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Test 8 > Path 4 Stomach > Flashcards

Path 4 Stomach Flashcards

1
Q

Parietal/Chief cell location

A

Fundus

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2
Q

Bicarbonate supply

A

Vasculature and Surface epithelium (protection)

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3
Q

Omphalocele

A

Herniation of bowel into umbilical cord (covered by peritoneum)

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4
Q

Gastroschisis

A

Herniated bowels with no peritoneum

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5
Q

Pyloric Stenosis

A
  • Projectile vomiting

- Tx Myotomy

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6
Q

Acute Gastritis Histology

A
  • Neutrophils in lamina propria

- Intact surface epithelium

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7
Q

Causes of acute ulceration

A

NSAIDs and severe physiologic stress

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8
Q

Normal prostaglandin function in stomach

A
  • Enhance bicarb secretion
  • Inhibit acid secretion
  • Promote mucin synthesis
  • Increase vascular perfusion
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9
Q

Stress ulcer

A

Post-shock, severe trauma

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10
Q

Curling ulcer

A
  • Post-severe burns

- Proximal duodenum

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11
Q

Cushing ulcer

A
  • Intracranial disease (stimulate vagus -> gastric acid secretion)
  • Stomach, duodenum/esophagus
  • Often perforate
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12
Q

ICU prophylaxis

A

H2-R blocker
PPIs
Prostaglandin analogs

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13
Q

Acute v Chronic Gastritis histology

A

Acute - Edema, Neutrophils in lamina propria

Chronic - Lymphoplasmacytic cells

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14
Q

Active Chronic Gastritis

A

Chronic gastritis with superimposed active inflammation

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15
Q

Acute v Chronic Gastritis clinical

A

Acute has much more prominent signs (vomiting)

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16
Q

Chronic Gastritis causes

A

H. Pylori, Autoimmune

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17
Q

H. Pylori infection location

A

Gastric Antrum

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18
Q

H. Pylori virulence factors (4)

A
  • Flagella
  • Urease (produce ammonia)
  • Adhesins
  • Cytotoxin A
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19
Q

H. Pylori infection result

A

Increased acid production

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20
Q

H. Pylori infection histology

A

Lymphoplasmacytic infiltrate in lamina propria

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21
Q

H. Pylori Dx

A

Endoscope & Biopsy
Serology
Urea breath test

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22
Q

Autoimmune Gastritis cause

A

Ab against Parietal cells, Intrinsic Factor

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23
Q

Autoimmune Gastritis mechanism

A

Loss of parietal cells -> achlorydia -> hypergastrinemia -> G-cell hyperplasia

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24
Q

Autoimmune Gastritis comorbidity (2)

A
  • Pernicious anemia

- Destruction of adjacent chief cells -> decreased pepsinogen

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25
Q

H. Pylori v Autoimmune chronic gastritis histology

A

Lymphoid aggregates only with H. Pylori

26
Q

Autoimmune gastritis spared locations

A

Antrum & cardia

27
Q

Autoimmune gastritis unique finding

A

Megaloblastic epithelial cells (pre-metaplastic)

28
Q

Autoimmune gastritis v. H. Pylori endoscope

A

Smooth mucosa v. Nodular Erythema

29
Q

Autoimmune gastritis hyperplasia

A

Endocrine cells (pre-neuroendocrine tumor)

30
Q

Gastrin changes in H. Pylori

A

Decreased or normal

31
Q

Gastrin changes in Autoimmune gastritis

A

Increased

32
Q

Reactive Gastropathy

A

Secondary to chemical injury, NSAID use, bile refulx

33
Q

Eosinophilic Gastritis

A

Secondary to allergies, soy, drugs, parasites

34
Q

Lymphocytic Gastritis

A
  • Ideopathic

- Associated with Celiac disease (women)

35
Q

Granulomatous Gastritis

A

Secondary to Crohns, Sarcoidosis, Infections

36
Q

Peptic Ulcer Disease common location

A

Proximal duodenum

37
Q

PUD main causes

A
  • H. Pylori

- NSAIDs, corticosteroids

38
Q

PUD syndrome cause

A

Zollinger-Ellison syndrome -

Gastrinoma (intestine or pancreas) -> Parietal cell hyperplasia

39
Q

PUD problems

A

Hemorrhage, Perforation (Xray free air under diaphragm)

40
Q

PUD clinical

A
  • Post prandial pain

- Iron deficiency anemia

41
Q

Intestinal complications of chronic gastritis

A
  • Metaplasia (goblet cells)

- Atrophy

42
Q

Inflammatory/Hyperplastic Polyps

A
  • Due to chronic gastritis

- Dysplastic if large

43
Q

Fundic Gland Polyps causes (2)

A
  • FAP (Familial Adenomatous Polyposis)

- PPIs (reduced acidity -> increased gastrin secretion -> glandular hyperplasia)

44
Q

Fundic Gland Polyp histology

A

Cystically dilated glands (parietal, chief), no inflammation

45
Q

Hyperplastic Polyp histology

A

Dilated, irregular glands, acute chronic inflammation

46
Q

Gastric Adenoma cause

A

Chronic gastritis with Atrophy and Intestinal Metaplasia

47
Q

Gastric Adenocarcinoma

A
  • 90% of all gastric cancers

- 20x in Japan (Nitrosamines)

48
Q

Gastric Adenocarcinoma predisposing factors (3)

A
  • Lower socioeconomic groups
  • Multifocal mucosal atrophy
  • Intestinal metaplasia
49
Q

2 type of Gastric Adenocarcinoma

A
  • Intestinal Type (well differentiated glands, ulcerated mass)
  • Diffuse type (Signet-ring cells, no glands, no mass)
50
Q

Linitica plastica

A

Leather bottle - Diffuse Type gross appearance

51
Q

Intestinal type genes

A

FAP

B-catenin mutation

52
Q

Diffuse type genes

A

BRCA2

E-cadherin (CDH1 gene)

53
Q

Common to both gastric adenocarcinomas

A

Neoplastic progression supported by chronic inflammation

54
Q

Gastric adenocarcinoma metastasis sites (3)

A
  • Virchow’s node (left supraclavicular)
  • Sister Mary Joseph nodule (periumbilical, intestinal type)
  • Krukenberg tumor (bilateral ovaries, diffuse type)
55
Q

Gastric adenocarcinoma dermatology

A
  • Acanthosis nigricans

- Leser-Trelat sign

56
Q

MALT lymphoma

A
  • Marginal zone B-cell lymphoma
  • Associated with H. pylori
  • Lymphoepithelial lesion (monoclonal lymphocytic infiltrate)
57
Q

Carcinoid Tumor

A
  • Neuroendocrine tumor, mostly in small intestine

- Secrete Histamine, Somatostatin, Serotonin

58
Q

Carcinoid histology

A

Salt-and-pepper chromatin

59
Q

Gastrointestinal Stromal Tumor (GIST)

A

Benign muscularis tumor

60
Q

GIST immunohistochemistry

A
  • C-KIT

- Imatinib inhibits c-KIT, used for Tx

Test 8 (21 decks)

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