Pathology of the Stomach Flashcards
Diaphragmatic Hernia Path
- Maldevelopment of diaphragm leading to absent all or part of dome resulting in abnormal protrusion of stomach (Herniation).
- Sometimes includes parts of other organs
Congenital Pyloric stenosis
- Hyperplasia + Hypertrophy of circular muscle of pyloris
- M>F
- S/s: Intermittent Vomiting, dehydration, Weight loss, electrolyte imbalance, sometimes palpable mass.
Aquired Pyloric stenosis Et
- Et: Infections, ulcers/scarring, cancer
Acute Gastritis
- Et: Heavu NSAID use, Alchohol, smoking, + Stress
- S/S: Epigastric pain, dyspepsia, n/v, Melena
- Morph: Predominant neutrophilic infiltration, petechial hemorrhage,
Stress-induced Gastritis Et
Shock, SEPSIS, trauma
Stress induced Ulcer Complications
- Cushing Ulcer: INC intracranial pressure -> Vagal stim -> INC H+
- Curling Ulcer: Burn/trauma -> Hypovolemia -> Mucosasl ischemia + large duodenal ulcers
Autoimmune Chronic Gastritis
- S/S: Dyspepsia, N/V, Upper abdominal pain + distention, indigestion
- Spares the antrum
- Abs against either parietal cells or intrinsic factor -> Pernicious Anemia
H. Pylori Gastritis Path
- Affects antrum
- H. Pylori generates NH3 to decrease acidity
- Enters gastric mucuous blanket via Proteases
- Ataches to epithelium via adhesins
- Bacteria obtain nutrients f/ cell, secretes VaCa, + expresses Cag A gene leading to death of the cell
- Bacteria proliferate in mucous of unaffected areas
Giant Hypertrophic Gastritis
- No accumulation leading to Abnormally large folds in gastric mucosa resembling polyps
- ## Gastric protein loss -> HCL Hypersecretion + Hypoglobinemia
Menetrier Disease
- Large ucosal folds similar to Giant Hypertrophic Gastritis, but NOT a true gastritis
- Extreme foveolar hyperplasia (TGF mediated) + glandular atrophy
Most common site of PUD
Antrum + Upper Duodenum
PUD Et
- NSAIDS
- H. Pylori
- Alcohol/Tobacco
- Corticosteroids
PUD Morphology
- Round to Oval punched out lesions smaller then 2 cm in diameter
- fibropurulent exudate with underlying necrosis
- May have granulation or fibrotic tissue
Types of Polyps
- Hyperplastic: Edge of ulcer in antrum; frmed by regeneration of mucosa
- Adenomatous: True benign tumors of surface epithelium up to 5 cm w/ dysplastic changes
- Fundal: Cystic glandular lesions usually in women
- Hamartomatous: Herditary; mulktiple in SI + pigmented areas around lips, mouth, + hands (Peutz-Jehgers Syndrome)
Most common cancer of stomach
adenocarcinoma
Associated risk factors adenocarcinoma
- H. Pylori
- Diet/ nitrosamines
- Smoking
- EBV
Molecular changes adenocarcinoma
- LOF CDH1
- Germline mutation APC
- B-catenin mutations
Gastric Adenocarcinoma Morphologies
- Polypoid: Solid mass projecting into lumen
- Ulcerating: Firm, raised, nodular, + irregular margins
- Infiltrating: extensive fibrosis in submucosa + muscularis
Linitis Plastica
Entire stomach wall is thickened
Intestinal type adenocarcinoma morphology
- Intestinal type epithelium
- bulky glandular structure grows along cohesive fronts as exophytic or ulcerating tumors
Diffuse adenocarcinoma morphology
- Discohesive cells w/ large mucin vacuole that result in eccentric nuclei (Signet ring cells) + infiltrate gastric wall (Linitis plastica)
Survival of advanced gastric tumors
20%
