gastroduodenal pathology Flashcards
what control is essential for peristalsis and where is this control derived from in the GI tract
nervous control - delivered by auerbach’s (myenteric) and Meissner’s (seubmucosal) plexuses
what are the layers of the oesophagus (in to out)
- mucosa
- sub mucosa
- muscularis
- adventitia/serosa
what kind of cell replaces the oesophageal epithelium in oesophageal cancer
squamous epithelium replaced by glandular epithelium
what does the gastric rugae aid with
the continuous movement of food
what is found in the mucosa/sub muscosa of the oesophagus (4)
- stratified squamous epithelia
- glands
- folds
- submucosal glands
what is found in the mucosa of the stomach (3)
- pits
- rugae
- glands
what is found in the mucosa/sub muscosa of the duodenum (4)
- villi
- microvilli
- lactea (sm)
- brunner’s gland (sm)
what is found in the mucosa/sub muscosa of the jejunum (2)
- intestinal gland/crypt
- blood/lymphatic vessels (sm)
what is found in the mucosa of the ileum
peyer’s patches
what is found in the mucosa of the colon (2)
- straight tubular glands
- goblet cells
what is congenital hypertrophic pyloric stenosis
a form of obstruction that presents between the third and sixth weeks of life
presentation of pyloric stenosis (4)
- regurgitation
- vomiting
- visible peristalsis
- palpable mass after feeding
what muscles are hypertrophied in pyloric stenosis
circular muscles of the muscularis
what types of musles make up the GI muscularis layer
circular and logitudinal
3 types pf chronic stomach inflammation
- H.pylori associated
- non-HP associated
- autoimmune
acute gastritis causes (5)
- irritants (smoking, alcohol)
- drugs (aspirin, NSAIDs, steroids)
- severe stress (burns, trauma, surgery etc.)
- radiation
- chemotherapy
complications of acute gastritis (2)
- erosions - small uclers where the depth is limited to Lamina propria and which bleed
- acute stress ulcers - penetrate the muscularis mucosa and particular associated w stress, alcohol, smoking etc, they can bleed
what are cushing’s ulcers
a gastro-duodenal ulcer produced by elevated intracranial pressure caused by an intracranial tumor, head injury or other space-occupying lesion
what are curling’s ulcers
Curling’s ulcers occur following burns involving greater than 30 percent total body surface area
what other conditions is HP gastritis associated with (4)
- duodenal ulcers
- gastric ulcers
- gastric MALT lymphoma
- gastric carcinomas
what is the mode of infection for H.pylori
person-to-person transmission via gastro-oral route (saliva, vomit, stool)
how does H.pylori colonise the gastric mucosa
they release urase which buffers the acid stomach environment, and virulence factors which allow colonisation and adhesion to gastric mucosa where factors promoting tissue damage are released
what are the 2 important components to H.pylori that allow for its colonisation
- urease
- virulence factors
what is non-HP chronic gastritis usually due to
bile reflux
autoimmune gastritis pathophys (4)
- autoimmune destruction of specialised glands of the body mucosa
- autoantibodies to IF and parietal cells
- loss of parietal cells leads to achlorhydria (absence of hydrochloric acid in the gastric secretions)
- loss of IF leads to B12 deficency and pernicious anaemia
tumour ulcers vs peptic ulcers
tumour- have rolled, rounded edges due to collapse from the tumour
peptic - vertical edge, punched out appearance, margins level or slightly elevated
what is Ménétrier’s disease
a rare disorder characterized by giant mucosal folds in the proximal part of the stomach, diminished acid secretion, and a protein-losing state with hypoalbuminemia
acute stress ulcer (5) vs chronic peptic ulcer (5)
acute stress:
1. does not penetrate muscularis propria
2. no scarring under ucler
3. no endartitis obliterans
4. heals by regeneration
5. anywhere and multiple
chronic peptic:
1. penetrates muscularis propria
2. scarring under ulcer
3. endarteritis obliterans (inflammation of inner artery which usually results in lumen obstruction)
4. heals by repair w fibrous scar
5. single and usually antral
what are the 4 zones of prptic ulcers
- zone of cicatrisation (layer of fibrosis)
- superficial exudative zone (cellular layer rich in neutrophil polymorphs)
- granulation tissue zone
- necrotic zone (surface layer)
complications of peptic ulcers (7)
- penetration into pancreas, liver, gastroduodenal artery etc.
- biliary peritonitis (GB penetraiton)
- gastro-colic fistula (tansverse colon penetration)
- perforation
- haemorrhage
- pyloric stenosis
- malignant change
what is zollinger ellerson syndrome
increased gastrin secretion by a gastrin secreting tumour resulting in a thick gastric body mucosa with pronounce rugal folds, hyperplasia of gastric parietal cells and increased gastric acid secretion
ZE syndrom presentation (3)
- pain
- multiple duodenal ulcers in atypical sites
- diarrhoea (due to increases gastric secretion)
what condition are 1/3 of ZE syndrome gastrinomas associated with
MEN1/Werner’s sydnrome - rare disorder that causes tumors in the endocrine glands and parts of the small intestine and stomach, characterised by premature ageing
the rest are sporadic
what gene mutation is associated with Werner’s syndrome
11q13
what are gastric neoplasmsasms
- adenocarcinoma
- malignant gastrointestinal stromal
- lymphoma
when might a lymphoma resolve
HP related MALT lymphomas may resolve with HP eradication
what is a polyp
a lesion raised above the mucosa
risk factors for gastric adenocarcinoma (5)
- genetic
- group A blood
- diet - carcinogens, polycyclic hydrocarbons in smoked foods, increased starch etc.
- premalignant condtions e.g. atrophic gastritis, adenomas
- pernicious anaemia
4 types of gastric carcinoma (?)
- polypoid
- fungating
- ulcerated
- inflitrative
what layer is early gastric cancer usually limited to
mucosa or submucosa
what is virchow’s node
left-sided supraclavicular lymph node -> Troisier’s sign (hard, raised node) is indicative of gastric cancer as their lymphatic supply is from the abdominal cavity
what is the main causative agent of stomach cancer
H.pylori
4 conditions associated w H.Pylori
- acute and chronic gastritis
- peptic ulcer disease
- gastric adenocarcinoma
- non-Hodgkin lymphoma
what is whipple’s disease
systemic disorder that not only involves malabsorption from the gastrointestinal tract but also affects other systems like the cardiovascular, central nervous system, joints, and vascular system - caused by a gram-positive bacteria, Tropheryma whippeli
whipple’s disease presentation (6)
- steatorrhoea
- diahhorea
- malabsoption
- lymphadenopathy
- arthritis
- encephalopathy (occasionally)
