Pathology of the stomach Flashcards
an ulcer penetrates past what layer?
muscularis mucosa (into submucosa or deeper)
what is the pathogenesis of acute gastritis?
disruption of defenses
stimulation of acid secretion
neutrophilic infiltration of mucosa in acute h pylori infection
what is the morphology of MILD acute gastritis?
hyperemia and edema
neutrophils ABOVE basement membrane
what is the morphology of SEVERE acute gastritis?
entire mucosal thickness, erosion, hemorrhage
does NOT cross muscularis mucosae
definition: chronic gastritis
mucosal atrophy and intestinal metaplsia due to chronic mucosal inflammatory changes
how does h pylori bind to surface epithelial cells?
bacterial adhesins
what is the role of urease in h pylori infection?
buffers gastric acid for more favorable environment
patients with what features are more likely to develop duodenal ulcer disease?
antral predominant gastritis
increased acid and gastrin
gastric carcinoma is more likely to be a result of h pylori infection in what area of the stomach?
body
autoimmune gastritis is characterized by antibodies made to what cells / molecules?
paritetal cells and intrinsic factor
is achlorydia possible in autoimmune gastritis?
yes
is achlorydia associated with h pylori infection?
no (never)
where do peptic ulcers arise?
stomach, duodenum, anywhere in GI tract
what is present in almost all duodenal ulcer patients?
h pylori
what ILs are produced in h pylori infection?
IL-6, IL-8
which IL is responsible for recruiting neutrophils in h pylori infection?
IL-8
what is zollinger ellison syndrome? how does it usually manifest?
endocrine tumor producing gastrin (gastrinoma)
usually presents with peptic ulcers
98% of peptic ulcers are located in what part?
1st portion of duodenum or stomach
what must be done to rule out carcinoma for peptic ulcers?
biopsy
what are the four zones of malignant ulcers?
necrosis of base and margins
inflammatory infiltrate
granulation tissue
scar (fibrosis)
what are the complications of peptic ulcer disease?
bleeding
perforation - most important
obstruction
intractable pain
patients with severe burns and trauma could develop what type of acute gastric ulcer? what is the major complication?
curling ulcers
bleeding
patients with CNS conditions that increase intracranial pressure could develop what type of acute gastric ulcer?
cushing ulcers
which types of polyp are precancerous? which type of cancer can develop?
adenomatous polyps
gastric adenoma
what accounts for 90-95% of malignancy occurring in the stomach?
primary gastric carcinoma
what are the two types of gastric carcinoma? what are the histologic characteristics of each?
intestinal - colonic adenocarcinoma with desmoplastic response
diffuse - signet ring cells
what is the most important factor in intestinal type gastric carcinoma?
h pylori infection
what is the most important prognostic indicator for gastric carcinoma?
depth of invasion
what is linitis plastica?
thickened wall in stomach - desmoplasia with signet ring cells
is diffuse type gastric carcinoma aggressive or non-aggressive?
aggressive
which primary gene is mutated in colon cancer?
APC
where is the virchow node? what is the significance?
sentinal supraclavicular node
metastasis site for gastric carcinoma
where is the sister mary joseph nodule? what is the significance?
periumbilical area
metastasis site for gastric carcinoma (intestinal type)
where are krukenberg tumors? what is the significance?
ovaries
metastasis site for gastric carcinoma
what are the cells associated with gastrointestinal stromal tumors (GISTs)?
cells of cajal - mesenchymal
the majority of GISTs are positive for what markers?
c-KIT (CD117)
GISTs will respond to what therapy?
tyrosine kinase inhibitor (imatinib - Gleevec)
