Gastric Disease

Question 1

contrast curling ulcer and cushing ulcer

Answer 1

curling: second to burns, loss of fluid causes mucosal hypoxia
cushing: brain trauma causes more CN10 firing and more gastric acid secretion

Question 2

chronic gastritis etiologies

Answer 2

prolonged H pylori infection

autoimmune
other like diet

Question 3

pathogenesis of chronic gastritis

Answer 3

lymphs, plasma cells, macros can cause epithelial cell necrosis- sometimes atrophy, metaplasia, cancer

Question 4

gross patho of chronic gastritis

Answer 4

thin, atrophic gastric wall and atrophy of rugal folds

Question 5

histopath of chronic gastritis

Answer 5

can have gland and mucosa atrophy

can have intestinal metaplasia- turn into simple columnar epithelium w/ goblet cells- dense pink absorptive cells

Question 6

pathogenesis of autoimmune chronic gastritis

Answer 6

autoAb to parietal cells cause chronic inflamation

atrophy and less acid production

less intrinsic factor cause less B12 and pernicious anemia

Question 7

PUD etiologies

Answer 7

H pylori, NSAIDs, increased gastric acid (ZE syndrome)

Question 8

PG role in ulcer formation

Answer 8

they are defensive, constitutive from COX 1 to help w/ mucus protection

inhibited by NSAIDs

Question 9

gross path of PUD

Answer 9

usually just one, punched out cookie cutter appearance w/ smooth base and margins

Question 10

4 zones of active ulcer

Answer 10

from top to bottom: 
fibrinopurulent exudate
necrotic tissue
granulation tissue
fibrotic tissue/scar

Question 11

uncomplicated PUD presentation

Answer 11

epigastric pain

can have nausea, bloating, fullness

Question 12

3 main complications of PUD

Answer 12

hemorrhage (common)

perforation (more common in duodenum)- can cause peritonitis

obstruction- esp in pylorus, gastric outlet obstruction (from edema, scar, hypertrophy)

Question 13

presentation of complicated PUD

Answer 13

bleeding- melena, hematemesis

perforation- toxic appearance/ shock, peritoneal signs

obstruction- vomiting, succusion splash

Question 14

management for uncomplicated vs complicated PUD

Answer 14

uncomplicated: mainly medical- PPI, eradicate H pylori, stop NSAIDs and smoking

complicated- scope for bleeding, NG suction and/or surgery for obstruction, surgery for perforation

Question 15

ZE syndrome

Answer 15

rare disease, gastrinoma in pancreasa secretes gastrin and causes ulcers

Question 16

menetrier disease pathophys

Answer 16

hyperplasia of gastric pit mucus cells and hypertrophy of gastric wall

more mucus, less protein

could be from excess TGF alpha

Question 17

gross patho of menetrier

Answer 17

think rugae looks like brain

Question 18

clinical of menetrier

Answer 18

epigastric pain, edema, precancerous adenocarcinoma

Question 19

2 gastric tumors and which is most common?

Answer 19

adenocarcinoma (diffuse and intestinal) in epithelium- 90-95%)

lymphoma below epithelium, 4-5%

Question 20

gross patho of malignant ulcer

Answer 20

heaped up margins, irregular sides, shaggy base

Question 21

common mets sites for gastric malignancy

Answer 21

local nodes, left supraclavicular (virchows) and periumbilical (sister mary joseph)

local invasion

distant sites like liver, brain, ovary (krukenberg)

Question 22

contrast diffuse and intestinal gastric adenocarcinoma

Answer 22

diffuse- from gastric mucous cells, poorly differntiated w/o glands, signet ring cells
-spread of single cells and clusters, can cause linitis plastica

intestinal- from metaplastic intestinal epithelium, forms glands infiltrating

not a big difference for prognosis

Question 23

other names for gastric lymphoma

Answer 23

MALT lymphoma= MALToma

Question 24

pathogenesis and type for gastric lymphoma

Answer 24

low grade B cell

usually:

• H pylori infection
• chronic inflammation and MALT expansion and influx of B cells

Question 25

histopath of MALToma

Answer 25

small malignant, monomorphic lymphocytes in mucosa, destroy gastric glands