Pathology of the stomach

Question 1

an ulcer penetrates past what layer?

Answer 1

muscularis mucosa (into submucosa or deeper)

Question 2

what is the pathogenesis of acute gastritis?

Answer 2

disruption of defenses
stimulation of acid secretion
neutrophilic infiltration of mucosa in acute h pylori infection

Question 3

what is the morphology of MILD acute gastritis?

Answer 3

hyperemia and edema

neutrophils ABOVE basement membrane

Question 4

what is the morphology of SEVERE acute gastritis?

Answer 4

entire mucosal thickness, erosion, hemorrhage

does NOT cross muscularis mucosae

Question 5

definition: chronic gastritis

Answer 5

mucosal atrophy and intestinal metaplsia due to chronic mucosal inflammatory changes

Question 6

how does h pylori bind to surface epithelial cells?

Answer 6

bacterial adhesins

Question 7

what is the role of urease in h pylori infection?

Answer 7

buffers gastric acid for more favorable environment

Question 8

patients with what features are more likely to develop duodenal ulcer disease?

Answer 8

antral predominant gastritis

increased acid and gastrin

Question 9

gastric carcinoma is more likely to be a result of h pylori infection in what area of the stomach?

Answer 9

body

Question 10

autoimmune gastritis is characterized by antibodies made to what cells / molecules?

Answer 10

paritetal cells and intrinsic factor

Question 11

is achlorydia possible in autoimmune gastritis?

Answer 11

yes

Question 12

is achlorydia associated with h pylori infection?

Answer 12

no (never)

Question 13

where do peptic ulcers arise?

Answer 13

stomach, duodenum, anywhere in GI tract

Question 14

what is present in almost all duodenal ulcer patients?

Answer 14

h pylori

Question 15

what ILs are produced in h pylori infection?

Answer 15

IL-6, IL-8

Question 16

which IL is responsible for recruiting neutrophils in h pylori infection?

Answer 16

IL-8

Question 17

what is zollinger ellison syndrome? how does it usually manifest?

Answer 17

endocrine tumor producing gastrin (gastrinoma)

usually presents with peptic ulcers

Question 18

98% of peptic ulcers are located in what part?

Answer 18

1st portion of duodenum or stomach

Question 19

what must be done to rule out carcinoma for peptic ulcers?

Answer 19

biopsy

Question 20

what are the four zones of malignant ulcers?

Answer 20

necrosis of base and margins
inflammatory infiltrate
granulation tissue
scar (fibrosis)

Question 21

what are the complications of peptic ulcer disease?

Answer 21

bleeding
perforation - most important
obstruction
intractable pain

Question 22

patients with severe burns and trauma could develop what type of acute gastric ulcer? what is the major complication?

Answer 22

curling ulcers

bleeding

Question 23

patients with CNS conditions that increase intracranial pressure could develop what type of acute gastric ulcer?

Answer 23

cushing ulcers

Question 24

which types of polyp are precancerous? which type of cancer can develop?

Answer 24

adenomatous polyps

gastric adenoma

Question 25

what accounts for 90-95% of malignancy occurring in the stomach?

Answer 25

primary gastric carcinoma

Question 26

what are the two types of gastric carcinoma? what are the histologic characteristics of each?

Answer 26

intestinal - colonic adenocarcinoma with desmoplastic response diffuse - signet ring cells

Question 27

what is the most important factor in intestinal type gastric carcinoma?

Answer 27

h pylori infection

Question 28

what is the most important prognostic indicator for gastric carcinoma?

Answer 28

depth of invasion

Question 29

what is linitis plastica?

Answer 29

thickened wall in stomach - desmoplasia with signet ring cells

Question 30

is diffuse type gastric carcinoma aggressive or non-aggressive?

Answer 30

aggressive

Question 31

which primary gene is mutated in colon cancer?

Answer 31

APC

Question 32

where is the virchow node? what is the significance?

Answer 32

sentinal supraclavicular node metastasis site for gastric carcinoma

Question 33

where is the sister mary joseph nodule? what is the significance?

Answer 33

periumbilical area metastasis site for gastric carcinoma (intestinal type)

Question 34

where are krukenberg tumors? what is the significance?

Answer 34

ovaries metastasis site for gastric carcinoma

Question 35

what are the cells associated with gastrointestinal stromal tumors (GISTs)?

Answer 35

cells of cajal - mesenchymal

Question 36

the majority of GISTs are positive for what markers?

Answer 36

c-KIT (CD117)

Question 37

GISTs will respond to what therapy?

Answer 37

tyrosine kinase inhibitor (imatinib - Gleevec)