Patho of stomach and Small bowel [2]

Question 1

General causes of acute gastritis

Answer 1

acute inflammation + injury due to:
alcohol
H. pylori
Chem injury (bile, strong acids, bases)
tobacco
NSAIDS

• Path: can see destruction of mucosal surface and inflammation

Question 2

Stress related mucosal disease/gastritis

• mediated by?
• why is it sig to know this disorder?

Answer 2

Morphologically resembles acute gastritis
Mediated by vasoconstriction/ischemia
- erosion and ulceration may be widespread

this occurs in 75% of critically ill patients

• trauma, shock, sepsis (stress ulcers)
• burns (curling ulcers)
• intracranial (cushings ulcers)

Question 3

On a stain, what do you expect to see with H. pylori infxns?

Answer 3

Neutrophil infiltrates (areas with lots of bacteria)
Lymphocyte infiltrates (lymphoid follicle - inflammatory injury of the stomach)

Question 4

Autoimmune gastritis

• what is it?
• How can you test for it?
• prevalence?
• histo?

Answer 4

example of chronic gastritis

Corpus restricted chronic atrophic gastritis
Anti-parietal cell and anti-intrinsic factor antibodies
+/- pernicious anemia

Common in scandinavian and european descent

lymphocyte and plasma cell infiltrate in body of stomach
glandular atrophy (parietal cells destroyed by inflamm infiltrates)
intestinal metaplasia (change from gastric to intestinal phenotype)
- no neutrophils or organisms

Question 5

Complications of peptic ulcer disease

Answer 5

Bleeding (15%)
Perforation (5%)
Obstruction (2%)

peptic - acid mediated
ulcer - ulceration
of stomach and duodenum

Question 6

Peptic ulcer disease appearance

Answer 6

mucosa hands over edge and ulcer has a clean base

Not ragged base, ulcer is punched out

Question 7

Causes of PUD

Answer 7

H. Pylori
smoking
ZE syndrome
COPD
Illicit drugs
NSAIDS
alcohol cirrhosis

Question 8

All polyps are benign, however, some have the capacity to turn malignant. Which ones betch?

Answer 8

Adenoma

• Increased incidence of FAP
• helicobacter gastritis + gastritides

Question 9

Which of the gastric polyps are the most common?

Answer 9

Inflammatory/hyperplastic polyps

• rare progression to cancer
• assoc w/ Helicobacter + gastritides

Question 10

Fundic gland polyp

Answer 10

Cystically dilated oxyntic gland

very rare progression to cancer
FAP associated
Sporadic (usually PPI assoc.)

• only of the gastric benign polyps not involving helicobacter

Question 11

Gastric Adenocarcinoma

Answer 11

epithelial tumor derived from malignant transformation of gastric epithelium
associated with chronic gastritis (esp helicobacter) + diet

90% of all gastric tumors and is the 2nd most common fatal malignancy in the WORLD

Question 12

Symptoms of gastric adenocarcinoma
early
late

Answer 12

early:
dyspepsia (indigestion), dysphagia, nausea

Late:
weight loss, anorexia, early satiety, anemia

Question 13

Adenocarcinoma
- for each one below, what type of cancer are they seen in?

Which signalling pathway?
Which gene mutation/methylation?
Amplification of which gene?

Answer 13

Wnt signalling pathway

• can occur with loss of APC (as in FAP)
• common in INTESTINAL type cancers

Loss of CDH1

• common in DIFFUSE type cancer
• familial gastric cancer

Amplification of Her2/neu
- minority of tumors (intestinal>diffuse)

Question 14

Signet ring cell histo

Answer 14

Diffuse gastric adenocarcinoma ( loss of CDH1)

Question 15

Most lymphomas are _____, which are _____.
They are associated with _____ and often driven by ____ infxn.
Many gastric lymphomas can be cured with ______

Answer 15

MALT, low grade B cell (→ high grade)
Chronic gastritis, Helicobacter infxn
antibiotics

Question 16

GIST

Answer 16

mesenchymal neoplasm derived from interstitial cells of cajal (pacemaker cells controlling peristalsis)

• most contain C-kit oncogene
• tx with TKI imatinib