Pathologic basis of gastric disease Flashcards
Sources of injury to the stomach epithelium
H. pylori infection, NSAID, tobacco, alcohol, gastric hyperacidity, duodenal-gastric reflux, ischemia, shock
epigastric pain, early satiety, nausea/vomiting, melena, hematemesis
gastritis, gastropathy, tumors, PUD, pyloric stenosis
hyperplasia of pyloric muscularis propria –> obstruction of gastric outflow
Presentation: 2nd-3rd week of life –> persistent projectile non-bilious vomiting; firm ovoid abd mass
hypertrophic pyloric stenosis
treatment of hypertrophic pyloric stenosis
surgical splitting of muscularis propria (myotomy)
inflammatory diseases of the stomach
acute gastritis, gastropathy, stress-related injury, chronic gastritis (H pylori, autoimmune), PUD
injury mediated by vasoconstriction/ischemia. may lead to widespread erosion and ulceration
occurs in 75% of critically ill patients
stress-related mucosal disease
mechanism of acid resistance of H pylori
abundant gastric urease
risk factors for H pylori infection
poverty, household crowding, rural areas
pathologic findings on H pylori gastritis
neutrophilic infiltrate of gastric epithelium
lymphocyte and plasma cell infiltrate of lamina propria, lymphoid follicle
anti-parietal and anti-instrinsic factor antibodies +/- pernicious anemia
scandanavian and N European descent
autoimmune gastritis
Pathologic findings of autoimmune gsatritis
lymphocyte and plasma cell infiltrate in body of stomach, glandular atrophy, intestinal metaplasia
benign gastric neoplasias
inflammatory/hyperplastic polyp, fundic gland polyp, adenomatous polyp (adenoma)
potentially malignant gastric neoplasias
adenocarcinoma, lymphoma, carcinoid tumor, gastrointestinal stromal tumor
pathology of inflammatory/hyperplastic polyp
inflammation and edema in lamina propria, cystically dilated foveolae
pathology of fundic gland polyp
cystically dilated oxyntic gland
pathology of adenoma
dark, atypical cells along glands and epithelium
neoplasias associated with H pylori
inflammatory/hyperplastic polyp, adenoma, adenocarcinoma, lymphoma
derived from interstitial cells of Cajal. mutations in tyrosine kinase CKIT or PDGFRA
gastrointestinal stromal tumor
Pathology of adenocarcinoma
diffuse (signet ring cell) type
types of adenocarcinoma
intestinal type (Wnt pathway activation) and diffuse type (germline loss of CDH1 in familial gastric cancer)
GI stromal tumor pathology
spindle cell proliferation, c-kit immunohistochemical stain
