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Gastroenterology > Gastritis > Flashcards

Gastritis Flashcards

1
Q

What does the term gastritis refer to?

A

Histologically documented inflammation of the gastric mucosa

Gastritis is not synonymous with mucosal erythema seen during endoscopy or with dyspepsia.

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2
Q

Is gastritis interchangeable with dyspepsia?

A

No

Gastritis specifically refers to inflammation of the gastric mucosa, while dyspepsia is a broader term for digestive discomfort.

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3
Q

Fill in the blank: Gastritis is classified based on _______ features.

A

[histologic]

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4
Q

What are the two main types of gastritis based on time course?

A

Acute and chronic

These classifications help in understanding the duration and potential treatment of gastritis.

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5
Q

What are the most common causes of acute gastritis?

A

Infectious causes, primarily H. pylori infection

Acute infection with H. pylori induces gastritis, though it has not been extensively studied.

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6
Q

What are the symptoms of acute H. pylori gastritis?

A

Sudden onset of epigastric pain, nausea, and vomiting

Limited mucosal histologic studies show marked infiltrate of neutrophils with edema and hyperemia.

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7
Q

What could happen if acute gastritis is not treated?

A

It may evolve into chronic gastritis

Hypochlorhydria lasting for up to 1 year may follow acute H. pylori infection.

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8
Q

What is phlegmonous gastritis?

A

A rare, potentially life-threatening disorder characterized by marked and diffuse acute inflammatory infiltrates of the entire gastric wall

It may be accompanied by necrosis.

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9
Q

Which individuals are at risk for phlegmonous gastritis?

A

Elderly individuals, alcoholics, and AIDS patients

Potential iatrogenic causes include polypectomy and mucosal injection with India ink.

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10
Q

What organisms are associated with phlegmonous gastritis?

A
  • Streptococci
  • Staphylococci
  • Escherichia coli
  • Proteus
  • Haemophilus species

Failure of supportive measures and antibiotics may result in gastrectomy.

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11
Q

What types of gastritis may occur in immunocompromised individuals?

A

Herpetic (herpes simplex) or CMV gastritis

Histologic findings of intranuclear inclusions would be observed in CMV gastritis.

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12
Q

What is chronic gastritis primarily characterized by histologically?

A

An inflammatory cell infiltrate consisting primarily of lymphocytes and plasma cells

Very scant neutrophil involvement is also noted.

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13
Q

What are the initial areas affected by the inflammation in chronic gastritis?

A

Superficial and glandular portions of the gastric mucosa

The inflammation may be patchy in distribution.

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14
Q

What can chronic gastritis progress to in terms of glandular destruction?

A

Atrophy and metaplasia

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15
Q

What histologic characteristics classify chronic gastritis?

A

Superficial atrophic changes and gastric atrophy

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16
Q

What is the association of atrophic gastritis with gastric cancer?

A

It has led to the development of endoscopic and serologic markers of severity.

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17
Q

List some tools used for assessing chronic gastritis severity.

A
  • Gross inspection during endoscopy
  • Magnification endoscopy
  • Endoscopy with narrow band imaging
  • Autofluorescence imaging
  • Measurement of serum biomarkers (pepsinogen I and II levels, gastrin-17, anti–H. pylori serologies)
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18
Q

What is the early phase of chronic gastritis called?

A

Superficial gastritis

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19
Q

What are the characteristics of superficial gastritis?

A

Inflammatory changes are limited to the lamina propria of the surface mucosa, with edema and cellular infiltrates separating intact gastric glands.

20
Q

What follows superficial gastritis in the progression of chronic gastritis?

A

Atrophic gastritis

21
Q

What occurs during the atrophic gastritis stage?

A

The inflammatory infiltrate extends deeper into the mucosa, leading to distortion and destruction of the glands.

22
Q

What is the final stage of chronic gastritis?

A

Gastric atrophy

23
Q

What happens to glandular structures during gastric atrophy?

A

Glandular structures are lost, and there is a paucity of inflammatory infiltrates.

24
Q

What can be observed endoscopically in gastric atrophy?

A

The mucosa may be substantially thin, permitting clear visualization of the underlying blood vessels.

25
Q

What is intestinal metaplasia in the context of chronic gastritis?

A

The conversion of gastric glands to a small intestinal phenotype with small-bowel mucosal glands containing goblet cells.

26
Q

What is a significant risk factor for gastric cancer?

A

Intestinal metaplasia

27
Q

How is chronic gastritis classified according to predominant site of involvement?

A
  • Type A: body-predominant form (autoimmune)
  • Type B: antral-predominant form (H. pylori–related)
28
Q

What does AB gastritis refer to?

A

A mixed antral/body picture

29
Q

True or False: Chronic gastritis can be classified based on histologic characteristics.

A

True

30
Q

Fill in the blank: The inflammatory infiltrate in atrophic gastritis extends _______ into the mucosa.

A

deeper

31
Q

What is Type A gastritis primarily associated with?

A

Pernicious anemia

Type A gastritis is also known as autoimmune gastritis.

32
Q

Which areas of the stomach does Type A gastritis primarily involve?

A

Fundus and body

It involves antral sparing.

33
Q

What type of antibodies are associated with Type A gastritis?

A

Antibodies against parietal cells and intrinsic factor (IF)

These antibodies are found in patients with pernicious anemia.

34
Q

What is the prevalence of parietal cell antibodies in patients with pernicious anemia?

A

> 90%

Up to 50% of patients with type A gastritis may also have these antibodies.

35
Q

What is the mechanism thought to be involved in the injury pattern of Type A gastritis?

A

Molecular mimicry

This involves mimicry between H. pylori LPS and H+ ,K+ -ATPase.

36
Q

What specific gastric cell type is targeted in Type A gastritis?

A

Parietal cells

This leads to achlorhydria.

37
Q

What is a consequence of the lack of intrinsic factor (IF) in Type A gastritis?

A

Vitamin B12 deficiency

This can lead to megaloblastic anemia and neurologic dysfunction.

38
Q

What happens to gastrin levels in patients with achlorhydria?

A

Elevated gastrin levels

Levels can exceed 500 pg/mL in patients with pernicious anemia.

39
Q

Which familial histocompatibility haplotypes are associated with autoimmune gastritis?

A

HLA-B8 and HLA-DR3

These haplotypes indicate a genetic predisposition.

40
Q

What is the significance of low pepsinogen levels in Type A gastritis?

A

It serves as a diagnostic tool

Low pepsinogen levels are indicative of autoimmune gastritis.

41
Q

True or False: Hypergastrinemia can occur in non-pernicious anemia associated Type A gastritis.

A

True

Achlorhydria and hypergastrinemia are common in both types.

42
Q

What potential tumor development can result from ECL cell hyperplasia due to gastrin trophic effects?

A

Gastric carcinoid tumors

This occurs as a consequence of elevated gastrin levels.

43
Q

What percentage of individuals aged over 60 may have parietal cell antibodies?

A

~20%

This prevalence is notable in older populations.

44
Q

Fill in the blank: Type A gastritis is also called _______.

A

autoimmune gastritis

45
Q

What is the role of gastric acid in relation to gastrin release?

A

Feedback inhibition

Gastric acid inhibits gastrin release from G cells.

Gastroenterology (14 decks)

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