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GI Exam 1 > Pathology of Stomach > Flashcards

Pathology of Stomach Flashcards

1
Q

acute gastritic immune cell?

A

PMN - inflammation of mucosa!

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2
Q

chronic gastritic immune cell?

A

lymphocyte/plasma cell

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3
Q

gastritis definition:

**Most cases of gastritis present how?

A
  • inflammation of gastric mucosa

* **-chronic and asymptomatic

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4
Q

**What to things are directly absorbed by stomach mucosa and cause acute gastritis?

A

-aspirin (NSAIDS) and alcohol

then H pylori

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5
Q

Pathogenesis of acute gastritis?

A
  • due to many factors
  • distruption of mucosa
  • inc acid secretion
  • dec production of bicarb buffer
  • dec mucosal blood flow
  • direct damage to barrier (MUCOUS LAYER DAMAGE)
  • PMN inflammation if H .Pylori
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6
Q

presentation of acute gastritis

A
  • hematemesis
  • melena
  • potentially fatal blood loss
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7
Q

Major cause of hematemesis is alcoholics??

A

acute gastritis!

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8
Q

acute gastritis - what you may see in speciment/biopsy:

A
  • pinpoint hemorrhages in mucosa

- Erosion that does no cross muscularis mucosa

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9
Q

chronic gastritis: definition?

-issue?

A
  • chronic mucosal inflammatory changes lead eventually to MUCOSAL ATROPHY AND INTESTINAL METAPLASIA
  • epithelial changes may become DYSPLASTIC ==> progress to carcinoma
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10
Q

***Predominant causes of chronic gastritis:

A

***pretty much same H pylori and NSAIDS

or can be autoimmune to parietal cells (pernicious anemia)

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11
Q

complication of gastritis chronic and H pylori?

A

inc risk for peptic ulcer
inc risk for carcinoma
some dev lymphoma

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12
Q

How does H pylori damage?

A
  • enzyme and toxins
  • motile so they move around
  • bind via adhesins
  • some have cytotoxins - proinflamamtory peptides CagA and VacA - cells lose polarity and tight junctions
  • urease to survive stomach - make ammonia to make less acidic environment
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13
Q

3 paths of disease for people with H pylori

A

1) most often no symptomatic disease with mixed gastritis
2) in the antrum = inc acid and gastrin = duodenal ulcer
3) in the body and cardia = gastric carcinoma

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14
Q

Autoimmune gastritis: how happens? consequences?

A
  • antibodies made againt parietal cells – these guys make HCl
  • may lead to gland destruction, mucosal atrophy, loss of acids, and loss of IF
  • loss of intrisic factor = B12 def = pernicious anemia (megaloblastic)
  • inc risk of carcinoma and endocrine tumors
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15
Q

Achloridia (lack/no HCl) seen with?

A

autoimmune gastritis

NOT WITH H PYLORI

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16
Q

early chronic gastritis: appearance

A

coarse red mucosa

  • inflammator infiltrate
  • chronc superficial gastritis
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17
Q

more severe chronic gastritis: appearance

A

variable atrophy
-thin flattened mucosa
regenerative changes
intestinal type metaplasia

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18
Q

late chronic gastritic:appearance

A

atrophy
dysplasia
carcinoma in situ

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19
Q

H pylori results in:

A

development of lympoid follicles (abnormal)

NEVER ACHLORHYDIA

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20
Q

autoimmune patients present with:

A
  • achlorhydia
  • hypergastrinemia
  • pernicious anemia
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21
Q

Peptic ulcer disease: definiton:

A

breach in mucosa extending through muscularis mucosa

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22
Q

Where can peptic ulcers be?

A

stomach or duodenum

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23
Q

High levels of what ion drives acid production?

A

calcium

24
Q

Peptic ulcers diagnosis:

A

imaging and endoscopy

NEVER BIOPSY - theres no cancer there

25
Q

classic presentation - peptic ulcer disease (PUD)

A

gnawng epigastric pain relieved with food and alkalis - 1-3 hous after eating , worse at night
shoulder pain

26
Q

major complication of PUD?

A

BLEEDING

27
Q

whcih ulcers do you biopsy?

A

gastric! NOT PEPTIC

28
Q

What do peptic ulcers look like layer wise?

A
  • necrotic debris
  • nonspecific acute inflammatory cells
  • granulation tissue
  • fibrosis
29
Q

H pylori proinflammatory cytokines that make inflammation and immune response greater:

A

-IL1
IL6
-IL8 –> brings in and activates PMNs

30
Q

98% of ulcers are located where?

A

duodenum

31
Q

benign ulcer appearance?

A
  • smooth borders
  • fibrous base
  • rugal folds pulled in
32
Q

How to find perforation in stomach/duodenal lining?

A

look for air under the diaphragm on x- ray

33
Q

Malignant ulcer appearance?

A
  • rough RIASED borders
  • base is irregular
  • necrotic center
34
Q

PUD complciations:

A

Bleeding
perforation
obstruction
intractable pain

35
Q

Stress ulcers: - definition:

A

focal acutely deveolping mucosal defects following SEVERE STRESS OR TREATMENT WITH NSAIDS OR H PYLORI

DO NOT BREACH MUSCULARIS MUCOSA

MULTIPLE ULCERS EVERYWHERE!

36
Q

Stress ulcers V acute gastritis V PUD

A

acute gastritis and stress ulcers NOT NOT BREACH MUSCULARIS MUCOSA

37
Q

Ulcers associated with extensive burns or severe trauma?

A

Curling ulcers

38
Q

Ulcers associated with CNS conditions that increase intracranial pressure/ headtruama?

A

Cushing ulcers

39
Q

Common patient population that gets stress ulcers?

A

ICU Patients!

40
Q

Gastric polyps: 2 common types and details?

A

1) Hyperplastic/inflammatory= more common and non-neoplastic; often seen in chronic gastritis – hyperplastic surface eptiherlium overlying dilated glandular tissue- usually treatable (PILLING UP OF GLANDS)
2) adenomatous= (gastric adenomas); true neoplasm; sessile(flat) or pedunculated; malignant potential; more common with age and males

41
Q

whcih cancer accounts for 90-95% of malignancies i nthe stomach?

A

gastric carcinoma **

42
Q

Second most common cancer in the world?

A

gastric carcinoma – especially common in Asia

43
Q

prognosis for stomach cancer?

A

poor survival

44
Q

2 types of gastric carcinomas?

A

1) intestinal type: males; dec frequency - gland formation

2) diffuse type: frequency unchanged; no male predominance* sheets of cells or infiltrating

45
Q

Which gastric carcinoma type has male predominance and which doesnt?

A

intestinal type has male

diffuse type no male predominance

46
Q

factors that inc gastric carcinoma risk?

A
  • environemntal - Pylori; socioeconomic status
  • diet - nitrites, smoked and salted foods, pickled things, chili peppers; no fresh fruits and veggies
  • host factors : conditions like chronic gastritis, barrett, gastric adenomas
  • genetics
47
Q

**High risk factor for intestinal type of gastric carcinoma?

A

H pylori infection***

48
Q

**Where do gastric carcinomas occur most often?

A

**Lesser curvature

49
Q

Lauren classification of gastric carcinomas includes what types?

A

durpp… intestinal and diffuse type

50
Q

Linitis plastica - assocaited with which cancer?

A

diffuse type adenocarcinoma

thickened stomach wall

51
Q

classic cell with diffuse type adenocarcinoma?

A

signet ring cells

52
Q

gastric carcinoma tumors start with mutations in?

A

APC germline genes

53
Q

virchows node definition:

A

involvement of sentinel supraclavicular node with cancer

54
Q

sister mary jopseph nodule definition:

A

metastasis to periumbilical area - BELLY BUTTON

55
Q

krukenberg tumor definition:

A

matastatic dissemination to ovaries

56
Q

Gastric lymphoma is a tumor of what cells?

A

B-cells!

57
Q

GIST tumors

  • tumor of what cells
  • most common location?
  • immune marker?
  • Tx?
A
  • mesenchymal- cells of cajal (important for motility)
  • stomach mostly
  • stain for c-KIT (CD117)
  • tyrosine kinase inh -gleevac but usually treated with surgery

GI Exam 1 (11 decks)

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