Pathology of Stomach and Duodenum Flashcards
inflammatory disorders of the stomach
acute gastritis
chronic gastritis
rare disordes
causes of acute gastritis
irritant chemical injury severe burns shock severe trauma head injury
causes of chronic gastritis
autoimmune
bacterial (H. pylori)
chemical
rare causes of an imflmmatroy disorder of the stomach
lymphocytic
eosinophilic
granulomatous
describe autoimmune chronic gastritis
rare
anti-parietal and anti-intrinsic antibodies
increased risk of malignant
pathology of autoimmune chronic gastritis
atrophy and intestinal metaplasia in body of stomach
pernicious anaemia, microcytic - due to vitamin B12 deficiency
describe bacterial associated chronic gastritis
common
bacteria inhibits niche between epithelial cell surface and mucous barrier, exciting early acute inflammatory response
if not cleared –> chronic active inflammation ensues
IL8 critical
describe H.pylori
gram negative curvilinear rod
complications of H.pylori gastritis
lamina propria plasma cells produce anti H/pylori antibodies increases risk of; duodenal ulcer gastric ulcer gastric carcinoma gastric lymphoma
causes of chemical gastritis
Non-steroidal anti-inflammatory drugs
alcohol
bile reflux
pathology of chemical gastritis
direct injury to mucus layer by fat solvents
marked epithelial regeneration, hyperplasia, congestion and little inflammation
may produce erosions r ulcers
what is peptic ulceration
breach in the GI mucosal as a result of acid and pepsin attack;
increased acid production
failure of mucosal defence
what are chronic peptic ulcers
ulceration is long-standing and often deep
sites of chronic peptic ulcers
duodenum - 1st part
stomach - body and antrum
oesophagi-gastric junciton
stomach ulcers
describe chronic duodenal ulcers
increased/inappropriately sustained acid secretion
consequence of excess acid in duodenum
produces gastric metaplasia, leading to (synergism); H.pylori infection inflammation epithelial damage ulceration
morphology of peptic ulcers
edges clear cut, punched out
microscopic changes in peptic ulcers
layered appearance
floor or necrotic fibrinopurulent debris
base of inflamed granulation tissue
deepest layer is fibrotic scar tissue
complication of peptic ulcers
perforation penetration haemorrhage stenosis intractable pain
benign gastric tumours
hyperplastic polyps
cystic funds gland polyps
malignant gastric tumours
adenocarcinomas
lymphomas
GI stromal tumurs (GISTs)
all gastric tumours regarded malignant until proven otherwise!
most common cause of gastric adenocarcinomas
H.pylori infection
pathogenesis of gastric adenocarcinoma
in order; H.pylori infection chronic gastritis intestinal metaplasia/atrophy dysplasia carcinoma
rare causes of gastric adenocarcinoma
pernicious anaemia
partial gastrectomy
HNPCC/Lynch syndrome
menetrier’s disease
subtypes of gastric adenocarcinoma
intestinal - exophytic/polypoid mass (better prognosis)
diffuse - expands/infiltrates stomach wall
can be mixed subtypes
describe a bengin peptic ulcer
mimics cancer
more punched out, lacks raised rolled edge
metastases of gastric adenocarcinoma
local - other organs, peritoneal cavity and ovaries (Kruckenberg)
lymph nodes
haematogenous (liver)
what is a gastric lymphoma
maltoma;
derived from mucosa associated lymphoid tissue (MALT)
causes of gastric lymphoma
H.pylori infection
pathology of gastric lymphoma
continuous inflammation inducing evolution into clonal B cell proliferation - low grade lymphoma
if unchecked, evolves into high grade B-cell lymphoma
