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Gastrointestinal System > EXAM #1: PATHOLOGY OF THE STOMACH > Flashcards

EXAM #1: PATHOLOGY OF THE STOMACH Flashcards

1
Q

What is the definition of gastritis?

A

Acidic damage causing superficial inflammation of the gastric mucosa

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2
Q

What is the underlying cause of acute gastritis?

A

Imbalance of mucosal defenses and acidic environment

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3
Q

What are the three major mucosal defenses?

A

1) Mucin layer
2) Bicarbonate secretion
3) Normal blood supply

Normal blood supply delivers nutrients and removes acid*

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4
Q

What wall layer does acute gastritis NOT penetrate through?

A

Muscularis mucosa

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5
Q

What causes acute gastritis?

A

1) NSAIDs (esp Aspirin) b/c of decreased PGE2
2) Alcohol
3) Chemotherapy
4) Increased ICP–>vagal stimulation that increases acid production
5) Severe burns–>hypovolemia causing decreased blood flow
6) Shock–>decreased blood flow

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6
Q

Describe the morphology of mild acute gastritis.

A
  • Hyperemia and edema

- Neutrophils above BM

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7
Q

Describe the morphology of severe acute gastritis.

A

Erosion of entire mucosal thickness and hemorrhage

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8
Q

What are the clinical features of acute gastritis?

A

Hematemesis*
Melena

*Especially in alcoholics

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9
Q

What is the definition of chronic gastritis? What does chronic gastritis lead to?

A

Chronic inflammatory changes of the gastric mucosa leading to:

  • Mucosal atrophy
  • Intestinal metaplasia
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10
Q

What at patients with chronic gastritis at risk for?

A

Progression to gastric carcinoma

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11
Q

What is the most common cause of Chronic Gastritis?

A

H. pylori

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12
Q

What are the characteristics of H. pylori?

A

Gram negative
Bacillus
S-shaped

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13
Q

Is H. pylori motile or non-motile?

A

Motile–contains a flagella

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14
Q

What enzyme allows H. pylori to survive in the gastric mucosa?

A

Urease

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15
Q

What allows H. pylori to bind to the epithelial surface of the stomach? What is the most common site of infection?

A
  • Adhesins

- Antrum

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16
Q

What factors associated with H. pylori induce the production of cytokines?

A

CagA
VacA

These are proinflammatory peptides associated with some strains of H. pylori

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17
Q

There are divergent responses to H. pylori infection. When H. pylori causes disease, what is the most common outcome?

A
  • Increased acid
  • Increased gastrin

Leading to DUODENAL ULCER disease

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18
Q

What is the less common scenario that occurs with H. pylori infection?

A
  • Decreased acid
  • Increased gastrin

Leading to a high risk of GASTRIC CARCINOMA

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19
Q

What is autoimmune gastritis?

A

Gastritis that results from autoantibodies to parietal and IF cells

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20
Q

What are the consequences of IF antibodies?

A

Pernicious anemia and megaloblastic anemia (B12 deficiency)

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21
Q

What cancer are patients with autoimmune gastritis most at risk for?

A

Gastric carcinoma

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22
Q

What does achlorhydia distinguish between?

A

Autoimmune gastritis can lead to achlorhydia, H. pylori does NOT

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23
Q

Which primary cause of Chronic Gastritis can lead to Lymphoma and PUD?

A

H. pylori

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24
Q

Which primary cause of Chronic Gastritis can lead to Endocrine tumors?

A

Autoimmune gastritis

25
Q

Structurally, what is the definition of an ulcer?

A

Involvement/ disruption of the muscularis mucosa

26
Q

What are is the classic presentation of a gastric ulcer?

A

Epigastric pain that is worse with eating

27
Q

How do you diagnose a gastric PUD?

A

1) Imaging
2) Endoscopy

Note that you need endoscopy for gastric ulcer, but NOT duodenal–these are NEVER cancerous

28
Q

What is the most common cause of duodenal ulcers?

A

H. pylori (70%)

29
Q

What are the proinflammatory cytokines induced by H. pylori will activate and recruit neutrophils?

A

IL-8

Note that this is especially seen with CagA and VacA

30
Q

How does H.pylori induced gastric acid secretion effect the duodenum?

A

Increased gastric acid secretion leads to decreases duodenal bicarbonate (protection)

31
Q

What is Zollinger-Ellison Syndrome?

A

Gastrinoma in the pancreas that drives HCl secretion in the stomach

32
Q

What is the worst complication of an ulcer?

A

Perforated ulcer leading to:

1) Peritonitis
2) Sepsis
3) Death

33
Q

Describe the morphology of a benign gastric ulcer. Where do these ulcers most commonly occur?

A

“Punched out” lesions along the Lesser Curvature (in the antrum)

34
Q

What are the characteristics of a malignant gastric ulcer?

A

Irregular with raised borders

35
Q

What is the major/ most common complication of PUD?

A

Bleeding

36
Q

What is a stress ulcer?

A

Multiple ulcers seen in the face of shock

*Caused by decreased gastric blood flow

37
Q

What is the morphologic feature of stress ulcers?

A

Multiple small ulcers

38
Q

What is a Curling Ulcer?

A

Stress ulcer associated with extensive burns

Hypovolemia–>decreased blood flow

39
Q

What is a Cushing Ulcer?

A

Increased ICP leads to stress ulcer formation

ICP–> increased vagal stimulation–>increased ACh release–>increased acid secretion

40
Q

What is a Gastric Polyp?

A

Mass lesion in the stomach above the mucosa

41
Q

What are the two major types of Gastric Polyps?

A

1) Hyperplastic or inflammatory polyp

2) Adenomatous polyps

42
Q

What is a gastric carcinoma? What stage is gastric carcinoma when it is typically found?

A

Malignant proliferation of gastric surface epithelial cells

–>Late stage (poor prognosis)

43
Q

What are the two major types of Gastric Carcinoma?

A

1) Intestinal

2) Diffuse

44
Q

Describe the morphology of an intestinal-type gastric carcinoma.

A
  • Large
  • Irregular
  • Heaped-up margins
45
Q

Where are intestinal-type gastric carcinomas typically found?

A

Found in the antrum of the stomach along the lesser curvature

46
Q

What are the major risk factors for gastric carcinoma?

A

1) H. pylori
2) Autoimmune gastritis
3) Nitrosamines in smoked foods (Japan)
4) Blood type A

47
Q

Describe the morphology of a diffuse-type gastric carcinoma.

A

Signet ring cells that diffusely infiltrate the gastric wall

48
Q

What is linitis plastica?

A

Desmoplasia–fibrosis– of the gastric wall in response to diffuse carcinoma that causes a THICKENING of the wall

49
Q

How does gastric carcinoma typically present?

A

Late with:

  • Weight loss
  • Abdominal pain
  • Anemia
  • Early satiety
50
Q

What is the prognosis for Gastric Carcinoma?

A

Poor–not found until late stage with less than 10% 5-year surivial

51
Q

What is a Virchow node?

A

Involvement of the sentinel supraclavicular node with cancer

52
Q

What is a Sister Mary Joseph nodule?

A

Gastric carcinoma to periumbilical area

53
Q

What is a Krukenburg Tumor?

A

Metastatic diffuse-type gastric carcinoma to the ovaries

54
Q

What is the Lymphoma associated with H. pylori infection?

A

MALToma

55
Q

How is MALToma treated?

A

Treat the underlying H. pylori infection

56
Q

What is a Gastrointestinal Stromal Tumor?

A

Neoplastic proliferation of mesenchymal cells i.e. “Cells of Cajal”

57
Q

What is a Carcinoid Tumor?

A

Neoplastic proliferation of gastric neuroendocrine cells

58
Q

What are GIST positive for?

A

c-KIT or CD117

59
Q

What drug can be used to treat GIST?

A

Imatinib i.e. tyrosine kinase inhibitors

Gastrointestinal System (42 decks)

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