GIT, Oral Cavity and Esophagus Path 2 Flashcards
chief cells secrete ______ where are they found?
pepsinogen
fundus and corpus (body)
ulcers with a CLEAN base is seen in _____ ulcer
acute gastric ulcer
superficial muscosal injury (erosions), ulcers (full thickness mucosal injury), hemorrhage on endoscopy and punctuate areas of hemorrhage, and edema and congestion of the lamina propria are seen in what disease of the stomach?
acute gastritis
acute is erosive while chronic is non erosive
what are oxyntic glands of the stomach and where can they be found?
- acid producing glands
- found in the fundus and corpus (body)
what are 3 major histological findings of autoimmune gastritis?
- chronic inflammation
- gastric atrophy
- intestinal metaplasia
GIST has ______ tumor cells
mesenchymal
lymphocytic aggregates that are mainly superficial is a marker of _______
H. pylori infection causes chronic gastritis
NSAIDS can cause gastritis due to _____
- inhibition prostaglandins which maintain intact gastric mucosal barrier by ↑ secretion of mucous and bicarbonate
- direct irritant: denudation of surface epithelium and ↑ mucosal permeability of ions
active ulcer has 4 zones:
- necrotic fibrinoid debris
- non specific inflammatory infiltrate that is predominately neutrophils
- granulation tissue
- fibrosis and collagenous scar
what is the most common carincoma of the stomach? where is it most commonly seen?
gastric adenocarcinoma; highest occurrence in Japan and South Korea (dietary habits)
what are two distinct types of gastric adenocarcinoma and which is more common?
- intestinal gastric adenocarcinoma (most common 90%) with intestinal metaplasia; associated with H. Pylori
- diffuse: due to E cadherin mutation with no risk factors, no gland formation and linitis plastica appearance
both autoimmune gastritis and H. pylori can extend into the fundus. What patterns of invasion can help you distinguish between the two causes?
- patchy pattern in fundus = H. pylori (but diffuse in the antrum)
- diffuse pattern in fundus = autoimmune
which parts of the stomach have glands with chief cells that secrete pepsinogen and parietal cells that secrete acid and intrinsic factor?
corpus and fundus
corpus: aka the body of the stomach
fundus: the very top of the stomach
describe that biology of H. pylori
- gram negative
- curvilinear
- motile w/ flagella
- non invasive
- UREASE POSITIVE bacillus
most common site of peptic ulcer is ______
duodenum > stomach (antrum/cardia) > gastro esophageal junction
what is the age range that is most commonly associated with diffuse gastric adenocarcionam
< 50 years old due to E cadherin mutation
what are two patterns of gastritis that are associated with H. pylori?
- diffuse antral gastritis
- multifocal atrophic gastritis
↑ ↑ levels of gastrin is seen in what cause of chronic gastritis?
- seen in autoimmune gastritis because oxyntic glands cannot produce HCl (achlorhydria) so ↑ gastrin
however, with H. pylori, there e is still acid secretion in the stomach so can see ↑ or normal levels of gastrin
what is the importance of prostaglandins for the gastric mucosa
- maintain blood flow
- ↑ mucous and bicarbonate secretin
- augment epithelial defenses
when do you feel pain in peptic ulcers and what relieves this pain?
- burning epigastric pain 1-2 hours AFTER a meal
- pain relieved by food and alkali
H. pylori chronic gastritis is most commonly seen in what part of the stomach?
antrum
prognosis of gastric adenocarcinoma depends on ______ and _____
depth of invasion and nodal status
most common causes of chronic gastritis are ______
H. pylori and autoimmune causes (pernicious anemia)
signet cells are associated with which gastric condition?
- diffuse gastric adenocarcinoma
what are some secondary changes that can occur in chronic gastritis?
- glandular atrophy
- intestinal metaplasia (goblet cells in epithelium)
- dysplasia
gastric ulcers is described as loss of mucosa that extends through _____
muscular mucosae or deeper
describe the mucosal cells seen on biopsy of a malignant GIST
normal mucosa (not in seen in gastric adneocarinoma) that covers the tumor is smooth
describe some etiological factors for acute gastritis
- NSAIDS
- excessive alcohol consumption
- heavy smoking
- ischemia and shock
- uremia
- severe stress
flat edges with a punched out out appearance is descriptive of _____
peptic ulcer
intestinal gastric adenocarcinoma has heaped up edges
autoimmune gastritis where there is autoantibodies to ________ in the _________ part of the stomach, is associated with ↑ risk for ______ and _____
parietal cell antigens/IF
found in the fundus and body (corpus)
while chronic gastritis caused by H. pylori would be most commonly seen in the antrum
↑ risk for: gastric carcinoma and neuroendocrine tumors (carcincoids) aka Zollinger Ellison syndrome
why is serology not a usually very good for diagnosing H. pylori infection?
- the antibodies can be present longer than the organism, ever after treating the infection
E cadherin gene mutation is associated with ________
- diffuse gastric adenocarcinoma
- lobular carcinoma of the breast
where can you expect to see peptic ulcers is Zollinger Ellison syndrome?
- stomach
- duodenum
- jejunum
due to ↑ ↑ secretion of gastrin
H. pylori is the most common cause of _____
peptic ulcers
krukenberg tumor which is __________ is associated with which gastric disease
bilateral ovarian spread;
can be seen with gastric adenocarcinoma
what are some acquired causes to pyloric stenosis?
- chronic antral gastritis
- peptic ulcers
- malignancy
biopsy of a patients stomach shows whorls and bundles of spindle shaped or epithelioid cells. What is the disease and the most commonly associated mutation
diagnosis: GIST
mutation: Kit (tyrosine kinase inhibitor)
what are 4 conditions that are associated with H. pylori?
- chronic gastritis (diffuse antral and multifocal atrophic)
- peptic ulcer
above two caused by enzymes released by H. pylori leading to mucosal damage - gastric carcinoma
- gastric lymphoma (MALToma)
above two due to H. pylori attacking PMN’s and inflammatory cells → uncontrolled B cell proliferation
GIST (gastrointestinal stromal tumors) are derived from _________ and ____ mutations are present in most tumors
- cells of Cajal (pacemaker cells)
- Kit mutations (tyrosine kinase inhibitor)
H. pylori produces _______ and is gram _____
urease; gram negative
urease produces ammonia which allows it to survive in the very acidic conditions of the stomach
ulcers with a necrotic base with granulation tissue is seen in _______
peptic ulcers (this a a chronic ulcer)
heaped up edges with polypoid growth is seen in _____
intestinal gastric adenocarcinoma
peptic ulcer has flat edges
is malignant transformation common in gastric and duodenal peptic ulcers?
no, but it is the surrounding gastritis that can lead to gastric carcinoma; NOT the ulcer
where in the GI do you most commonly see ulcers due to H. Pylori infection
duodenum; (second is gastric ulcers)
parietal cells secrete ____________
where are they found?
acid and intrinsic factor
corpus and fundus (body)
thick walled stomach with flattened rugae is a description of stomach due to ______
diffuse adenocarcinoma (leather bottle stomach)
severe trauma (head injuries) or major surgeries or extensive burns are associated with ______ ulcers
acute gastric ulcers;
systemic acidosis and hypoxia: severe trauma and burns
vagal stimulation: intracranial lesions
which gastric neoplasm is derived from the cells of Cajal (pacemaker cells)
GIST
rapid urease test and urea breath test are used to diagnose ______
H. pylori
what are 3 genetic conditions that are associated with congenital hypertrophic pyloric stenosis
- Turner syndrome
- Trisomy 18
- esophageal atresia
will see concentric hypertrophy of circular muscular coat
what are the two most common sites of involvement of gastric adenocarcinoma
- pylorus
- antrum
- cardia (25%)
these are sites that have glands that secrete mucus
how do you differentiate between chronic gastritis caused by H. pylori vs. autoimmune?
autoimmune cause: atrophic gastritis
- will see thick mucosal folds in H. Pylori caused chronic gastritis
glands that only secrete mucus are found in the ____ and ____
cardia and antrum
cardia: part right under the esophagus
antrum: part that is right before the pyloric canal which is before the pylorus
what drug is given to treat GIST?
Gleevec which is a tyrosine kinase inhibitor
Kit gene is a _______ and a mutation in these gene is seen in ______
tyrosine kinase inhibitor; GIST
reactive gastropathy is a precursor lesion for ulcers formed due to ______
NSAIDs
- also other drugs and meds: iron
- acid, alkali, alcohol
- bile: due to duodeno pancreatic reflux
has minimal inflammation
