Pathology of the stomach

Question 1

What are some inflammatory disorders of the stomach?

Answer 1

Acute gastritis
- burns, shock, trauma

Chronic gastritis
- autoimmune, bacterial, chemical

(rare - lymphocytic, eosinophilic, granulomatous)

Question 2

Descrive autoimmune chronic gastritis?

Answer 2

rarest
Anti-parietal and anti-intrinsic factor antibodies
Atrophy and intestinal metaplasia in the body of stomach
Increased risk of malignancy
Can lead to pernicious anaemia

Question 3

Describe H.Pylori associated chronic gastritis?

Answer 3

Most common type
Bacteria inhabits between epithelial cell surface and mucous barrier
Gram negative
Excites early acute inflammatory response
IL-8 is critical

Question 4

What does H.Pylori gastritis increase your risk of?

Answer 4

DU
GU
gastric cancer

Question 5

Describe chemical gastritis?

Answer 5

Due to NSAIDS, alcohol, bile reflux
Direct injury to mucus layer by fat solvents
Marked epithelial regeneration, hyperplasia, congestion and little inflammation

May produce erosions or ulcers

Question 6

What is peptic ulceration?

Answer 6

A breach in the gastrointestinal mucosa as a result of acid and pepsin attack

Question 7

What is also important to remember as a cause in chronic peptic ulcers?

Answer 7

Not just due to increased acid production

Also due to failure of mucosal defence

Question 8

Describe what a peptic ulcer might look like?

Answer 8

Edges are clear cut and punched out

Question 9

Describe what a peptic ulcer might look like down the microscope?

Answer 9

Layered Appearance

Floor of necrotic fibrinopurulent debris

Base of inflamed Granulation tissue

Deepest layer is fibrotic scar tissue

Question 10

What are 2 benign gastric tumours?

Answer 10

Hyperplastic polyps

Cystic fundic gland polyps

Question 11

What are 3 malignant gastric tumours?

Answer 11

• Carcinomas (adenocarcinoma)
• Lymphomas
• Gastrointestinal Stromal tumours (GISTs)

Question 12

Where do adenocarcinomas of the stomach usually occur?

Answer 12

Proximally in the cardia/GO junction region

Question 13

What is strongly linked with gastric adenocarcinomas?

Answer 13

H.Pylori

Question 14

Describe the rough pathogenesis for gastric adenocarcinoma?

Answer 14

H.Pylori infection 
Chronic gastritis
Intestinal metaplasia/atrophy
Dysplasia
Carinoma

Question 15

What are some other pre malignant conditions which could cause gastric adenocarcinoma?

Answer 15

Pernicious anaemia

Partial gastrectomy

HNPCC / Lynch syndrome

Menetrier’s Disease

Question 16

What are the 2 types of gastric adenocarcinomas?

Answer 16

Intestinal - polypoid mass

Diffuse - expands/infiltrates stomach wall

Question 17

Which type of gastric adenocarcinoma has a better prognosis?

Answer 17

Intestinal type

Question 18

Where might gastric adenocarcinoma spread?

Answer 18

Local: Into other organs and into peritoneal cavity and ovaries…Kruckenberg

Lymph nodes

Haematogenous:
(To the liver)

Question 19

Describe gastric lymphomas (MALTomas)?

Answer 19

Derived from mucosa associated lymphoid tissue (MALT)

Associated with H.Pylori infection

Continuous inflammation induces an evolution into a clonal B-cell proliferation…low grade lymphoma

If unchecked evolves into a high grade B-cell lymphoma

Question 20

What can cause gastritis?

Answer 20

NSAIDS, Hiatus hernia, H.Pylori,

Question 21

How might gastritis present?

Answer 21

Epigastric pain, vomiting, haematemesis

Question 22

How do you treat gastritis?

Answer 22

PPI or ranitidine