Pathology of the Stomach

Question 1

Inflammatory disorders of the stomach

Answer 1

Acute gastritis, chronic gastritis, lymphocytic gastritis, eosinophilic gastritis, granulomatous gastritis

Question 2

Causes of acute gastritis

Answer 2

Chemical injury, severe burns, shock, severe trauma, head injury

Question 3

Causes of chronic gastritis

Answer 3

Autoimmune, bacterial (H.pylori), chemical

Question 4

Autoimmune chronic gastritis:

• How common is it?
• What antibodies are associated?
• What pathology occurs in the body of the stomach?
• What can it cause?

Answer 4

• Rarest type
• Anti-parietal and anti-intrinsic factor antibodies
• Atrophy and intestinal metaplasia
• Macrocytic anaemia due to vitamin B12 deficiency

Question 5

Most common type of chronic gastritis

Answer 5

H.pylori associated

Question 6

Which interleukin is critical in H.pylori associated chronic gastritis?

Answer 6

IL-8

Question 7

What does H.pylori associated chronic gastritis increase the risk of?

Answer 7

Duodenal ulcer, gastric ulcer, gastric carcinoma, gastric lymphoma

Question 8

What can cause chemical gastritis?

Answer 8

NSAIDs, alcohol, bile reflux

Question 9

Where is the injury in chemical gastritis?

Answer 9

Mucus layer

Question 10

Histological signs of chemical gastritis

Answer 10

Epithelial regeneration, hyperplasia, congestion, a little inflammation

Question 11

Sites of chronic peptic ulcers

Answer 11

First part of duodenum, stomach, oesophagi-gastric junction, stoma

Question 12

Microscopic appearance of peptic ulcers

Answer 12

• Layered appearance
• Floor of necrotic fibrinopurulent debris
• Base of inflamed granulation tissue
• Deepest layer is fibrotic scar tissue

Question 13

Complications of peptic ulcers

Answer 13

Perforation, penetration, haemorrhage, stenosis, intractable pain

Question 14

Benign gastric tumours - polyps

Answer 14

Hyperplastic polyps, cystic fundic gland polyps

Question 15

Malignant gastric tumours

Answer 15

Carcinomas, lymphomas, GI stromal tumours

Question 16

Gastric adenocarcinomas:

• High incidence areas
• Premalignant conditions
• Subtypes

Answer 16

• Japan, China, Columbia, Finland
• H.pylori infections, pernicious anaemia, partial gastrectomy, Lynch syndrome/HNPCC, Menetrier’s disease
• Intestinal type, diffuse type

Question 17

Pathogenesis of gastric adenocarcinomas from H.pylori infection

Answer 17

H.pylori infection → chronic gastritis → intestinal metaplasia/atrophy → dysplasia → carcinoma

Question 18

Gastric lymphoma:

• What is it derived from?
• What infection is it associated with?
• Pathogenesis

Answer 18

• Mucosa associated lymphoid tissue
• H.pylori
• Continuous inflammation induces an evolution into a clonal B-cell proliferation (low grade lymphoma), and if unchecked evolves into a high grade lymphoma