Gastric-Path Flashcards
What are the parts of the stomach?
cardia
funds
body
antrum
what part(s) of the stomach are lined by mucin-secreating foveolar cells that form small glands?
cardia and antrum
what part of the stomach also has cells that secrete gastrin
antrum
what does gastrin do?
stimulate luminal acid secretion by parietal cells ( in the funds and body)
what part of the stomach has parietal cells and chief cells?
body and fundus
what cells secrete pepsin?
chief cells
what is acute gastritis?
transient mucosal inflammation
what are the sx of acute gastritis?
- may be asymptomatic
- epigastric pain, nausea, vomiting
- if severe: mucosal erosion, hemorrhage, hematemesis or melon (black stools)
what is a complication of acute gastritis and ICU patients?
most develop gastric ulcers
can perforate
how do you treat acute gastritis in the ICU?
H2 histamine receptor blockers
PPI’s
-must treat underlying disease
what is the ph in the gastric lumen of someone who has acute gastritis?
ph close to 1
how often is gastric mucosa replaced?
every 2 to 6 days
what are the protective barriers for acute gastritis?
- Foveolar cells (form a thin layer of mucin)
- mucus layer (neutral pH due to bicarb ion secretion by surface epithelial cells)
- vascular supply(O2, bicarb, nutrients and washes away acid)
What can cause gastritis?
- Elderly(reduced mucin synthesis)
- NSAIDS
- Uremia
- H. pylori
- ingesting harsh chemicals
- excessive alcohol consumptions
- radiation
- chemo (not enough mucosal regeneration)
- High altitudes (decreased oxygen delivery…hypoxia -> vasoconstriction)
how do NSAIDS cause acute gastritis?
cycloxygenase inhibition-> interferes with prostaglandins (protective) and decrease bicarb secretion, decreases mucin synthesis and decreased vascular perfusion
How does H. Pylori cause acute gastritis?
inhibits bicarb transport by ammonium ions
how does the micro of acute gastritis look?
- Moderate edema
- slight vascular congestion
- scattered PMN’s in epithelium or w/in glands
what is the micro of acute erosive hemorrhagic gastritis look like?
-erosion (surface epithelium disrupted and hemorrhage)
what does the micro of acute gastritis with chronic gastritis?
lymphocytes and plasma cells
What are stress ulcers associated with?
- shock sepsis
- severe trauma
what are curling ulcers associated with?
-burns or trauma
where are curling ulcers seen?
in proximal duodenum
what are cushing ulcers associated with?
patients with intracranial disease
where can cushings ulcers be seen ?
in stomach
esophagus or duodenum
(can perforate)
what is the main basis behind acute gastric ulcers?
- due to vagal stimulation (hypersecrete gastric acid)
- systemic acidosis (decrease pH of mucosal cells)
what is the gross of acute gastric ulcers?
- round and less than 1 cm in diameter
- the base is brown/black (due to acid digestion of extravasated blood)
- can be multiple and all over the stomach
what is the micro of acute gastric ulcers?
- normal mucosa adjacent to ulcer
- no scarring and no thinking of blood vessels ( would only see in chronic)
are the sx of chronic gastritis more severe or less severe then acute gastritis?
less severe
how often is hematemesis in chronic gastritis?
rare
what are the sx of chronic gastritis?
- nausea
- upper abdominal discomfort
- vomiting
what is the most common cause of acute gastritis?
1 h. pylori
- autoimmune gastritis
- stomach irritants
how is h. pylori transmitted?
- fecal/oral
- oral/oral
Describe the bacteria look with h. pylori?
-spiral shaped or curved bacilli
H. Pylori gastritis is seen in almost all patients with ________ and most patients with __________ and 90% of cases of ____________
- duodenal ulcers
- gastric ulcers
- chronic gastritis in antrum
what can h. pylori lead to?
-peptic ulcer dx
what does H. pylori increase the risk of?
-gastric cancer
Describe the pathology of getting carcinoma from H. Pylori?
- pangastritis
- multifocal gastritis with atrophy and intestinal metaplasia
- carcinoma
what infection can you get from pets?
H. Heilmanni
what are cool facts about autoimmune gastritis?
- SPARES THE ANTRUM (although antral endocrine cell hyperplasia)
- HYPERGASTRINEMIA (b/c Ab to parietal cells and IF.vitb12 def)
What does the absence of gastric acid secretion lead to?
hypergastrinemia and hyperplasia of gastrin producing G cells
what does autoimmune gastritis show micro?
diffuse damage of the oxyntic (acid producing) muoca
where is autoimmune gastritis seen?
body and the fundus
what is the median age of diagnosis for autoimmune gastritis?
60 years
and females get it more
what are symptoms of vitamin b12 deficiency?
- atrophic glossitis
- epithelial megaloblastosis
- malaborptive diarrhea
- Neuro: peripheral neuropathy, spinal cord lesions, demyelination, personality changes neuro not reversed
what are some complications of reactive gastropathy?
- foveolar (mucus secreting cells) hyperplasia
- gland regenerative changes
- mucosal edema
- bile reflux
what causes reactive gastropathy?
NSAIDS
gastric antral vascular ectasia aka
watermelon stomach
what is the cause of gastric antral vascular ectasia
astral trauma
Where do you see esonophillic gastritis?
astral or pylorus
in kids what is esonophillic gastritis associated with?
soy and milk allergies
or collagen vascular disease
what bacteria is peptic ulcer disease associated with and where?
H. pylori/NSAIDS
duodenal ! and gastric ulcers
how do you discriminate peptic ulcer disease ulcer vs stress ulcer?
with a peptic ulcer disease ulcer you will see chronic gastritis next to it
what are the symptoms of peptic ulcer disease ?
- epigastric burning and aching pain
- nausea
- vomiting
- IRON DEFICIENCY ANEMIA
- hemorrhage
- WORSE AT NIGHT!
- relieved by alkali or food
how do you treat peptic ulcer disease ?
PPI
H2 blockers and
H. pylori treatment
where are ulcers in peptic ulcer disease usually seen the most
duodenal usually solitary
how can you tell if an ulcer is cancerous?
if it has heaped up margins
how do you diagnose peptic ulcer disease ?
free are under the diaphragm due to perforation
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