Pathology of stomach

Question 1

What are the 3 inflammatory disorders of the stomach?

Answer 1

acute gastritis
chronic gastritis
rare

Question 2

What does acute gastritis consist of?

Answer 2

irratant chemical injury 
severe burns
shock 
severe trauma
head injury

Question 3

What does chronic gastritis consist of?

Answer 3

autoimmune
bacterial
chemical

Question 4

What does rare inflammatory disorders of stomach consist of?

Answer 4

lymphocytic
eosinophilic
granulomatous

Question 5

Autoimmune chronic gastritis consists of which two antibodies?

Answer 5

anti-parietal and anti-intrinsic factor

Question 6

What occurs in the body of the stomach during autoimmune chronic gastritis?

Answer 6

atrophy and intestinal metaplasia

Question 7

what two things occur in autoimmune chronic gastritis due to b12 deficiency?

Answer 7

pernicious anaemia and macrocytic

Question 8

H.pylori linked chronic gastritis affects stomach lining how?

Answer 8

bacteria inhabits a niche between the epithelial cell surface and mucous barrier

Question 9

Does h.pylori excite an early acute inflammatory response?

Answer 9

yes

Question 10

Which INTERLEUKIN is critical in h.pylori associated chronic gastritis ?

Answer 10

IL8

Question 11

Which cells produce anti- H.pylori antibodies?

What does this increase risk of? (4)

Answer 11

lamina propria plasma cells

duodenal ulcer
gastric ulcer
gastric carcinoma
gastric lymphoma

Question 12

What is the causes of chemical gastritis?

Answer 12

NSAIDS, alcohol, bile reflux

Question 13

What occurs in mucus layer in chemical gastritis?

Answer 13

direct injury to mucus layer by fat solvents. Marked epithelial regeneration, hyperplasia, congestion and little inflammation

Question 14

What is peptic ulceration ?

Answer 14

breach in the gastrointestinal mucosa as a result of acid and pepsin attack

Question 15

Where does chronic peptic ulcers occur?

Answer 15

duodenum-1st part
stomach-junction of the body and antrum
oesophago-gastric junction
stomach ulcers

Question 16

What occurs in chronic duodenal ulcers when there is excess acid in duodenum or failure in mucosal defense?

Answer 16

produces gastric metaplasia and lead to h.pylori infection, inflammation, epithelial damage and ulceration

Question 17

What are the complications of peptic ulcers?

Answer 17

performation, penetration, haemorrhage, stenosis, intractable pain

Question 18

What are the two types of benign gastric tumour polyps?

Answer 18

• hyperplastic polyps

- cystic fundic gland polyp

Question 19

What are the three malignant tumours?

Answer 19

• carcinomas
• lymphomas
• gastrointestinal stromal tumours

Question 20

is there a positive relationship between h.pylori infection prevalence and incidence of gastric cancer?

Answer 20

yes

Question 21

h.pylori is the major cause of chronic gastritis? t/f?

Answer 21

true

Question 22

What is the pathological process from h.pylori infection to carcinoma?

Answer 22

h.pylori infection, chronic gastritis, intestinal metaplasia/atrophy, dysplasia and finally carcinoma

Question 23

What are other premalignant conditions for gastric adenocarcinoma?

Answer 23

pernicious anaemia
partial gastrectomy
HNPCC/Lynch syndrome
menetriers disease

Question 24

What are the two subtypes of gastric adenocarcinomas?

Answer 24

intestinal-exophytic/polypoid mass

diffuse-expands/infiltrates stomach wall

Question 25

Where does gastric adenocarcinoma spread to?

Answer 25

local-into other organs and into peritoeneal cavity and ovaries (krukenberg)

• lymph nodes
• haematogenous- to liver

Question 26

What is gastric lymphoma-specifically maltoma?

Answer 26

• derived from mucosa associated lymphoid tissue

- linked with h.pylori infection

Question 27

What does continuous inflam of gastric lymphoma lead to?

Answer 27

induces evolution into a clonal b-cell proliferation-low-grade lymphoma
-if unchecked can lead to high grade b cell lymphoma

Question 28

What is lymphoma?

Answer 28

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.

Question 29

Where does the dyspepsia of peptic ulcer disease radiate to?

Answer 29

back

Question 30

Is PUD nocturnal?

Answer 30

yes

Question 31

causes of peptic ulcer disease ?

Answer 31

h.pylori
NSAIDS-COX1, COX2, PGE
gastric dysmotility, outflow obstruction

Question 32

H.pylori-acquired in infancy. What time of bacteria is it?

Answer 32

gram -ve microacerophillic flagellated bacillus

Question 33

How does h.pylori spread?

Answer 33

oral-oral faecal-oral

Question 34

how to diagnose h pylori infection?

Answer 34

-gastric biopsy
-urease test
-histology
culture/sensitivity
-FAT -faecal antigen test
-serology IGA ANTIBIODIES

Question 35

What is treatment of PUD?

Answer 35

Anti-secretory-PPI
Test for presence of h.pylori (if -ve still give PPI)
-Withdraw nsaid
-

Question 36

Anti-secretory therapy guidlines ?

Answer 36

-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

Question 37

What is the eradication therapy fo h.pylori?

Answer 37

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

Question 38

What are the complications of peptic ulcer disease?

Answer 38

anaemia, bleeding, perforation, gastric outlet/duodenal obstruction fibrotic scar

Question 39

What are the alarm symptoms for gastric cancer?

Answer 39

dyspepsia and weight loss, anaemia, mass, recurrent vomiting, achlorhydia increases risk eg pernicious anaemia, previous gastric surgery, family history common,