Gastric pathology Flashcards
What are some of the causes of acute gastritis?
Chemical injury e.g. alcohol, medication
Shock
Trauma
Why does shock or trauma cause acute gastritis?
Ischaemia
What are some of the causes of chronic gastritis?
Autoimmune
Bacterial
Chemical
In autoimmune gastritis, what are the host targets for antibodies?
Parietal cells
Intrinsic factor
Why might autoimmune gastritis cause pernicious anaemia?
Attack on intrinsic factor which allows absorption of B12 - B12 deficiency is a form of anaemia
What histological changes might occur in autoimmune chronic gastritis?
Loss of parietal cells
Fibrosis of lamina propria
Intestinal metaplasia in body of stomach
Which is the most common type of chronic gastritis?
H. pylori associated chronic gastritis
Describe H. pylori.
Gram negative curved rod
What is the pathogenesis of H. pylori associated chronic gastritis?
H. pylori inhabit a niche between mucous barrier and epithelial surface
They excite an acute inflammatory response
If bacteria isn’t then cleared, a chronic active inflammation ensues
Which inflammatory mediator is critical in the inflammatory response related to H. pylori associated chronic gastritis?
IL-8
What further disease does H. pylori associated chronic gastritis predispose to?
Duodenal ulcer
Gastric ulcer
Gastric carcinoma
Gastric lymphoma
What might cause chemical gastritis?
Alcohol
Bile reflux
NSAIDs
What pathological changes might be seen in chemical gastritis?
Epithelial cell loss and marked epithelial regeneration
Hyperplasia
Congestion
What is peptic ulceration?
A breach in the gastrointestinal mucosa as a result of acid and pepsin attack
What are the major sites of peptic ulcer?
1st part of duodenum
Junction of antrum and body in stomach
Distal oesophagus
Which part of the oesophagus are peptic ulcers most commonly found in?
The squamous-columnar junction
What is the pathogenesis of peptic ulcer?
Increased acid secretion
H. pylori infection
Inflammation and epithelial damage
This leads to ulceration
What is the microscopic appearance of a peptic ulcer?
Fibrous scar tissue, inflamed granulation tissue covered with necrotic tissue
The muscularis propria can be completely replaced with fibrous tissue
What are some of the complications of peptic ulcer?
Perforation Penetration Haemorrhage Stenosis Pain
What is the most common cancer of the stomach?
Adenocarcinoma
Which two layers does tumour growth have to be confined to for it to be defined as “early” gastric cancer?
Mucosa
Submucosa
Into which layer does a tumour have to grow to be defined as an “advanced” gastric cancer?
Into the muscularis propria
Then penetrates - subserosa, peritoneum, adjacent structures
What has been identified as the most important environmental risk factor for gastric cancer?
H. pylori
What is the pathogenesis from H. pylori infection to gastric cancer?
H. pylori infection Chronic gastritis Intestinal metaplasia/atrophy Dysplasia Carcinoma
What are some of the other premalignant conditions in the pathogenesis of gastric adenocarcinoma?
Pernicious anaemia
Partial gastrectomy
Menetrier’s disease
What histological changes might you see in intestinal type gastric adenocarcinoma?
Gland formation
Tubular formations of cohesive cells
What histological changes might you see in diffuse type gastric adenocarcinoma?
Scattered clusters of non-cohesive cells
Signet ring cells
Sclerosis
Which gastic adenocarcinoma has the best prognosis: intestinal or diffuse type?
Intestinal type
What is the name given to metastases of gastric carcinoma into the ovaries?
Kruckenberg tumours
Where can gastric carcinomas spread?
Into other organs or peritoneal cavity and ovaries
To lymph nodes
To the liver
Which lymph node, distant to the stomach, might be palpable in gastric cancer?
Virchow’s node (left supraclavicular)
Other than adenocarcinoma, which gastric malignancy is also related to H. pylori infection?
Lymphoma
Where are gastric lymphoma derived from?
Mucosa associated lymphoid tissue (MALT)
What is the pathogenesis of gastric lymphoma?
H. pylori infection (or other cause) provokes an influx of lymphocytes
Continuous inflammation induces an evolution into a clonal B cell proliferation - low grade lymphoma
If unchecked, develops into high grade B cell lymphoma
What is the result of a low grade gastric lymphoma developing?
Lymphocytes attack the gastric epithelium
What is gastroparesis?
Delayed/lack of gastric emptying with no physical obstruction
Stomach paralysis
What are some of the symptoms of gastroparesis?
Feeling of fullness Nausea Vomiting Weight loss Upper abdominal pain
What are some of the causes of gastroparesis?
Idiopathic
Diabetes mellitus
Cannabis
Medication e.g. opiates, anticholinergics
Systemic diseases e.g. systemic sclerosis
Which ulcers are more likely to perforate?
Duodenal ulcer
