Pathology of stomach Flashcards
What are the 3 inflammatory disorders of the stomach?
acute gastritis
chronic gastritis
rare
What does acute gastritis consist of?
irratant chemical injury severe burns shock severe trauma head injury
What does chronic gastritis consist of?
autoimmune
bacterial
chemical
What does rare inflammatory disorders of stomach consist of?
lymphocytic
eosinophilic
granulomatous
Autoimmune chronic gastritis consists of which two antibodies?
anti-parietal and anti-intrinsic factor
What occurs in the body of the stomach during autoimmune chronic gastritis?
atrophy and intestinal metaplasia
what two things occur in autoimmune chronic gastritis due to b12 deficiency?
pernicious anaemia and macrocytic
H.pylori linked chronic gastritis affects stomach lining how?
bacteria inhabits a niche between the epithelial cell surface and mucous barrier
Does h.pylori excite an early acute inflammatory response?
yes
Which INTERLEUKIN is critical in h.pylori associated chronic gastritis ?
IL8
Which cells produce anti- H.pylori antibodies?
What does this increase risk of? (4)
lamina propria plasma cells
duodenal ulcer
gastric ulcer
gastric carcinoma
gastric lymphoma
What is the causes of chemical gastritis?
NSAIDS, alcohol, bile reflux
What occurs in mucus layer in chemical gastritis?
direct injury to mucus layer by fat solvents. Marked epithelial regeneration, hyperplasia, congestion and little inflammation
What is peptic ulceration ?
breach in the gastrointestinal mucosa as a result of acid and pepsin attack
Where does chronic peptic ulcers occur?
duodenum-1st part
stomach-junction of the body and antrum
oesophago-gastric junction
stomach ulcers
What occurs in chronic duodenal ulcers when there is excess acid in duodenum or failure in mucosal defense?
produces gastric metaplasia and lead to h.pylori infection, inflammation, epithelial damage and ulceration
What are the complications of peptic ulcers?
performation, penetration, haemorrhage, stenosis, intractable pain
What are the two types of benign gastric tumour polyps?
- hyperplastic polyps
- cystic fundic gland polyp
What are the three malignant tumours?
- carcinomas
- lymphomas
- gastrointestinal stromal tumours
is there a positive relationship between h.pylori infection prevalence and incidence of gastric cancer?
yes
h.pylori is the major cause of chronic gastritis? t/f?
true
What is the pathological process from h.pylori infection to carcinoma?
h.pylori infection, chronic gastritis, intestinal metaplasia/atrophy, dysplasia and finally carcinoma
What are other premalignant conditions for gastric adenocarcinoma?
pernicious anaemia
partial gastrectomy
HNPCC/Lynch syndrome
menetriers disease
What are the two subtypes of gastric adenocarcinomas?
intestinal-exophytic/polypoid mass
diffuse-expands/infiltrates stomach wall
Where does gastric adenocarcinoma spread to?
local-into other organs and into peritoeneal cavity and ovaries (krukenberg)
- lymph nodes
- haematogenous- to liver
What is gastric lymphoma-specifically maltoma?
- derived from mucosa associated lymphoid tissue
- linked with h.pylori infection
What does continuous inflam of gastric lymphoma lead to?
induces evolution into a clonal b-cell proliferation-low-grade lymphoma
-if unchecked can lead to high grade b cell lymphoma
What is lymphoma?
Lymphoma is cancer that begins in infection-fighting cells of the immune system, called lymphocytes. These cells are in the lymph nodes, spleen, thymus, bone marrow, and other parts of the body.
Where does the dyspepsia of peptic ulcer disease radiate to?
back
Is PUD nocturnal?
yes
causes of peptic ulcer disease ?
h.pylori
NSAIDS-COX1, COX2, PGE
gastric dysmotility, outflow obstruction
H.pylori-acquired in infancy. What time of bacteria is it?
gram -ve microacerophillic flagellated bacillus
How does h.pylori spread?
oral-oral faecal-oral
how to diagnose h pylori infection?
-gastric biopsy
-urease test
-histology
culture/sensitivity
-FAT -faecal antigen test
-serology IGA ANTIBIODIES
What is treatment of PUD?
Anti-secretory-PPI
Test for presence of h.pylori (if -ve still give PPI)
-Withdraw nsaid
-
Anti-secretory therapy guidlines ?
-all 4 H2RAS-cimetidine, ranitidine, famotidine and nizatidine
PPI omeprazole 20-40 mg/day healing rates of 63/93% at 2 weeks and 80-100% at 4 weeks
What is the eradication therapy fo h.pylori?
triple therapy for 1 week common-85% success (PPI +amoxicillin 1g bd and clarithromycin 250mg bd
2 week regimens- higher eradication rates, poorer compliance (PPI +1 antibiotic not recommended)
quardruple therapy +culture directed therapy
What are the complications of peptic ulcer disease?
anaemia, bleeding, perforation, gastric outlet/duodenal obstruction fibrotic scar
What are the alarm symptoms for gastric cancer?
dyspepsia and weight loss, anaemia, mass, recurrent vomiting, achlorhydia increases risk eg pernicious anaemia, previous gastric surgery, family history common,
