Pathologic basis of gastric disease

Question 1

Sources of injury to the stomach epithelium

Answer 1

H. pylori infection, NSAID, tobacco, alcohol, gastric hyperacidity, duodenal-gastric reflux, ischemia, shock

Question 2

epigastric pain, early satiety, nausea/vomiting, melena, hematemesis

Answer 2

gastritis, gastropathy, tumors, PUD, pyloric stenosis

Question 3

hyperplasia of pyloric muscularis propria –> obstruction of gastric outflow

Presentation: 2nd-3rd week of life –> persistent projectile non-bilious vomiting; firm ovoid abd mass

Answer 3

hypertrophic pyloric stenosis

Question 4

treatment of hypertrophic pyloric stenosis

Answer 4

surgical splitting of muscularis propria (myotomy)

Question 5

inflammatory diseases of the stomach

Answer 5

acute gastritis, gastropathy, stress-related injury, chronic gastritis (H pylori, autoimmune), PUD

Question 6

injury mediated by vasoconstriction/ischemia. may lead to widespread erosion and ulceration

occurs in 75% of critically ill patients

Answer 6

stress-related mucosal disease

Question 7

mechanism of acid resistance of H pylori

Answer 7

abundant gastric urease

Question 8

risk factors for H pylori infection

Answer 8

poverty, household crowding, rural areas

Question 9

pathologic findings on H pylori gastritis

Answer 9

neutrophilic infiltrate of gastric epithelium

lymphocyte and plasma cell infiltrate of lamina propria, lymphoid follicle

Question 10

anti-parietal and anti-instrinsic factor antibodies +/- pernicious anemia

scandanavian and N European descent

Answer 10

autoimmune gastritis

Question 11

Pathologic findings of autoimmune gsatritis

Answer 11

lymphocyte and plasma cell infiltrate in body of stomach, glandular atrophy, intestinal metaplasia

Question 12

benign gastric neoplasias

Answer 12

inflammatory/hyperplastic polyp, fundic gland polyp, adenomatous polyp (adenoma)

Question 13

potentially malignant gastric neoplasias

Answer 13

adenocarcinoma, lymphoma, carcinoid tumor, gastrointestinal stromal tumor

Question 14

pathology of inflammatory/hyperplastic polyp

Answer 14

inflammation and edema in lamina propria, cystically dilated foveolae

Question 15

pathology of fundic gland polyp

Answer 15

cystically dilated oxyntic gland

Question 16

pathology of adenoma

Answer 16

dark, atypical cells along glands and epithelium

Question 17

neoplasias associated with H pylori

Answer 17

inflammatory/hyperplastic polyp, adenoma, adenocarcinoma, lymphoma

Question 18

derived from interstitial cells of Cajal. mutations in tyrosine kinase CKIT or PDGFRA

Answer 18

gastrointestinal stromal tumor

Question 19

Pathology of adenocarcinoma

Answer 19

diffuse (signet ring cell) type

Question 20

types of adenocarcinoma

Answer 20

intestinal type (Wnt pathway activation) and diffuse type (germline loss of CDH1 in familial gastric cancer)

Question 21

GI stromal tumor pathology

Answer 21

spindle cell proliferation, c-kit immunohistochemical stain