L80

Question 1

How do you distinguish between antrum // fundus + body on histo?

Answer 1

Antrum:

- More glands w/ pale mucin

Question 2

What is gastropathy vs gastritis?

Answer 2

Gastropathy: changes to mucosa w/ little or mild inflammation
Gastritis = INFLAM

Question 3

Histo features of gastritis caused by chemicals (bile, etc)

Answer 3

Fovea on top are longer - look more like vili

+ Lymphocytes in lamina propria

Question 4

What is iron pill gastritis? What does it look like on histo?

Answer 4

Inflam b/c you’re taking iron pills
Likely chronic gastritis
SEE IRON ON HISTO

Question 5

Where in the stomach does H pylori infect? How does gastritis caused by this look on histo?

Answer 5

Antrum - but can be anywhere

See BUGS on histo

Question 6

Explain metaplasia in relation to H pylori infection

Answer 6

In short term, its a way to fight the infection = good
BUT won’t ever be enough to eradicate infection
Long term metaplasia = increases risk of cancer

Question 7

Why does H pylori increase risk for lymphoma?

Answer 7

Lymphoma = gut lymph centers where immune system is trying to fight this bacterial infection

Question 8

Lymphoma on histo

Answer 8

Lymphoepithelial lesion

Aka lymphocytes are destroying glands in stomach

Question 9

Another name for pernicious anemia

Answer 9

AI gastritis
Abs vs IF + parietal cells
T cells go to these Abs to do damage
= chronic inflammation

Question 10

What parts of stomach does AI gastritis effect?

Answer 10

Body and fundus - aka where normal acid and IF is made

Gets replaced with antral-like mucosa

Question 11

What diseases can result from untreated AI gastritis // pernicious anemia?

Answer 11

Macrocytic anemia
Peptic ulcer disease
Cancer

Question 12

Explain the connection between AI gastritis and euro-nendocrine tumors

Answer 12

No acid
More gastrin to try to increase acid
Gastrin works on ECL cells = overgrowth
Linear hyperplasia
Nodular hyperplasia = tiny tumors
Neuro endocrine tumors
- Mostly benign -> can be monitored for growth

Question 13

Stain for neuroendocrine tumors

Answer 13

W/ synapthophysin and chromogranin!!! Duh!!!

Question 14

H pylori or AI gastritis: which has decreased acid

Answer 14

AI

Question 15

H pylori or AI gastritis: which has decreased gastrin

Answer 15

HP

Question 16

H pylori or AI gastritis: which can form adenocarcinoma?

Answer 16

Both

Question 17

H pylori or AI gastritis: which can form lymphoma?

Answer 17

HP

Question 18

H pylori or AI gastritis: which can form neuro-endocrine tumors?

Answer 18

AI

Question 19

H pylori or AI gastritis: which is associated with other auto-immune disorders?

Answer 19

AI… duh

Question 20

Crohn’s is a SI disease - can it present with upper GI symptoms?

Answer 20

YEP - pain, N & V

Question 21

Triad for ZE syndrome

Answer 21

Hypergastrin
High acid in stomach
Duodenal ulcers - vili burned off due to acid

Question 22

Which area of the stomach undergoes hyperplasia in ZE?

Answer 22

Fundus

**Look for this on histo

Question 23

What is an antral heterotopia polyp?

Answer 23

Polyp @ body or fundus of stomach
Made of antral-like mucosa
Clinical NO CONSEQUENCE

Question 24

What is a pancreatic hetertopia polyp?

Answer 24

Normal pancreatic tissue in stomach
Submucosal
NO CONSEQUENCE

Question 25

What is a hyperplastic polyp? - Tissue type - Associated diseases - Cancerous?

Answer 25

= Overgrowth of fovea epi See dilated glands underneath Associated with gastritis If >2cm, worry about cancer

Question 26

What is a fundic gland polyp? - Cancerous? - 2 causes

Answer 26

Benign stomach polyp Due to: - Long term PPI - Familal adenomaous polyposus

Question 27

What is polyposis? | - Cancerous?

Answer 27

Many gastric polyps HUGH cancer risk: APC mutations - Do a colonoscopy

Question 28

What is gastric dysplasia? - Is it a polyp? - Cancerous?

Answer 28

FLAT lesion Reaction to something going on the in the stomach Can regress OR can progress to cancer

Question 29

What do you call a low grade glandular polyp?

Answer 29

Adenoma | > 2cm = worry about cancer

Question 30

2 types gastric adenocarcinoma

Answer 30

Intestinal (less bad) | Diffuse (bad bad)

Question 31

2 features of intestinal type gastric adenocarcinoma?

Answer 31

Glands cohesive | Still a discrete cancer mass

Question 32

Describe diffuse type gastric adenocarcinoma

Answer 32

"Thickening" of entire stomach Signet righ NOT cohesive - probably infiltrating DEAD WITHIN 6 MOs :(

Question 33

How stage gastric cancer?

Answer 33

``` Direct spread - Through muscularis proproa? - Through serosa? LN Mets Distant mets ```

Question 34

What predictive marker can be used for stomach cancer treatment

Answer 34

Her2/neu | Trastuzimab

Question 35

What are the 3 types of neuroendocrine tumors in the stomach? Why are they called tumors instead of carcinoma?

Answer 35

``` Classified by the condition associated with the tumor Type 1 = AI gastritis 2 = ZE 3 = sporadic Tumors b/c hard to predict behavior ```

Question 36

36 yo pt has 30lb unintentional weight loss. Endoscopy show no discrete mass, but generalized abnormality of the stomach. Biopsy show single infiltrative cells. What is the cancer? What are the risk factors?

Answer 36

Diffuse type adenocarcinoma | No know risk factors

Question 37

What is gastric antral vascular ectasia? - Where in stomach - Patho - Other disease association

Answer 37

Watermelon stomach @ antrum Dilated capillaries w/ FIBRIN thrombi AI association

Question 38

What is caliber persistant artery? - Symptoms - Treat

Answer 38

Large artery going all way to stomach surface Look for pts w/ recurrent bleeding and no other symptoms Stop bleeding endoscopically