GI Pathology I: Stomach Flashcards
What cells are found in the fundus and the body of the stomach?
- Chief Cells
- Parietal Cells
Omphalocele
- Persistent herniation of bowel into umbilical cord
- Failure of abdominal wall to return to body cavity during development
- Covered by peritoneum and amnion of cord
Gastroschisis
•Malformation of abdominal wall causing exposure of abdominal contents
What is the main difference in the omphalocele and the gastroschisis?
Omphaloceles are partially protected so surgery can be delayed
Pyloric Stenosis
Congenital hypertrophy of smooth muscle of pylorus
What are the signs of pyloric stenosis?
- More common in males
- Causes projectile vomiting in first 2‐6 weeks of life
- Visible peristalsis
- Olive‐like mass in abdomen
What are some of the possible causes of gastritis?
- NSAID/Aspirin/Cigarettes/Alcohol can cause injury
- Ischemia/Shock/Delayed Emptying can impair defenses
What are the common causes of acute gastritis?
Impairment of protective system: NSAIDs, ingestion, direct injury
What is the common cause of chronic gastritis?
H. pylori infection
What is the gross finding of acute gastritis?
Hyperemic
What is the histologic finding of acute gastritis?
Infiltration of neutrophils and breakage of the mucosa
What are some of the risks of H. pylori infection?
– Poverty – Household crowding – Limited education – African American or Mexican American ethnicity – Poor sanitation – Birth outside of US
Where is H. pylori infection of the stomach most often found in?
Antrum
What cancers does H. pylori increase the risk of?
- Gastric Adenocarcinoma
- MALT Lymphoma
What are the main treatment options for H. pylori?
Antibiotics with proton pump inhibitors
- Tripe and Quadruple Therapy
- Sequential Therapy
Autoimmune Chronic Gastritis
- Spare the antrum
- Ab are made against the parietal cells and intrinsic factor
What can autoimmune chronic gastritis lead to?
- Pernicious Anemia
- Gastric Adenocarcinoma
- Defective Acid Secretion
63‐year‐old male with occasional nausea and upper abdominal pain undergoes upper endoscopy. Biopsy shows chronic gastritis of the fundus with flattened mucosa and no ulceration. Which of the following is most likely to be associated with this finding?
A. Hyperchlorhydria B. Infection with H. pylori C. Diet high in nitrates D. Elevated gastrin levels E. Autoantibodies to parietal cells
E. Autoantibodies to parietal cells
What are stress ulcers associated with?
• Stress ulcers: shock, sepsis, severe trauma
What are Curling ulcers associated with?
• Curling ulcers: severe burns, trauma
What are Cushing ulcers associated with?
• Cushing ulcers: intracranial disease
What are the most common causes of chronic peptic ulcer disease?
- H. pylori
- NSAIDs
Where are chronic peptic ulcers most often found?
- Proximal Duodenum
- Antrum
How does food affect duodenal ulcers?
• Food Decreases pain with Duodenal ulcers
How does food affect gastric ulcers?
• Pain becomes Greater with Gastric ulcers
What are the mechanisms used to diagnose H. pylori?
- Biopsy
- Serologic testing for H pylori antibodies
- Fecal detection
- Urea breath test
What are some risk factors for chronic peptic ulcer disease?
– NSAIDs – Cigarette smoking – High‐dose corticosteroids – Alcoholic cirrhosis – COPD – Chronic renal failure – Hyperparathyroidism – Psychologic stress
40‐year‐old female with obesity and diabetes mellitus presents to her doctor with 2 months of intermittent RUQ abdominal pain associated with food, most notably after eating fatty foods. What is the most likely diagnosis?
A. Biliary colic from gallstones
B. Acute gastritis
C. Gastroesophageal reflux disease (GERD)
D. Autoimmunegastritis
A. Biliary colic from gallstones
Gastric Polyp
Nodule or mass that projects above the level of the surrounding mucosa and forms due to hyperplasia, inflammation, ectopia or neoplasia.
Where do extra nodal lymphomas occur most commonly?
Extra nodal lymphomas occur most commonly in GI tract, especially stomach.
What is the origin of gastric carcinoid tumors?
Arise from neuroendocrine organs – G‐cells in stomach - with 40% found in the small intestine
Gastrointestinal stromal tumor
GIST are a mesenchymal neoplasm of interstitial cells of Cajal: pacemaker cells for gut peristalsis. Solitary, well‐circumscribed, fleshy, submucosal mass.
What population is GIST more prevalent in?
Males
What is the treatment for GIST?
- Surgical resection if possible
* Imatinib is a drug that inhibits tyrosine kinase activity of c‐KIT and PDGRFA
What are the types of Gastric Adenocarcinoma?
- Intestinal
- Diffuse
Intestinal Gastric Adenocarcinoma
Bulky, have glandular structures, exophytic mass or
ulcerated tumor
Diffuse Gastric Adenocarcinoma
Infiltrative growth, discohesive cells with large mucin vacuoles with signet ring cells
What is the main mutation in diffuse adenocarcinoma?
E-cadherin mutations can lead to cell movement - diffuse
What is the main mutation in intestinal adenocarcinoma?
APC mutation which regulates cell growth - intestinal
What are some of the metastases of gastric adenocarcinoma?
- Left supraclavicular node: Virchow node
* Distant metastases often liver
What is the metastasis of diffuse adenocarcinoma?
Bilateral ovaries: Krukenberg tumor
What is the metastasis of intestinal adenocarcinoma?
Periumbilical region: Sister Mary Joseph nodule
56y female presents with abdominal fullness, nausea and weight loss worsening over 2 months. CT abdomen/pelvis shows thickening of her stomach and bilateral ovarian masses.
What would be expected on the ovarian biopsies?
A. Squamous cell cancer
B. Mucinous adenocarcinoma
C. Signet ring cells
D. Leiomyosarcoma
C. Signet ring cells
