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imed3004 > Pathology of The Stomach > Flashcards

Pathology of The Stomach Flashcards

1
Q

What are the types of gastritis?

A

Acute erosive

Chronic (helicobacter pylori)

Peptic ulcer

Atrophic gastritis (Pernicious anaemia)

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2
Q

What causes acute erosive gastropathy?

A

Caused by exposure to injurious substances like ETOH, NSAIDs, bile, iron tablets, other

Chemotherapy/Radiotherapy

Mucosal ischaemia (trauma, burns, sepsis)

CNS injury (Cushing’s ulcers in ICU)

Damage to surface epithelium, loss of protective mucin layer, alteration of blood flow, penetration of acid and other substances

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3
Q

How is acute gastritis treated usually?

A

Usually self-limiting

PPIs (lowers acidity of stomach lumen)

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4
Q

What does histology show with gastritis?

A

Lots of inflammatory cells (neutrophils) especially pronounced in chronic gastritis.

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5
Q

Where do helicobacter pylori sit?

A

Usually under the mucin and within the pits.

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6
Q

What kind of symptoms are associated with helicobacter pylori?

A

Can produce an acute gastritis (pain, nausea, vomiting)

But usually presents as chronic dyspepsia

Typically antral initially then loss of acid produces cells and migration proximally. (important for biopsy)

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7
Q

How common is helicobacter pylori usually?

A

Endemic in most communities

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8
Q

What are the guidelines for helicobacter diagnosis?

A

Invasive or non-invasive (not necessarily biopsy)

Direct or indirect

ACG guidelines: Test and treat for uninvestigated dyspepsia in under 55 years and no alarm features. Endoscopy needs are depndent on clinical presentation.

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9
Q

What kinds of tests are conducted for helicobacter diagnosis?

A

Urea breath test

Serology (High sensitivity low specificity because it could be cleared)

Stool antigen assay

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10
Q

What types of stains can be used for helicobacter pylori?

A

H+E, Toluidine blue, immunohistochemical staining, on-site urease test

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11
Q

When can a peptic ulcer be treated empriically for helicobacter?

A

When there is some evidence from endoscopy and urease breath test.

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12
Q

How can a gastric ulcer be differentiated from cancer?

A

Presence of lots of inflammatory cells.

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13
Q

What are potential complications from gastric ulcers?

A

Perforation or haemorrhage (present with severe pain)

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14
Q

How are gastric ulcers treated?

A

Cease cause if possible

Helicobacter eradication if present

Antisecretory therapy

Surgery is rarely necessary

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15
Q

What causes autoimmune gastritis?

A

Immune response to parietal cells of stomach.

Presents as pernicious anaemia (B12 deficiency)

Iron deficiency

May be associated with other autoimmune disorders

1 - 2% older population

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16
Q

What does histology show in autoimmune gastritis?

A

Chronic inflammation atrophy and lots of blue cells

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17
Q

What happens to intestines in autoimmune gastritis?

A

Can lead to intestinal metaplasia

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18
Q

What are the classes of stomach tumours?

A

Epithelial (Dysplasia/carcinoma)

Mesenchymal (Gastrointestinal stromal tumour or GIST)

Lymphoid (MALT lymphoma)

Neuroendocrine (Carcinoid)

19
Q

What is a fundic gland poly? How can they be discovered?

A

Fundic gland polyp is a type of gastric polyp which forms in people on PPIs. (can be picked with endoscopes)

20
Q

What are hyperplastic polyps?

A

Gastric polyps that can be seen in the antrum they can be up to multiple centimeters in size.

They are often secondary to gastritis.

21
Q

What is an adenocarcinoma?

A

A mucin producing cancer of the stomach that arises in the wall of a hollow tube

22
Q

What are the signs and symptoms of adenocarcinoma?

A

Often asymptomatic until late but results in obstruction/dysphagia, constipation

Pain due to disordered contraction

Bleeding from ulceration (anaemia and haematemesis/malaena)

Perforation (Peritonitis and tumour seeding)

23
Q

Dysplasia is a precursor to what stomach conditions?

A

Some carcinomas.

24
Q

What are the types of adenocarcinomas that can affect the stomach?

A

Tubular type (carcinoma retains a gland like structure round lumen like structures.)

Poorly cohesive type (signey ring cells)

25
Q

What is linitis plastica?

A

Linitis Plastica: Diffuse growth pattern creating a leather bottle like structure on the stomach

26
Q

Which adenocarcinoma often goes unnoticed due to being hard to see on histology?

A

Signey ring cells

27
Q

Where is gastric carcinoma seen most often?

A

In Russia and East Asia

Rarely seen in Australia

Possibly due to dietary differences

28
Q

Is there ulceration in GISTs?

A

No, GISTs are mesenchymal and thus don’t affect the epithelium to cause ulceration.

29
Q

What are the types of morphologies of GIST?

A

Spindled look almost syncytial.

Epithelioid have more distinct membranes

30
Q

What stains are used for GIST tumours?

A

DOG1

CD117

31
Q

How can DOG1 be used to identify a GIST?

A

Smooth muscle present in large amounts.

32
Q

What does GIST risk of invasion depend on?

A

Mitotic index

Size (depends on location)

33
Q

What does CD117 look for?

A

A protein called c-kit which is a gene which causes 80% of GIST tumours.

34
Q

What kind of gene is c-kit?

A

It is a receptor tyrosine kinase which pushes cells to proliferate

35
Q

What mutations cause GISTs?

A

80% are c-kit mutations (mutation site is a prognostic factor in response to therapy)

10% PDGFR (Platelet Derived Growth Factor Regulator)

5% syndromic (NF1, Carney triad, familial GIST syndrome, Carney-Stratakis)

36
Q

What are tumours of the GI tract lymphoid tissues called?

A

Gastric MALT tumours

37
Q

What causes gastric MALT tumours?

A

Most strongly linked to H pylori infection

38
Q

What are the histological features of gastric MALT lymphomas?

A

Lymphoid cells

Lymphoepithelial lesions (where nests of lymphoid cells are seen in the epithelium)

39
Q

What stain can be used to detect gastric MALT lymphomas?

A

brown CD20 (red cytokeratin)

40
Q

How can flow cytometry show a gastric MALT lymphoma?

A

Run through flow cytometry which results in lots of kappa light chains and hardly any lambda light chains.

41
Q

How is gastric diffuse large B cell lymphoma treated?

A

Unless lesion is very large it is treated with antibiotics. (To treat infective cause.)

42
Q

How common are hereditary diffuse gastric carcinomas?

A

10% of gastric cancers show “familial clustering” Of these 1 - 3% are HDGC. Of these 30 - 40% have known CDH1 mutation.

43
Q

How is hereditary diffuse gastric carcinoma prevented?

A

Prophylactic total gastrectomy

44
Q

What gene can cause hereditary diffuse gastric carcinoma?

A

Inherited mutation in CDH1 (e-cadherin) gene

imed3004 (50 decks)

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