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FA - Gastrointestinal > GI - Pathology (Stomach & Ulcers) > Flashcards

GI - Pathology (Stomach & Ulcers) Flashcards

Pg. 351-352 in First Aid 2014 Sections include: -Gastritis -Menetrier disease -Stomach cancer -Peptic ulcer disease -Ulcer complications

1
Q

What are 2 types of gastritis? Which is erosive versus nonerosive?

A

(1) Acute gastritis (erosive) (2) Chronic gastritis (nonerosive)

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2
Q

What is the general underlying mechanism of acute gastritis?

A

Disruption of mucosal barrier => inflammation.

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3
Q

What are 6 causes of acute gastritis (erosive)?

A

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)

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4
Q

What is the mechanism by which NSAIDs cause acute gastritis?

A

NSAIDs (decrease PGE2 => decreased gastric mucosa protection)

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5
Q

What cause of gastritis leads to Curling versus Cushing ulcers and via what mechanisms?

A

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.”

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6
Q

In what 2 patient populations is acute gastritis especially common?

A

Especially common among (1) alcoholics and (2) patients taking daily NSAIDs (e.g., patients with rheumatoid arthritis).

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7
Q

What are 2 types of chronic (nonerosive) gastritis, and where in the stomach is each type found? Which is most common type?

A

(1) Type A (fundus/body) (2) Type B (antrum); Type B = Most common type.

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8
Q

What kind of disorder is Type A chronic gastritis? What are 3 things that characterize it? With what disorder/risk is it associated?

A

Autoimmune disorder characterized by Autoantibodies to parietal cells, pernicious Anemia, and Achlorhydria. Associated with other autoimmune disorders.

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9
Q

What causes Type B chronic gastritis? What 2 serious risks does this type increase?

A

Caused by H. pylori infection. Increased risk of MALT lymphoma and gastric adenocarcinoma.

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10
Q

What causes Type A versus Type B chronic gastritis? Again, where in the stomach is each type found?

A

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”

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11
Q

What change defines Menetrier disease? Give 3 characteristic effects.

A

Gastric hypertrophy with protein loss, parietal cell atrophy, and increased mucous cells

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12
Q

Is Menetrier disease related to cancer? If so, how?

A

Yes. Precancerous.

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13
Q

What gross appearance of the stomach characterizes Menetrier disease?

A

Rugae of stomach are so hypertrophied that they look like brain gyri

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14
Q

What is the most common stomach cancer?

A

Almost always adenocarcinoma

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15
Q

Describe the spread/metastases of stomach cancer (adenocarcinoma).

A

Early aggressive local spread and node/liver metastases.

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16
Q

With what condition does stomach cancer often present?

A

Often presents with acanthosis nigricans

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17
Q

What are 2 types of gastric adenocarcinoma?

A

(1) Intestinal (2) Diffuse

18
Q

With what 5 conditions/factors is intestinal gastric adenocarcinoma associated?

A

Associated with H. pylori infection, dietary nitrosamines (smoke foods), tobacco smoking, achlorhydria, chronic gastritis.

19
Q

Where is intestinal gastric adenocarcinoma commonly found? How does it look?

A

Commonly on lesser curvature; looks like ulcer with raised margins

20
Q

What is an important factor/association that distinguishes diffuse gastric adenocarcinoma from the intestinal type?

A

Diffuse - NOT associated with H. pylori (whereas intestinal type is)

21
Q

What histologic finding characterizes diffuse gastric adenocarcinoma?

A

Signet ring cells

22
Q

Describe the gross appearance of the stomach that characterizes diffuse gastric adenocarcinoma. What is the name for this?

A

Stomach wall grossly thickened and leathery (linitis plastica)

23
Q

What are the names of 3 common metastases to associate with gastric adenocarcinoma?

A

(1) Virchow node (2) Krukenberg tumor (3) Sister Mary Joseph nodule

24
Q

What is Virchow node?

A

Involvement of left supraclavicular node by metastasis from stomach

25
Q

What is Krukenberg tumor? What characterizes it on histology?

A

Bilateral metastases (of gastric adenocarcinoma) to ovaries. Abundant mucus, signet ring cells

26
Q

What is Sister Mary Joseph nodule?

A

Subcutaneous periumbilical metastasis (of gastric adenocarcinoma)

27
Q

What is the pain and weight change that occurs with gastric versus duodenal ulcers?

A

GASTRIC ULCER: Can be Greater with meals - weight loss; DUODENAL ULCER: Decreases with meals - weight gain

28
Q

What percentage of Gastric versus Duodenal ulcer cases are associated with H. pylori infection?

A

GASTRIC ULCER: In 70%; DUODENAL ULCER: In almost 100%

29
Q

What is the mechanism behind Gastric versus Duodenal ulcers?

A

GASTRIC ULCER: Decreased mucosal protection against gastric acid; DUODENAL ULCER: Decreased mucosal protection OR Increased gastric acid secretion

30
Q

Besides H. pylori infection, what are other causes of gastric versus duodenal ulcers?

A

GASTRIC ULCER: NSAIDs; DUODENAL ULCER: Zollinger-Ellison syndrome

31
Q

What is the risk of carcinoma associated with gastric versus duodenal ulcers?

A

GASTRIC ULCERS: Increased; DUODENAL ULCERS: Generally benign

32
Q

In what patient population do gastric ulcers often occur?

A

Often occurs in older patients

33
Q

What structural change is associated with duodenal ulcers?

A

Hypertrophy of Brunner glands

34
Q

What are 2 types of peptic ulcer disease?

A

(1) Gastric ulcer (2) Duodenal ulcer

35
Q

What are 2 ulcer complications?

A

(1) Hemorrhage (2) Perforation

36
Q

For what kind(s) of peptic ulcer disease can hemorrhage occur as a complication? In which direction is this complication greater?

A

Gastric, duodenal (posterior > anterior)

37
Q

For what kind(s) of peptic ulcer disease can perforation occur as a complication? In which direction is this complication greater?

A

Duodenal (anterior > posterior)

38
Q

Where is hemorrhage from gastric ulcer likely to occur, and what would be the source of bleeding?

A

Ruptured gastric ulcer on the lesser curvature of the stomach => bleeding from left gastric artery

39
Q

Where is hemorrhage from duodenal ulcer likely to occur, and what would be the source of bleeding?

A

An ulcer on posterior wall of the duodenum => bleeding from gastroduodenal artery

40
Q

What imaging and historical findings characterize perforation as a duodenal ulcer complication?

A

May see free air under diaphragm with referred pain to shoulder

FA - Gastrointestinal (24 decks)

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