L13: Gastric Disorders Flashcards
what is Gastritis?
Inflammation of the gastric mucosa
Dx of Gastritis
Diagnosis mostly histological
Nature of Acute Gastritis
Acute mucosal inflammatory process usually of a transient nature.
Nature of infiltration in Acute Gastritis
Neutrophilic infiltration
Causes of Acute Gastritis
Pathogenesis of Acute Gastritis
Morphology of gastric mucosa in Acute Gastritis
Def of Chronic Gastritis
- Presence of chronic mucosal inflammatory changes leading eventually to mucosal atrophy and intestinal metaplasia, usually in the absence of erosions
Causes of Chronic Gastritis
Pathogenesis of Chronic atrophic gastritis
Pathogenesis of Autoimmune atrophic gastritis
Morphology of Chronic Gastritis
Def of Gastric Polyps
luminal lesions projecting above the plane of the mucosal surface.
Main goal in managment of Gastric Polyps
- to rule out the possibility of malignancy
Various subtypes of gastric polyps are recognized and generally divided into:
- Non- neoplastic
- Neoplastic.
epidemeology of Gastric Polyps
Incidence of Gastric Polyps
1-3% of all gastroscopies
Age of Gastric Polyps
2/3 Above age of 60 years.
Frequency and type of gastric polyps vary depending on the population and location.
- H Pylori common & PPI less common →
- H Pylori less common & PPI common →
- Hyperplastic / adenoma > Fundic
- Fundic > Hyperplastic / adenoma
- Fundic glands polyp common in the West.
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- Specific genetic mutations are responsible for polyp formation.
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BSG Classification of Gastric Polyps
Benign epithelial gastric polyps BEGP
Non-mucosal intramural polyps
Types of Fundic Gland Polyps
sporadic or associated with polyposis
syndrome.
Characters of Fundic Gland Polyps
Typically small (0.1 -0.8 cm), hyperemic, sessile, flat,
nodular lesions that have a smooth surface contour
Site of Fundic Gland Polyps
Exclusively in the gastric corpus. Can sometimes be large.
ME of Fundic Gland Polyps
Composed of normal gastric corpus-type epithelium, arranged in a disorderly and/or microcystic configuration.
Incidence of Sporadic Fundic Gland Polyps
Sporadic FGP: F>M, middle age, 40% multiple.
Long Term Use of PPI & Fundic Gland Polyps
Long term PPI associate with 4x risk of FGP
H.Pylori & Fundic Gland Polyps
H Pylori infection appears to protect the development of FGP
Fundic Gland Polyps in FAP
Fundic Gland Polyps in FAP
- Gene Mutation
Mutation of the APC gene
Incidnce of Hyperplastic Polyps
75 % of gastric polyps in areas where H. pylori is common.
Shape of Hyperplastic Polyps
Small, dome-shaped, or stalked polyps (average size 1.0 cm), single or multiple.
Site of Hyperplastic Polyps
Primarily in the antrum, but may develop in the fundus or
cardia.
Incidence of Adenomatous Polyps
- 6 to 10 % of gastric polyps.
ME of Hyperplastic Polyps
elongated, dilated or cystic, architecturally
distorted, foveolar epithelium within chronically inflamed lamina propria.
Site of Adenomatous Polyps
Found in the antrum, some occur in the
corpus and cardia.
Shape of Adenomatous Polyps
flat or polypoid
Size of Adenomatous Polyps
Range in size from a few mm to
several cm.
ME of Adenomatous Polyps
similar to typical colonic adenomas: tubular, tubulovillous, or villous, are sessile or stalked, occasionally large sizes
Incidence of Hamartomatous Polyps
Rare
Types of Hamartomatous Polyps
- Juvenile polyps
- PJS: (peutz jeghers syndrome)
- Cowden disease
Juvenile polyps
solitary, antral, inflammatory or hamartomatous, no malignant potential.
PJS
AD, hamartomatous Gl polyps, mucocutan. Pigmentation, increase risk of cancer.
Cowden disease
AD, orocutaneous hamartomatous, extra Gl abnormalities.
Malignant transformation in Hamartomatous polyps
rare
Tumors in Inflammatory Fibroid Polyps
Vanek tumors.
Incidence of Inflammatory Fibroid Polyps
Rare, 1% of all gastric polyps.
Origin of Inflammatory Fibroid Polyps
Originate from submucosa, usually in antrum or peripyloric area.
Characters of Inflammatory Fibroid Polyps
Central depression/ ulceration.
Symptoms of Inflammatory Fibroid Polyps
Asymptomatic, can be present with bleeding or gastric outlet obstruction.
Malignant transformation of Inflammatory Fibroid Polyps
No malignant potential but as with chronic atrophic gastritis.
ME of Inflammatory Fibroid Polyps
Submucosal proliferation of spindle cells/small vessels with an inflammatory infiltrate with many eosinophils.