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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?

24
Q

Peptic ulcers diagnosis:

A

imaging and endoscopy

NEVER BIOPSY - theres no cancer there

25
classic presentation - peptic ulcer disease (PUD)
gnawng epigastric pain relieved with food and alkalis - 1-3 hous after eating , worse at night shoulder pain
26
major complication of PUD?
BLEEDING
27
whcih ulcers do you biopsy?
gastric! NOT PEPTIC
28
What do peptic ulcers look like layer wise?
- necrotic debris - nonspecific acute inflammatory cells - granulation tissue - fibrosis
29
H pylori proinflammatory cytokines that make inflammation and immune response greater:
-IL1 IL6 -IL8 --> brings in and activates PMNs
30
98% of ulcers are located where?
duodenum
31
benign ulcer appearance?
- smooth borders - fibrous base - rugal folds pulled in
32
How to find perforation in stomach/duodenal lining?
look for air under the diaphragm on x- ray
33
Malignant ulcer appearance?
- rough RIASED borders - base is irregular - necrotic center
34
PUD complciations:
Bleeding perforation obstruction intractable pain
35
Stress ulcers: - definition:
focal acutely deveolping mucosal defects following SEVERE STRESS OR TREATMENT WITH NSAIDS OR H PYLORI DO NOT BREACH MUSCULARIS MUCOSA MULTIPLE ULCERS EVERYWHERE!
36
Stress ulcers V acute gastritis V PUD
acute gastritis and stress ulcers NOT NOT BREACH MUSCULARIS MUCOSA
37
Ulcers associated with extensive burns or severe trauma?
Curling ulcers
38
Ulcers associated with CNS conditions that increase intracranial pressure/ headtruama?
Cushing ulcers
39
Common patient population that gets stress ulcers?
ICU Patients!
40
Gastric polyps: 2 common types and details?
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
whcih cancer accounts for 90-95% of malignancies i nthe stomach?
gastric carcinoma **
42
Second most common cancer in the world?
gastric carcinoma -- especially common in Asia
43
prognosis for stomach cancer?
poor survival
44
2 types of gastric carcinomas?
1) intestinal type: males; dec frequency - gland formation **2) diffuse type: frequency unchanged; no male predominance*** sheets of cells or infiltrating
45
Which gastric carcinoma type has male predominance and which doesnt?
intestinal type has male diffuse type no male predominance
46
factors that inc gastric carcinoma risk?
- 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
**High risk factor for intestinal type of gastric carcinoma?
H pylori infection***
48
**Where do gastric carcinomas occur most often?
**Lesser curvature
49
Lauren classification of gastric carcinomas includes what types?
durpp... intestinal and diffuse type
50
Linitis plastica - assocaited with which cancer?
diffuse type adenocarcinoma thickened stomach wall
51
classic cell with diffuse type adenocarcinoma?
signet ring cells
52
gastric carcinoma tumors start with mutations in?
APC germline genes
53
virchows node definition:
involvement of sentinel supraclavicular node with cancer
54
sister mary jopseph nodule definition:
metastasis to periumbilical area - BELLY BUTTON
55
krukenberg tumor definition:
matastatic dissemination to ovaries
56
Gastric lymphoma is a tumor of what cells?
B-cells!
57
GIST tumors - tumor of what cells - most common location? - immune marker? - Tx?
- 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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