Pathology of the Stomach Flashcards
What are the cells that accumulate in an acute gastritis? Chronic?
Acute = PMNs Chronic = lymphocytes or plasma cells
Erosions of the stomach do not go past what layer of the GI tract? What happens it does?
Muscularis mucosa
Becomes an ulcer
What are the causes of acute gastritis?
- Disruption of the mucus layer
- Decrease bicarb secretion
- Decreased mucosal blood flow
What are the two major chemicals that are absorbed through the stomach?
NSAIDs and EtOH
How can renal disease lead to gastritis?
Uremia
What is the morphology of acute gastritis?
Hyperemia and edema with PMNs above the BM
What is the morphology of more severe gastritis?
Entire mucosal thickness eroded and/or hemorrhage.
What is acute erosive hemorrhagic gastritis?
When the mucus layer of the stomach has eroded away, and is bleeding
What are the ssx of acute gastritis?
Hematemesis
Melena
What is chronic gastritis?
Chronic mucosal inflammatory changes eventually leading to mucosal atrophy and intestinal metaplasia
What CA can result from chronic gastritis?
Carcinoma
What is the autoimmune cause of gastric gastritis?
Pernicious anemia
What is the cause of granulomatous gastritis?
Crohn’s disease
What are the gram staining and morphological characteristics of chronic gastritis?
S shaped gram negative rod
Is H.Pylori invasive?
no
True or false: most H.pylori infections are asymptomatic
True
What are the risk factors of having an H.Pylori infection?
Increase peptic ulcer
carcinoma
Lymphoma
Where does H.pylori reside in the stomach?
In the mucus layer
What are the virulence factors that some strains of H.pylori produce? MOA?
CagA
VacA (forms vacuoles)
Both are inflammatory cytokines
True or false: H.pylori are flagellated
True
What are the protein that allow H.pylori to bind to the epithelial cells of the stomach?
Adhesins
What is a major cause of gastric epithelial degradation?
Pepsin is allowed in, degrading proteins
What is the major difference between acute an chronic gastritis secondary to H.pylori infection?
PMNs cause damage in chronic infections
Atrophy / dysplasia
What happens when H.pylori infections become symptomatic? (2 scenarios) where does this usually occur?
Increase acid and gastrin secretion. OR just increased gastrin.
usually occurs in the antrum.
Less commonly in the body
Autoimmune gastritis can have antibodies to what?
Parietal cells and IF
What are the microcytic anemias? (5)
Fe deficiency Chronic disease Pb exposure Sideroblastic Thalassemias
What is the MOA of CagA that H.pylori produces?
Activates IL-8, attracting PMNs
What are the histological characteristics of H.pylori dysplasia?
PMN infiltration
Dysplasia
What is the late morphology of Chronic gastritis?
Atrophy, dysplasia
carcinoma in situ
What is the early morphological characteristics of chronic gastritis?
Coarse, red mucosa; inflammatory infiltrate
What are the more severe morphological changes associated with chronic gastritis?
Variable atrophy
Thin, flattened mucosa
Regenerative changes
What happens to the rugal folds in chronic gastritis?
Flattening
What are the symptoms of autoimmune chronic gastritis (besides pernicious anemia?
Achlorhydria and hypergastrinemia
What is an ulcer?
Erosion below the muscularis mucosa
Where do peptic ulcers form?
Antrum of the stomach
Pylorus
body of the stomach
Duodenum
Who is affected with PUD more often: men or women
Men
What is the relationship between hyperparathyroidism and PUD?
Hypercalcemia increases gastrin production
What are the ssx of PUD?
Gnawing epigastric pain occurring 1-3 hours, worse at night
How do you diagnose PUD?
Endoscopy and imaging
Does eating improve or worsen the ssx of PUD?
Improve
Which ulcers are usually cancerous: duodenal or stomach
Duodenal
What is the main pathological cause of PUD?
Imbalance between mucosal defense and damaging forces
H. Pylori is present in almost all (___) ulcers and most of the time in (___) ulcers?
Duodenal
Gastric
What are some of the defensive forces against developing an ulcer?
Mucosal blood flow
Mucus
Bicarb secretion
Prostaglandins
What are the pro-inflammatory cytokines that are secreted by H.pylori?
IL-1
IL-6
TNF
IL-8
What is the role of IL-8 in H.pylori infection
Recruits PMNs
What is the effect H.Pylori has on gastric acid secretion? Bicarb?
Increased gastric acid
Decreased bicarb
What are the three enzymes that H.pylori secretes?
Urease
Protease
Phospholipase
What is Zollinger-ellison syndrome?
Gastrinoma producing extra HCl
What are the problems with the lower pyloric sphincter that can contribute to ulcer formation?
Delayed gastric emptying
Duodenal-gastric reflux
What are the severe symptoms of gastric ulcers?
Hematemesis
Melena
Where are the vast majority of ulcer located?
1st portion of the duodenum
What is the best way to diagnose an ulcer?
Look at it (EGD)
What are the characteristics of a benign gastric ulcer?
Small, punched out appearance without other signs of inflammation or dysplasia
What do gastric carcinomas look like?
Raised edges around an ulcer
What are the four demonstrable zones histologically of a peptic ulcer?
- Necrosis of ulcer base and margins
- Inflammatory infiltrate
- Granulation tissue
- Scarring (fibrosis)
What are the 4 major complications with PUD?
Bleeding
Perforation
Obstruction
Intractable pain
What causes the obstructive problems with PUD?
Edema or scarring
What is the characteristic of stress ulcers? Where do these usually occur?
Multiple, small ulcers that Do not breach the muscularis mucosa
Stomach and the duodenum, esophagus
True or false: stress ulcers are a precursor to chronic PUD
False
What are Curling ulcers?
an acute peptic ulcer of the duodenum resulting as a complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa.
What are Cushing ulcers?
Increased intracranial pressure may lead to overstimulation of the vagus nerve, causing increased gastric acid secretion, and ulcer formation
What are polyps?
Mass lesions arising from and projecting above the mucosa
What are hyperplastic or inflammatory polyps?
Usually nonneoplastic but hyperplastic epithelium overlying dilated glandular tissue
What are adenomatous polyps?
True neoplasms–
What type of polyps in the stomach are precancerous?
Adenomatous polyps
What are the histological characteristics of hyperplastic gastric polyps?
Tons o’ glands in the epithelium
What is the most common type of malignancy of the stomach?
Gastric carcinoma
What are the two types of gastric carcinomas?
Intestinal types
Diffuse type
Where, geographically, are most gastric carcinomas found?
Asia
What is the most important factor for the development of the intestinal type of gastric carcinoma?
H.Pylori infection
What are the major environmental influences on the intestinal type of gastric carcinoma?
nitrosamines
Benzopyrenes
Where in the stomach does gastric carcinoma usually occur?
Lesser curvature of the stomach
What is the most important prognostic factor for gastric carcinoma?
Depth of invasion
What is the shape, generally, of a malignant ulcer?
Ragged edges with elevated edges
What is the shape, generally, of a benign ulcer?
Smooth, round edges
What is linitis plastic?
Diffuse gastric carcinoma that spreads out, causing diffuse thickening of the walls of the stomach
Signet rings in gastric cells is indicative of what?
“Diffuse” typu adenocarcinoma
What is the gene that is mutated that causes gastric carcinoma?
APC