Gastrointestinal Pathology - Stomach Flashcards
What is omophalocele and what causes it?
It is a persistent herniation of bowel into umbilical cord and is caused by the failure of herniated intestines to return to the body cavity during development. The contents are covered by peritoneum and amnion of the umbilical cord.
What is Gastrochsis and how would the patient present?
It is a congenital malformation of the anterior abdominal wall leading to exposure of abdominal contents.
You are a resident in the pediatric clinic and the mother brings her two week old baby. She complains that the baby has been vomiting in a projectile fashion, when she felt his belly he has a mass in his abdomen, and you can see that there is visible peristalsis. What do you think the baby has? How would you treat him?
The baby has pyloric stenosis which is a congenital hypertrophy of pyloric smooth muscle. It is more common in males. Treatment is myotomy.
What is acute gastritis and how does the body protects itself?
Acute gastritis is acidic damage to this, because. The body defends itself by using the mucin layer produced by foveolar cells, bicarbonate secretion by surface epithelium, and normal blood supply.
What are the risk factors for acute gastritis and what does it do to the body?
Risk factors are severe burn, NSAIDs, heavy alcohol consumption, chemotherapy, Cushing ulcer, and shock. Acid damage results in superficial inflammation, erosion and ulcer.
What is chronic gastritis and what are the two types?
It is chronic inflammation of stomach mucosa. The two types are chronic autoimmune gastritis and chronic capital H. Pylori gastritis.
What causes chronic autoimmune gastritis and what is it associated with? What causes the pathogenesis?
It is due to autoimmune destruction of gastric parietal cells which are located in the stomach body and friends. It is associated with anybody’s against parietal cells and or intrinsic factors. Pathogenesis is mediated by T cells which is a type four hypersensitivity.
What are the four clinical features of chronic gastritis?
Atrophy of mucosal with intestinal metaplasia; achlorhydria with increased gastrin levels and antral G cell hyperplasia; megaloblastic anemia due to lack of intrinsic factor; increased risk for gastric adenocarcinoma.
What is the most common form of gastritis and what site does it favor?
Chronic H pylori gastritis at the stomach antrum. H. pylori ureases and proteases along with inflammation weaken mucosal defenses.
How does Chronic H pylori gastritis present and how is it treated and how do you confirm the disease is gone?
Presents with epigastric abdominal pain, increased risk for ulceration (peptic ulcer disease) , gastric adenocarcinoma (intestinal type and MALT lymphoma.
Tx involves triple therapy
1. Gastritis / ulcer is resolved and intestinal metaplasia is reversed
2. Negative urea breath test and lack of stool antigen confirm eradication of H. pylori
A patient present with epigastric pain to your clinic. He mentions that he feels better after eating a meal. What could he have and what organism is causing it? What would you see on biopsy? Is this condition malignant? Can you see bleeding from this ulcer?
He has duodenal ulcer due to H. pylori. Endoscopic biopsy shows ulcer with hypertrophy of Brunner glands. It usually arises in anterior duodenum. Almost never malignant. (ZE syndrome is also a rare cause) When present in posterior duodenum. rupture may lead to bleeding from the gastro duodenal artery or acute pancreatitis.
A patient present with epigastric pain to your clinic. He mentions that he feels worse after eating a meal. What could he have and what organism is causing it? Where is this located? Is this condition malignant?
He has gastric ulcer due to H. Pylori. Other causes include NSAIDs and bile reflux. Ulcer is usually located on the lesser curvature of the Antrum. Rupture carries risk of bleeding from left gastric artery. It can be malignant if it is large and irregular.
What is gastric carcinoma and what are the two types?
Malignant proliferation of surface epithelial cells (adenocarcinoma). Sub classified into intestinal and diffuse types.
How does intestinal gastric carcinoma present? Which location does it favor? What are some risk factors? If it metastasizes, which site does it prefer?
Presents as a large irregular ulcer with heaped up margins commonly involving the lesser curvature of the antrum. Risk factors include intestinal metaplasia (due to H, pylori and autoimmune gastritis), nitrosamines in smoked food, blood type A. Periumbilical region (Sister Mary Joseph nodule)
You are looking at a biopsy that shows signet ring cells that diffusely infiltrate the gastric wall. What are you looking at? What happens to the stomach wall as a result? Does it have the same risk factors as intestinal type? If this metastasizes where does it go?
Diffuse type of gastric carcinoma. Desmoplasia (invasion by fibrous tissue) results in thickening of the stomach wall (linitis plastica). Bilateral ovaries (Krukenberg tumor).
