Pathology of the Stomach Flashcards
What causes acute gastritis?
Irritant chemical injury
systemic disease
severe burns
What are the main groups of causes of chronic gastritis?
Autoimmune (rarest)
Bacterial (H. Pylori)
Chemical
Give 3 rare inflammatory disorders of the stomach
Lymphocytic
Eosinophilic
Granulomatous
Which antibodies cause autoimmune chronic gastritis?
Anti-parietal and anti-intrinsic factor antibodies
What happens in autoimmune chronic gastritis?
There is an attack on the lining or products of stomach excretion by the immune system
Where does H. pylori inhabit a niche?
between the epithelial cell surface and mucous barrier
What happens if H. pylori is not cleared?
A chronic active inflammation ensues which damages epithelial cells and can lead to ulcers
H. pylori gastritis increases the risk of what?
Duodenal ulcer
Gastric ulcer
Gastric lymphoma
Gastric carcinoma
What causes chemical gastritis?
NSAIDs
alcohol
bile reflux
What happens in chemical gastritis?
There is direct injury to mucus layer by fat solvents
What is peptic ulceration?
a breach in the gastrointestinal mucosa as a result of acid and pepsin attack
Sites of chronic peptic ulcers
1st part of the duodenum
Stomach (junction of body and antrum
Oesophago-gastric junction
Stomal ulcers
What are the 2 parts of the pathogenesis of chronic peptic ulcers?
Increased acid production
Failure of mucosal defence
What is the morphology of peptic ulcers?
2-10cm across edges are clear cut, punched out flat along margin - benign raised rolled edge - malignant once established, inability to repair means they get larger and larger
What is the deepest layer of a peptic ulcer?
Fibrotic scar tissue
Complications of peptic ulcers
Perforation Penetrations haemorrhage stenosis intractable pain
Primary malignant gastric tumours
carcinomas (adenocarciomas)
lymphomas
gastrointestinal stromal tumours (rarest)
Premalignant conditions to gastric adenocarcioma
- Pernicious anaemia – automimmune gastritis
- Partial gastrectomy
- HNPCC / Lynch syndrome – familial
- Menetrier’s Disease
Describe an intestinal type gastric adenocarcinoma
discrete localised mass
Describe a diffuse type gastric adenocarcinoma
epands/infiltrates stomach wall
cannot be removed surgically
poor prognosis
Which type of gastric adenocarcinoma (intestinal or difffuse) has a slightly better prognosis?
Intestinal type
How do gastric adenocarcinomas spread?
Local
Lymph nodes
Haematogenous (to the liver)
What are Maltomas (type of gastric lymphoma) derived from?
mucosa associated lymphoid tissue (MALT)
What happens in a maltoma?
lymphocytes destroy the gastric epithelium by attacking crypts one by one
What is a gastrointestinal stromal tumour (GIST)?
Neoplasma of connective tissue of stomach
Can arise in oesophagus and small bowel but rare
What are the symptoms an signs of gastric cancer?
Dyspepsia upper GI haemorrhage weight loss abdominal mass jaundice (if compresses bile duct) Paraneoplastic syndromes (hyperthyroidism can occur)
What investigations are used to diagnose gastric cancer?
Upper Gi endoscopy and biopsy #1
barium meal
CT/MRI scan
Why is surgery carried out in gastric cancer?
For palliation of symptoms
for improved survival
Contraindications to gastric cancer surgery
widely metastatic disease
malignant ascites
brief life expectancy
If the gastric cancer was in a distal lesion what kind of surgery would be carried out?
Partial gastrectomy
If the gastric cancer was in a proximal lesion what kind of surgery would be carried out?
total gastrectomy
What is the 5 year survival rate of gastric cancer? Does it increase if the pt has surgery?
15%
Yes, increases to 40-50%
Gastric ulceration usually occurs with normal or low acid production. True or false.
True
What is gastric adenocarcinoma associated with?
H. pylori infection
achlorhydria
pernicious anaemia
