Gastric Pathologies Flashcards
Gastritis
Acute vs. Chronic
Result of acid damage
Patient population
Acute = Inc. acid/dec. mucosal protection
- NSAIDS –> dec. PGE2 –> dec. gastric mucosa protection
- Burns (Curling ulcer) –> hypovolemia –> mucosal ischemia
- Brain injury (Cushing ulcer) –> inc. intracranial P –> inc. vagal stimulation –> inc. ACh –> inc. H+ production
Acid damage –> superficial inflammation, erosion (loss of superficial epithelium), or ulcer (loss of mucosal layer)
Patient population:
- Alcoholics
- Patients taking daily NSAIDs (e.g., patients with rheumatoid arthritis)
Gastritis
Acute vs. Chronic
Chronic = mucosal inflammation, often leading to atrophy (hypochlorhydria (low HCl production) –> hypergastrinemia) and intestinal metaplasia (inc. risk of gastric adenocarcinoma - intestinal type)
- H. pylori
- Most common
- Inc. risk of peptic ulcer disease, MALT lymphoma
- Affects antrum first –> spread to body
- Autoimmune
- Autoantibodies to parietal cells and IF
- Pathogenesis mediated by T cells (type IV hypersensitivity)
- Consequence, not cause
- Inc. risk of megaloblastic (pernicious) anemia due to lack of IF
- Affects body/fundus
- Autoantibodies to parietal cells and IF
Menetrier disease
Gastric hyperplasia of mucosa –> hypertrophied rugae (looks like brain gyri), excess mucus production + resultant protein loss and parietal cell atrophy –> dec. acid production
Precancerous
Gastric cancer
Spread/presentation
- Most common: gastric adenocarcinoma
- Early aggressive local spread with node/liver metastases
- Often presents late, w weight loss, early satiety
- Sometimes: acanthosis nigricans (discoloration) or Leser-Trelat sign (pigmentation)
Gastric cancer
Two types
- Intestinal:
- Associated w H. pylori, dietary nitrosamines (smoked foods), tobacco smoking, achlorhydia, chronic gastritis
- Presentation: ulcer with raised margins
- Diffuse:
- NOT associated with H. pylori
- Signet ring cells (mucin-filled cells w peripheral nuclei)
- Stomach wall thickened and leathery (linitis plastica)
Gastric cancer
Virchow node
Krukenberg tumor
Sister Mary Joseph nodule
Virchow node:
- involvement of L supraclavicular node by metastasis from stomach
Krukenberg tumor:
- bilateral metastases to ovaries
- Abundant mucin-secreting, signet ring cells
- Seen with diffuse type
Sister Mary Joseph nodule:
- Subcutaneous periumbilical metastasis
- Seen with intestinal type
Peptic Ulcer Disease: Gastric Ulcer (10%) vs. Duodenal Ulcer (90%)
Pain
H. pylori infection
Mechanism
Other causes
Risk of carcinoma
Other
Pain: can be Greater with meals –> weight loss
H. pylori infection –> ~70%
Mechanism –> dec. mucosal protection against gastric acid
Other causes –> NSAIDs
Risk of carcinoma –> Inc
Other –> biopsy margins to rule out malignancy
Peptic Ulcer Disease: Gastric Ulcer (10%) vs. Duodenal Ulcer (90%)
Pain
H. pylori infection
Mechanism
Other causes
Risk of carcinoma
Other
Pain: Decreases with meals –> weight gain
H. pylori infection –> ~90%
Mechanism –> dec. mucosal protection or inc. gastric acid secretion
Other causes –> Zollinger-Ellison syndrome
Risk of carcinoma –> Generally benign
Other –> Hypertrophy of Brunner glands
Ulcer complications:
Hemorrhage
Obstruction
Perforation
- Gastric, duodenal (posterior > anterior)
- Ruptured gastric ulcer on lesser curvature of stomach –> bleeding from left gastric a.
- Ulcer on posterior wall of duodenum –> bleeding from gastroduodenal a.
Ulcer complications:
Hemorrhage
Obstruction
Perforation
Pyloric channel, duodenal
Ulcer complications:
Hemorrhage
Obstruction
Perforation
Duodenal (anterior > posterior)
May see free air under diaphragm w referred pain to shoulder via phrenic n.
