GI Pathology I: Stomach

Question 1

What cells are found in the fundus and the body of the stomach?

Answer 1

• Chief Cells

- Parietal Cells

Question 2

Omphalocele

Answer 2

• 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

Question 3

Gastroschisis

Answer 3

•Malformation of abdominal wall causing exposure of abdominal contents

Question 4

What is the main difference in the omphalocele and the gastroschisis?

Answer 4

Omphaloceles are partially protected so surgery can be delayed

Question 5

Pyloric Stenosis

Answer 5

Congenital hypertrophy of smooth muscle of pylorus

Question 6

What are the signs of pyloric stenosis?

Answer 6

• More common in males
• Causes projectile vomiting in first 2‐6 weeks of life
• Visible peristalsis
• Olive‐like mass in abdomen

Question 7

What are some of the possible causes of gastritis?

Answer 7

• NSAID/Aspirin/Cigarettes/Alcohol can cause injury

- Ischemia/Shock/Delayed Emptying can impair defenses

Question 8

What are the common causes of acute gastritis?

Answer 8

Impairment of protective system: NSAIDs, ingestion, direct injury

Question 9

What is the common cause of chronic gastritis?

Answer 9

H. pylori infection

Question 10

What is the gross finding of acute gastritis?

Answer 10

Hyperemic

Question 11

What is the histologic finding of acute gastritis?

Answer 11

Infiltration of neutrophils and breakage of the mucosa

Question 12

What are some of the risks of H. pylori infection?

Answer 12

– Poverty
– Household crowding
– Limited education
– African American or Mexican American ethnicity
– Poor sanitation
– Birth outside of US

Question 13

Where is H. pylori infection of the stomach most often found in?

Answer 13

Antrum

Question 14

What cancers does H. pylori increase the risk of?

Answer 14

• Gastric Adenocarcinoma

- MALT Lymphoma

Question 15

What are the main treatment options for H. pylori?

Answer 15

Antibiotics with proton pump inhibitors

• Tripe and Quadruple Therapy
• Sequential Therapy

Question 16

Autoimmune Chronic Gastritis

Answer 16

• Spare the antrum

- Ab are made against the parietal cells and intrinsic factor

Question 17

What can autoimmune chronic gastritis lead to?

Answer 17

• Pernicious Anemia
• Gastric Adenocarcinoma
• Defective Acid Secretion

Question 18

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

Answer 18

E. Autoantibodies to parietal cells

Question 19

What are stress ulcers associated with?

Answer 19

• Stress ulcers: shock, sepsis, severe trauma

Question 20

What are Curling ulcers associated with?

Answer 20

• Curling ulcers: severe burns, trauma

Question 21

What are Cushing ulcers associated with?

Answer 21

• Cushing ulcers: intracranial disease

Question 22

What are the most common causes of chronic peptic ulcer disease?

Answer 22

• H. pylori

- NSAIDs

Question 23

Where are chronic peptic ulcers most often found?

Answer 23

• Proximal Duodenum

- Antrum

Question 24

How does food affect duodenal ulcers?

Answer 24

• Food Decreases pain with Duodenal ulcers

Question 25

How does food affect gastric ulcers?

Answer 25

• Pain becomes Greater with Gastric ulcers

Question 26

What are the mechanisms used to diagnose H. pylori?

Answer 26

* Biopsy * Serologic testing for H pylori antibodies * Fecal detection * Urea breath test

Question 27

What are some risk factors for chronic peptic ulcer disease?

Answer 27

``` – NSAIDs – Cigarette smoking – High‐dose corticosteroids – Alcoholic cirrhosis – COPD – Chronic renal failure – Hyperparathyroidism – Psychologic stress ```

Question 28

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

Answer 28

A. Biliary colic from gallstones

Question 29

Gastric Polyp

Answer 29

Nodule or mass that projects above the level of the surrounding mucosa and forms due to hyperplasia, inflammation, ectopia or neoplasia.

Question 30

Where do extra nodal lymphomas occur most commonly?

Answer 30

Extra nodal lymphomas occur most commonly in GI tract, especially stomach.

Question 31

What is the origin of gastric carcinoid tumors?

Answer 31

Arise from neuroendocrine organs – G‐cells in stomach - with 40% found in the small intestine

Question 32

Gastrointestinal stromal tumor

Answer 32

GIST are a mesenchymal neoplasm of interstitial cells of Cajal: pacemaker cells for gut peristalsis. Solitary, well‐circumscribed, fleshy, submucosal mass.

Question 33

What population is GIST more prevalent in?

Answer 33

Males

Question 34

What is the treatment for GIST?

Answer 34

* Surgical resection if possible | * Imatinib is a drug that inhibits tyrosine kinase activity of c‐KIT and PDGRFA

Question 35

What are the types of Gastric Adenocarcinoma?

Answer 35

- Intestinal | - Diffuse

Question 36

Intestinal Gastric Adenocarcinoma

Answer 36

Bulky, have glandular structures, exophytic mass or | ulcerated tumor

Question 37

Diffuse Gastric Adenocarcinoma

Answer 37

Infiltrative growth, discohesive cells with large mucin vacuoles􏰀 with signet ring cells

Question 38

What is the main mutation in diffuse adenocarcinoma?

Answer 38

E-cadherin mutations can lead to cell movement - diffuse

Question 39

What is the main mutation in intestinal adenocarcinoma?

Answer 39

APC mutation which regulates cell growth - intestinal

Question 40

What are some of the metastases of gastric adenocarcinoma?

Answer 40

* Left supraclavicular node: Virchow node | * Distant metastases often liver

Question 41

What is the metastasis of diffuse adenocarcinoma?

Answer 41

Bilateral ovaries: Krukenberg tumor

Question 42

What is the metastasis of intestinal adenocarcinoma?

Answer 42

Periumbilical region: Sister Mary Joseph nodule

Question 43

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

Answer 43

C. Signet ring cells