Path 4 Stomach Flashcards
Parietal/Chief cell location
Fundus
Bicarbonate supply
Vasculature and Surface epithelium (protection)
Omphalocele
Herniation of bowel into umbilical cord (covered by peritoneum)
Gastroschisis
Herniated bowels with no peritoneum
Pyloric Stenosis
- Projectile vomiting
- Tx Myotomy
Acute Gastritis Histology
- Neutrophils in lamina propria
- Intact surface epithelium
Causes of acute ulceration
NSAIDs and severe physiologic stress
Normal prostaglandin function in stomach
- Enhance bicarb secretion
- Inhibit acid secretion
- Promote mucin synthesis
- Increase vascular perfusion
Stress ulcer
Post-shock, severe trauma
Curling ulcer
- Post-severe burns
- Proximal duodenum
Cushing ulcer
- Intracranial disease (stimulate vagus -> gastric acid secretion)
- Stomach, duodenum/esophagus
- Often perforate
ICU prophylaxis
H2-R blocker
PPIs
Prostaglandin analogs
Acute v Chronic Gastritis histology
Acute - Edema, Neutrophils in lamina propria
Chronic - Lymphoplasmacytic cells
Active Chronic Gastritis
Chronic gastritis with superimposed active inflammation
Acute v Chronic Gastritis clinical
Acute has much more prominent signs (vomiting)
Chronic Gastritis causes
H. Pylori, Autoimmune
H. Pylori infection location
Gastric Antrum
H. Pylori virulence factors (4)
- Flagella
- Urease (produce ammonia)
- Adhesins
- Cytotoxin A
H. Pylori infection result
Increased acid production
H. Pylori infection histology
Lymphoplasmacytic infiltrate in lamina propria
H. Pylori Dx
Endoscope & Biopsy
Serology
Urea breath test
Autoimmune Gastritis cause
Ab against Parietal cells, Intrinsic Factor
Autoimmune Gastritis mechanism
Loss of parietal cells -> achlorydia -> hypergastrinemia -> G-cell hyperplasia
Autoimmune Gastritis comorbidity (2)
- Pernicious anemia
- Destruction of adjacent chief cells -> decreased pepsinogen
H. Pylori v Autoimmune chronic gastritis histology
Lymphoid aggregates only with H. Pylori
Autoimmune gastritis spared locations
Antrum & cardia
Autoimmune gastritis unique finding
Megaloblastic epithelial cells (pre-metaplastic)
Autoimmune gastritis v. H. Pylori endoscope
Smooth mucosa v. Nodular Erythema
Autoimmune gastritis hyperplasia
Endocrine cells (pre-neuroendocrine tumor)
Gastrin changes in H. Pylori
Decreased or normal
Gastrin changes in Autoimmune gastritis
Increased
Reactive Gastropathy
Secondary to chemical injury, NSAID use, bile refulx
Eosinophilic Gastritis
Secondary to allergies, soy, drugs, parasites
Lymphocytic Gastritis
- Ideopathic
- Associated with Celiac disease (women)
Granulomatous Gastritis
Secondary to Crohns, Sarcoidosis, Infections
Peptic Ulcer Disease common location
Proximal duodenum
PUD main causes
- H. Pylori
- NSAIDs, corticosteroids
PUD syndrome cause
Zollinger-Ellison syndrome -
Gastrinoma (intestine or pancreas) -> Parietal cell hyperplasia
PUD problems
Hemorrhage, Perforation (Xray free air under diaphragm)
PUD clinical
- Post prandial pain
- Iron deficiency anemia
Intestinal complications of chronic gastritis
- Metaplasia (goblet cells)
- Atrophy
Inflammatory/Hyperplastic Polyps
- Due to chronic gastritis
- Dysplastic if large
Fundic Gland Polyps causes (2)
- FAP (Familial Adenomatous Polyposis)
- PPIs (reduced acidity -> increased gastrin secretion -> glandular hyperplasia)
Fundic Gland Polyp histology
Cystically dilated glands (parietal, chief), no inflammation
Hyperplastic Polyp histology
Dilated, irregular glands, acute chronic inflammation
Gastric Adenoma cause
Chronic gastritis with Atrophy and Intestinal Metaplasia
Gastric Adenocarcinoma
- 90% of all gastric cancers
- 20x in Japan (Nitrosamines)
Gastric Adenocarcinoma predisposing factors (3)
- Lower socioeconomic groups
- Multifocal mucosal atrophy
- Intestinal metaplasia
2 type of Gastric Adenocarcinoma
- Intestinal Type (well differentiated glands, ulcerated mass)
- Diffuse type (Signet-ring cells, no glands, no mass)
Linitica plastica
Leather bottle - Diffuse Type gross appearance
Intestinal type genes
FAP
B-catenin mutation
Diffuse type genes
BRCA2
E-cadherin (CDH1 gene)
Common to both gastric adenocarcinomas
Neoplastic progression supported by chronic inflammation
Gastric adenocarcinoma metastasis sites (3)
- Virchow’s node (left supraclavicular)
- Sister Mary Joseph nodule (periumbilical, intestinal type)
- Krukenberg tumor (bilateral ovaries, diffuse type)
Gastric adenocarcinoma dermatology
- Acanthosis nigricans
- Leser-Trelat sign
MALT lymphoma
- Marginal zone B-cell lymphoma
- Associated with H. pylori
- Lymphoepithelial lesion (monoclonal lymphocytic infiltrate)
Carcinoid Tumor
- Neuroendocrine tumor, mostly in small intestine
- Secrete Histamine, Somatostatin, Serotonin
Carcinoid histology
Salt-and-pepper chromatin
Gastrointestinal Stromal Tumor (GIST)
Benign muscularis tumor
GIST immunohistochemistry
- C-KIT
- Imatinib inhibits c-KIT, used for Tx