GI - Pathology (Stomach & Ulcers) Flashcards
Pg. 351-352 in First Aid 2014 Sections include: -Gastritis -Menetrier disease -Stomach cancer -Peptic ulcer disease -Ulcer complications
What are 2 types of gastritis? Which is erosive versus nonerosive?
(1) Acute gastritis (erosive) (2) Chronic gastritis (nonerosive)
What is the general underlying mechanism of acute gastritis?
Disruption of mucosal barrier => inflammation.
What are 6 causes of acute gastritis (erosive)?
Can be caused by (1) Stress, (2) NSAIDs (decrease PGE2 => decreased gastric mucosa protection), (3) Alcohol, (4) Uremia, (5) Burns (Curling ulcer - low plasma volume => sloughing of gastric mucosa), and (6) Brain injury (Cushing ulcer - high vagal stimulation => increased ACh => increased H+ production)
What is the mechanism by which NSAIDs cause acute gastritis?
NSAIDs (decrease PGE2 => decreased gastric mucosa protection)
What cause of gastritis leads to Curling versus Cushing ulcers and via what mechanisms?
Burns (Curling ulcer - low plasma volume => sloughing of gastric mucosa), and Brain injury (Cushing ulcer - high vagal stimulation => increased ACh => increased H+ production); Think: “burned by the Curling iron. always Cushion the brain.”
In what 2 patient populations is acute gastritis especially common?
Especially common among (1) alcoholics and (2) patients taking daily NSAIDs (e.g., patients with rheumatoid arthritis).
What are 2 types of chronic (nonerosive) gastritis, and where in the stomach is each type found? Which is most common type?
(1) Type A (fundus/body) (2) Type B (antrum); Type B = Most common type.
What kind of disorder is Type A chronic gastritis? What are 3 things that characterize it? With what disorder/risk is it associated?
Autoimmune disorder characterized by Autoantibodies to parietal cells, pernicious Anemia, and Achlorhydria. Associated with other autoimmune disorders.
What causes Type B chronic gastritis? What 2 serious risks does this type increase?
Caused by H. pylori infection. Increased risk of MALT lymphoma and gastric adenocarcinoma.
What causes Type A versus Type B chronic gastritis? Again, where in the stomach is each type found?
TYPE A - Autoimmune; First part of the stomach (fundus/body); TYPE B - H. pylori Bacteria; Second part of stomach (antrum); Think: “A comes before B”
What change defines Menetrier disease? Give 3 characteristic effects.
Gastric hypertrophy with protein loss, parietal cell atrophy, and increased mucous cells
Is Menetrier disease related to cancer? If so, how?
Yes. Precancerous.
What gross appearance of the stomach characterizes Menetrier disease?
Rugae of stomach are so hypertrophied that they look like brain gyri
What is the most common stomach cancer?
Almost always adenocarcinoma
Describe the spread/metastases of stomach cancer (adenocarcinoma).
Early aggressive local spread and node/liver metastases.
With what condition does stomach cancer often present?
Often presents with acanthosis nigricans
What are 2 types of gastric adenocarcinoma?
(1) Intestinal (2) Diffuse
With what 5 conditions/factors is intestinal gastric adenocarcinoma associated?
Associated with H. pylori infection, dietary nitrosamines (smoke foods), tobacco smoking, achlorhydria, chronic gastritis.
Where is intestinal gastric adenocarcinoma commonly found? How does it look?
Commonly on lesser curvature; looks like ulcer with raised margins
What is an important factor/association that distinguishes diffuse gastric adenocarcinoma from the intestinal type?
Diffuse - NOT associated with H. pylori (whereas intestinal type is)
What histologic finding characterizes diffuse gastric adenocarcinoma?
Signet ring cells
Describe the gross appearance of the stomach that characterizes diffuse gastric adenocarcinoma. What is the name for this?
Stomach wall grossly thickened and leathery (linitis plastica)
What are the names of 3 common metastases to associate with gastric adenocarcinoma?
(1) Virchow node (2) Krukenberg tumor (3) Sister Mary Joseph nodule
What is Virchow node?
Involvement of left supraclavicular node by metastasis from stomach
What is Krukenberg tumor? What characterizes it on histology?
Bilateral metastases (of gastric adenocarcinoma) to ovaries. Abundant mucus, signet ring cells
What is Sister Mary Joseph nodule?
Subcutaneous periumbilical metastasis (of gastric adenocarcinoma)
What is the pain and weight change that occurs with gastric versus duodenal ulcers?
GASTRIC ULCER: Can be Greater with meals - weight loss; DUODENAL ULCER: Decreases with meals - weight gain
What percentage of Gastric versus Duodenal ulcer cases are associated with H. pylori infection?
GASTRIC ULCER: In 70%; DUODENAL ULCER: In almost 100%
What is the mechanism behind Gastric versus Duodenal ulcers?
GASTRIC ULCER: Decreased mucosal protection against gastric acid; DUODENAL ULCER: Decreased mucosal protection OR Increased gastric acid secretion
Besides H. pylori infection, what are other causes of gastric versus duodenal ulcers?
GASTRIC ULCER: NSAIDs; DUODENAL ULCER: Zollinger-Ellison syndrome
What is the risk of carcinoma associated with gastric versus duodenal ulcers?
GASTRIC ULCERS: Increased; DUODENAL ULCERS: Generally benign
In what patient population do gastric ulcers often occur?
Often occurs in older patients
What structural change is associated with duodenal ulcers?
Hypertrophy of Brunner glands
What are 2 types of peptic ulcer disease?
(1) Gastric ulcer (2) Duodenal ulcer
What are 2 ulcer complications?
(1) Hemorrhage (2) Perforation
For what kind(s) of peptic ulcer disease can hemorrhage occur as a complication? In which direction is this complication greater?
Gastric, duodenal (posterior > anterior)
For what kind(s) of peptic ulcer disease can perforation occur as a complication? In which direction is this complication greater?
Duodenal (anterior > posterior)
Where is hemorrhage from gastric ulcer likely to occur, and what would be the source of bleeding?
Ruptured gastric ulcer on the lesser curvature of the stomach => bleeding from left gastric artery
Where is hemorrhage from duodenal ulcer likely to occur, and what would be the source of bleeding?
An ulcer on posterior wall of the duodenum => bleeding from gastroduodenal artery
What imaging and historical findings characterize perforation as a duodenal ulcer complication?
May see free air under diaphragm with referred pain to shoulder
