pathology 2 Gastritis-Stomach cancer-Peptic ulcer disease-Ulcer complications Flashcards
____ (Acute/Chronic) gastritis is erosive, whereas ____ (acute/chronic) gastritis is nonerosive
Acute; chronic
Where does type A chronic gastritis occur? Where does type B occur?
Fundus/body; antrum
Name some causes of acute gastritis
NSAIDs, alcohol, stress, uricemia, burns, brain injury
A patient with severe burns develops which complication of acute gastritis?
Curling ulcer (burned by the Curling iron)
A man with brain injury acutely develops raw, burning epigastric pain. He should be treated to prevent which complication?
Cushing ulcers (remember, always cushion the brain)
In a patient with type A (fundal) gastritis, the autoantibodies are directed against what?
Parietal cells
Type A (fundal) gastritis is characterized by what two pathologic states?
Type A is caused by pernicious Anemia and Achlorhydria (A comes before B—pernicious Anemia is Autoimmune in first part of stomach)
Type B (antral) gastritis is caused by infection with what organism?
Type B is caused by Helicobacter pylori (H. pylori Bacteria in second part of stomach
Type ____ gastritis is autoimmune related, whereas type ____ gastritis is caused by infectious diseases (e.g., H. pylori).
A; B
____ (Acute/Subacute/Chronic) gastritis carries an increased risk of gastric carcinoma.
Chronic
Chronic gastritis carries an increased risk of what kind of gastric carcinoma(s)?
Mucosa-associated lymphoid tissue (MALT) lymphoma and gastric adenocarcinoma
A patient on chronic NSAID therapy complains of stomach pain and is found to be anemic. What is the pathophysiology of his condition?
NSAIDs reduce prostaglandin E2, causing erosive gastritis (this is erosive gastritis), which causes occult blood loss and mild anemia
By what mechanism do severe burns cause acute gastritis?
Curling ulcers are caused by a decrease in plasma volume, leading to a sloughing of gastric mucosa
How can brain injury cause acute gastritis?
Cushing ulcers are caused by increased vagal stimulation, which increases acetylcholine and, in turn, acid production by parietal cells
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?
Fundus/body (this is chronic type A gastritis of the stomach, with pernicious anemia, associated with other autoimmunity such as Graves)
In acute gastritis, there is disruption of what type of barrier?
Disruption of mucosal barrier
What type of gastritis is an alcoholic most at risk for?
Acute gastritis
A patient with rheumatoid arthritis, adherent to his medications, has nausea and abdominal pain. What type of gastritis are you considering?
Acute gastritis (the patient is likely taking NSAIDs daily)
What is the most common histologic subtype of stomach cancer?
Adenocarcinoma
Where are intestinal stomach cancers most commonly located in the stomach: lesser curvature, greater curvature, fundus, or cardiac region?
Lesser curvature
A patient with stomach cancer is at risk of metastasis to what organ?
The liver (this is the next downstream organ)
Name at least three risk factors for stomach cancer.
Nitrosamines (from smoked foods), achlorhydria, chronic gastritis, smoking, H. pylori (the intestinal kind) infection
What is meant when stomach cancer is termed linitis plastica?
Diffuse infiltrative cancer makes the stomach rigid
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?
Left-sided supraventricular nodes (also called Virchow nodes) (metastasis from stomach cancer classically spreads to these nodes)
A woman has bilateral ovarian cancer with abundant mucus & signet ring cells. Could this cancer in fact be a metastasis?
Yes, as this could represent metastasis from the stomach to both ovaries (Krukenberg tumor)
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?
One may see Sister Mary Joseph nodules (subcutaneous periumbilical metastasis) (this is acanthosis nigricans, suggesting stomach cancer)
What is the histologic appearance of the Krukenberg tumor?
Metastatic gastric adenocarcinoma often has mucus-filled cells termed signet ring cells
What is the Sister Mary Joseph nodule, and where is it located?
It is a metastasis of gastric cancer located in the subcutaneous periumbilical area
A 65-year-old man has a growing periumbilical mass and abdominal fullness. What umbilical finding might be present on exam?
Sister Mary Joseph nodules (palpable and bulging due to metastases of various GI cancers)
This type of gastrointestinal ulcer is more likely to be associated with weight gain.
Duodenal ulcer (the pain associated with duodenal ulcers decreases with meals, thereby resulting in weight gain)
Patients with duodenal ulcers tend to have hypertrophy of these glands.
Brunner glands
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?
Malignancy (carcinoma)—peptic ulcers have clean margins and a punched-out appearance
In a patient with Zollinger-Ellison syndrome, what type of ulcer is the patient at risk for?
Duodenal ulcer (Zollinger-Ellison syndrome is associated with increased gastric secretions, resulting in ulcer formation)
What is the pathology of duodenal ulcers?
Decrease in mucosal protection or increase in gastric acid secretion
Which type of peptic ulcer disease puts the patient at a higher risk of developing a carcinoma?
Gastric ulcer
Peptic ulcer disease affects what two regions of the gastrointestinal tract?
The stomach (gastric ulcers) and the duodenum (duodenal ulcers)
A patient has significant weight loss and abdominal pain after eating. Endoscopy shows ulcers. What kind of ulcers are they likely to be?
Gastric ulcers, which generally result in increased pain after meals (Gastric ulcer pain is Greater with meals)
What etiologic factor is associated with 70% of gastric ulcers?
Helicobacter pylori infection
A patient on NSAIDs for back pain presents with abdominal pain exacerbated by meals. What is the most likely cause of his abdominal pain?
Chronic use of NSAIDs leading to gastric ulcers
What is the pathophysiology of gastric ulcers?
Decreased mucosal production leading to destruction of tissue by gastric acid due to decreased protection
What artery is most likely to hemorrhage with a ruptured gastric ulcer on the lesser curvature of the stomach?
Left gastric artery
What artery is most likely to hemorrhage secondary to a ruptured duodenal ulcer on the posterior wall of the duodenum?
Gastroduodenal artery
Ulcer hemorrhages are likely to occur ____ (anteriorly/posteriorly); ulcer perforations are likely to occur ____ (anteriorly/posteriorly).
Posteriorly; anteriorly
