pathology 2 Gastritis-Stomach cancer-Peptic ulcer disease-Ulcer complications

Question 1

____ (Acute/Chronic) gastritis is erosive, whereas ____ (acute/chronic) gastritis is nonerosive

Answer 1

Acute; chronic

Question 2

Where does type A chronic gastritis occur? Where does type B occur?

Answer 2

Fundus/body; antrum

Question 3

Name some causes of acute gastritis

Answer 3

NSAIDs, alcohol, stress, uricemia, burns, brain injury

Question 4

A patient with severe burns develops which complication of acute gastritis?

Answer 4

Curling ulcer (burned by the Curling iron)

Question 5

A man with brain injury acutely develops raw, burning epigastric pain. He should be treated to prevent which complication?

Answer 5

Cushing ulcers (remember, always cushion the brain)

Question 6

In a patient with type A (fundal) gastritis, the autoantibodies are directed against what?

Answer 6

Parietal cells

Question 7

Type A (fundal) gastritis is characterized by what two pathologic states?

Answer 7

Type A is caused by pernicious Anemia and Achlorhydria (A comes before B—pernicious Anemia is Autoimmune in first part of stomach)

Question 8

Type B (antral) gastritis is caused by infection with what organism?

Answer 8

Type B is caused by Helicobacter pylori (H. pylori Bacteria in second part of stomach

Question 9

Type ____ gastritis is autoimmune related, whereas type ____ gastritis is caused by infectious diseases (e.g., H. pylori).

Answer 9

A; B

Question 10

____ (Acute/Subacute/Chronic) gastritis carries an increased risk of gastric carcinoma.

Answer 10

Chronic

Question 11

Chronic gastritis carries an increased risk of what kind of gastric carcinoma(s)?

Answer 11

Mucosa-associated lymphoid tissue (MALT) lymphoma and gastric adenocarcinoma

Question 12

A patient on chronic NSAID therapy complains of stomach pain and is found to be anemic. What is the pathophysiology of his condition?

Answer 12

NSAIDs reduce prostaglandin E2, causing erosive gastritis (this is erosive gastritis), which causes occult blood loss and mild anemia

Question 13

By what mechanism do severe burns cause acute gastritis?

Answer 13

Curling ulcers are caused by a decrease in plasma volume, leading to a sloughing of gastric mucosa

Question 14

How can brain injury cause acute gastritis?

Answer 14

Cushing ulcers are caused by increased vagal stimulation, which increases acetylcholine and, in turn, acid production by parietal cells

Question 15

A woman with Graves disease is anemic with a high MCV despite taking iron. She has bad abdominal pain. What part of her stomach is affected?

Answer 15

Fundus/body (this is chronic type A gastritis of the stomach, with pernicious anemia, associated with other autoimmunity such as Graves)

Question 16

In acute gastritis, there is disruption of what type of barrier?

Answer 16

Disruption of mucosal barrier

Question 17

What type of gastritis is an alcoholic most at risk for?

Answer 17

Acute gastritis

Question 18

A patient with rheumatoid arthritis, adherent to his medications, has nausea and abdominal pain. What type of gastritis are you considering?

Answer 18

Acute gastritis (the patient is likely taking NSAIDs daily)

Question 19

What is the most common histologic subtype of stomach cancer?

Answer 19

Adenocarcinoma

Question 20

Where are intestinal stomach cancers most commonly located in the stomach: lesser curvature, greater curvature, fundus, or cardiac region?

Answer 20

Lesser curvature

Question 21

A patient with stomach cancer is at risk of metastasis to what organ?

Answer 21

The liver (this is the next downstream organ)

Question 22

Name at least three risk factors for stomach cancer.

Answer 22

Nitrosamines (from smoked foods), achlorhydria, chronic gastritis, smoking, H. pylori (the intestinal kind) infection

Question 23

What is meant when stomach cancer is termed linitis plastica?

Answer 23

Diffuse infiltrative cancer makes the stomach rigid

Question 24

A man has 1 month of fatigue, weight loss, and early satiety. If he has palpable lymph nodes (from metastases), where are they likely found?

Answer 24

Left-sided supraventricular nodes (also called Virchow nodes) (metastasis from stomach cancer classically spreads to these nodes)

Question 25

A woman has bilateral ovarian cancer with abundant mucus & signet ring cells. Could this cancer in fact be a metastasis?

Answer 25

Yes, as this could represent metastasis from the stomach to both ovaries (Krukenberg tumor)

Question 26

A patient has dark leathery patches on the nape of his neck and in the axillae. It is from malignancy. What might you see on his umbilicus?

Answer 26

One may see Sister Mary Joseph nodules (subcutaneous periumbilical metastasis) (this is acanthosis nigricans, suggesting stomach cancer)

Question 27

What is the histologic appearance of the Krukenberg tumor?

Answer 27

Metastatic gastric adenocarcinoma often has mucus-filled cells termed signet ring cells

Question 28

What is the Sister Mary Joseph nodule, and where is it located?

Answer 28

It is a metastasis of gastric cancer located in the subcutaneous periumbilical area

Question 29

A 65-year-old man has a growing periumbilical mass and abdominal fullness. What umbilical finding might be present on exam?

Answer 29

Sister Mary Joseph nodules (palpable and bulging due to metastases of various GI cancers)

Question 30

This type of gastrointestinal ulcer is more likely to be associated with weight gain.

Answer 30

Duodenal ulcer (the pain associated with duodenal ulcers decreases with meals, thereby resulting in weight gain)

Question 31

Patients with duodenal ulcers tend to have hypertrophy of these glands.

Answer 31

Brunner glands

Question 32

A man with stomach pain is found on endoscopy to have a lesion with irregular, raised margins. Is this more likely an ulcer or a malignancy?

Answer 32

Malignancy (carcinoma)—peptic ulcers have clean margins and a punched-out appearance

Question 33

In a patient with Zollinger-Ellison syndrome, what type of ulcer is the patient at risk for?

Answer 33

Duodenal ulcer (Zollinger-Ellison syndrome is associated with increased gastric secretions, resulting in ulcer formation)

Question 34

What is the pathology of duodenal ulcers?

Answer 34

Decrease in mucosal protection or increase in gastric acid secretion

Question 35

Which type of peptic ulcer disease puts the patient at a higher risk of developing a carcinoma?

Answer 35

Gastric ulcer

Question 36

Peptic ulcer disease affects what two regions of the gastrointestinal tract?

Answer 36

The stomach (gastric ulcers) and the duodenum (duodenal ulcers)

Question 37

A patient has significant weight loss and abdominal pain after eating. Endoscopy shows ulcers. What kind of ulcers are they likely to be?

Answer 37

Gastric ulcers, which generally result in increased pain after meals (Gastric ulcer pain is Greater with meals)

Question 38

What etiologic factor is associated with 70% of gastric ulcers?

Answer 38

Helicobacter pylori infection

Question 39

A patient on NSAIDs for back pain presents with abdominal pain exacerbated by meals. What is the most likely cause of his abdominal pain?

Answer 39

Chronic use of NSAIDs leading to gastric ulcers

Question 40

What is the pathophysiology of gastric ulcers?

Answer 40

Decreased mucosal production leading to destruction of tissue by gastric acid due to decreased protection

Question 41

What artery is most likely to hemorrhage with a ruptured gastric ulcer on the lesser curvature of the stomach?

Answer 41

Left gastric artery

Question 42

What artery is most likely to hemorrhage secondary to a ruptured duodenal ulcer on the posterior wall of the duodenum?

Answer 42

Gastroduodenal artery

Question 43

Ulcer hemorrhages are likely to occur ____ (anteriorly/posteriorly); ulcer perforations are likely to occur ____ (anteriorly/posteriorly).

Answer 43

Posteriorly; anteriorly