Pathology of the Stomach

Question 1

Diaphragmatic Hernia Path

Answer 1

• Maldevelopment of diaphragm leading to absent all or part of dome resulting in abnormal protrusion of stomach (Herniation).
• Sometimes includes parts of other organs

Question 2

Congenital Pyloric stenosis

Answer 2

• Hyperplasia + Hypertrophy of circular muscle of pyloris
• M>F
• S/s: Intermittent Vomiting, dehydration, Weight loss, electrolyte imbalance, sometimes palpable mass.

Question 3

Aquired Pyloric stenosis Et

Answer 3

• Et: Infections, ulcers/scarring, cancer

Question 4

Acute Gastritis

Answer 4

• Et: Heavu NSAID use, Alchohol, smoking, + Stress
• S/S: Epigastric pain, dyspepsia, n/v, Melena
• Morph: Predominant neutrophilic infiltration, petechial hemorrhage,

Question 5

Stress-induced Gastritis Et

Answer 5

Shock, SEPSIS, trauma

Question 6

Stress induced Ulcer Complications

Answer 6

• Cushing Ulcer: INC intracranial pressure -> Vagal stim -> INC H+
• Curling Ulcer: Burn/trauma -> Hypovolemia -> Mucosasl ischemia + large duodenal ulcers

Question 7

Autoimmune Chronic Gastritis

Answer 7

• S/S: Dyspepsia, N/V, Upper abdominal pain + distention, indigestion
• Spares the antrum
• Abs against either parietal cells or intrinsic factor -> Pernicious Anemia

Question 8

H. Pylori Gastritis Path

Answer 8

• 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

Question 9

Giant Hypertrophic Gastritis

Answer 9

• No accumulation leading to Abnormally large folds in gastric mucosa resembling polyps
• ## Gastric protein loss -> HCL Hypersecretion + Hypoglobinemia

Question 10

Menetrier Disease

Answer 10

• Large ucosal folds similar to Giant Hypertrophic Gastritis, but NOT a true gastritis
• Extreme foveolar hyperplasia (TGF mediated) + glandular atrophy

Question 11

Most common site of PUD

Answer 11

Antrum + Upper Duodenum

Question 12

PUD Et

Answer 12

• NSAIDS
• H. Pylori
• Alcohol/Tobacco
• Corticosteroids

Question 13

PUD Morphology

Answer 13

• Round to Oval punched out lesions smaller then 2 cm in diameter
• fibropurulent exudate with underlying necrosis
• May have granulation or fibrotic tissue

Question 14

Types of Polyps

Answer 14

• 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)

Question 15

Most common cancer of stomach

Answer 15

adenocarcinoma

Question 16

Associated risk factors adenocarcinoma

Answer 16

• H. Pylori
• Diet/ nitrosamines
• Smoking
• EBV

Question 17

Molecular changes adenocarcinoma

Answer 17

• LOF CDH1
• Germline mutation APC
• B-catenin mutations

Question 18

Gastric Adenocarcinoma Morphologies

Answer 18

• Polypoid: Solid mass projecting into lumen
• Ulcerating: Firm, raised, nodular, + irregular margins
• Infiltrating: extensive fibrosis in submucosa + muscularis

Question 19

Linitis Plastica

Answer 19

Entire stomach wall is thickened

Question 20

Intestinal type adenocarcinoma morphology

Answer 20

• Intestinal type epithelium

- bulky glandular structure grows along cohesive fronts as exophytic or ulcerating tumors

Question 21

Diffuse adenocarcinoma morphology

Answer 21

• Discohesive cells w/ large mucin vacuole that result in eccentric nuclei (Signet ring cells) + infiltrate gastric wall (Linitis plastica)

Question 22

Survival of advanced gastric tumors

Answer 22

20%