contents reflux into the stomach
What are the histological findings associated with chronic bile reflux and long term NSAID use?
Mucosal oedema
Congestion
Fibromuscular hyperplasia in the lamina propria
Pit or foveolar hyperplasia
What are the clinical manifestations in reflux gastritis?
Epigastralgia is the most important one (epigastric pain) that occurs after food ingestion, not relieved by anti ulcerous drugs and is increased by alkaline substances
How do you diagnose reflux gastritis?
Physical examination
Endoscopy
Gastric X-ray
Values of biliary acids (should be high)
What does endoscopy shoes for reflux gastritis?
Distribution of lesions - most frequent in antrum
What are the main causes of chronic non infectious granulomatous gastritis?
Chron disease
Sarcoidosis
Isolated granulomatous gastritis
What are the clinical features of chron disease and gastric involvement?
Gastric pain
Nausea
Vomiting
What is sarcoidosis off the stomach usually associated with?
Granulomatous inflammation in other locations, especially the lungs, hilar nodes or salivary glands
What are the symptoms of sarcoid involvement in gastritis?
Gastric ulcers
Haemorrhage
Pyloric stricture
Gastric outlet obstruction
What are the clinical manifestations of lymphocytic gastritis?
Non specific dyspepsia
Epigastralgia
Heartburn
Nausea
Anorexia
Anemia
Weight loss
What is the diagnosis for lymphocytic gastritis?
Biopsy and counting number of lymphocytes from gastric corpus (diagnosis can be made when 30 or more lymphocytes per 100 consecutive epithelial cells are observed)
What normally accompanies eosinophilic gastritis?
Parasitic infection (gastro enteritis)
What doe patients normally have in peripheral blood?
Eosinophilia
What can cause eosinophilic gastroenteritis in some cases?
Foods allergy, usually milk or soy
Which connective tissue disorders can also cause eosinophilic gastritis?
Scleroderma
Polymyositis
Dermamysoitis
What are the clinical features for eosinophilic gastritis with predominant mucosal involvement?
Nausea
Vomiting
Abdominal pain related to ingestion of specific foods
What are the clinical features for eosinophilic gastritis with predominant muscularis propria involvement?
Outlet obstruction symptoms
What is the treatment for eosinophilic gastritis?
Removal of certain foods and steroid therapy
What are the histological findings in eosinophilic gastritis?
Patchy infiltration by numerous eosinophils (typically contain 10-50 eosinophils per high power field and plasma cells)
Mucosal oedema
Congestion
Necrosis of the surface epithelium
What does radiation lead to in radiation gastritis?
Degenerative changes in epithelial cells and a no specific chronic inflammatory infiltrate in the lamina propria
What will higher levels of radiation lead to?
Permanent mucosal damage
Atrophy of fundus glands
Mucosal erosions
Capillary hemorrhage
What causes ischemic gastritis?
Atherosclerotic thrombi arising from the celiac and superior mesenteric arteries
What can chronic ischemia in ischemic gastritis lead to?
Superficial erosions and rarely deep ulcers
What are the clinical features of menetrier’s gastritis?
Epigastralgia
Nausea
Vomit
Oedema of lower extremities due to hypoproteinemia
What are the lab findings for menetrier’s gastritis?
Decreased HCL secretion
Increased mucous secretion
Hypoproteinemia
What is the treatment for menetrier’s gastritis?
Protective alimentary diet
Correction of protein imbalance by parenteral adminstration of aminofusin aminosteril
Cytoprotective drugs
Surgery - vagotomised combined with partial gastrectomy
What is found is 25-74% of patients with liver cirrhosis?
Congestive gastropathy
Heart is the pasthology congestive gastropathy?
Gastric mucosa congestion is produced due to portal hypertension
What are the clinical findings of congestive gastropathy?
Nausea
Vomiting
Anorexia
Clinical manifestations of liver cirrhosis
What are the lab findings for congestive gastropathy?
Endoscopy - hyperaemia, erosions, oedema, microhaemorrhages (located at cardial angle and fundus)
What is the treatment for congestive gastropathy?
Treatment of portal hypertension
