Pathology of the stomach and duodenum

Question 1

When does the pyloric channel end?

Answer 1

when the duodenum begins

Question 2

Describe acute gastritis? Aeitology?

Answer 2

• irratant chemical injury

Severe burns
Shock
Severe trauma
Head Injury

Question 3

What is the aeitology of chronic gastritis?

Answer 3

Autoimmune
Bacterial (H.pylori)
Chemical

Question 4

What are rare forms of inflammatory stomach disorders?

Answer 4

Lymphocytic
Eosinophillic
Granulomatous

Question 5

Describe Autoimmune chronic gastritis?

Answer 5

Atrophy and intestinal metaplasia in body of stomach

• due to the immune system producing antibodies against own stomach lining
• Anti-parietal and anti-intrinsic factor antibodies
• pernicious anaemia, macrocytic (insufficient oxygen), due to B12 deficiency
• increased risk of malignancy

Question 6

Describe Baterial chronic gastritis?

Answer 6

H.pylori
Bacteria inhabits a niche between the epithelial cell surface and mucous barrier
Excites early acute inflammatory response
Gram negative curvilinear rod
If not cleared then a chronic active inflammation ensues
IL8 is critical

Question 7

What produces anti H.pylori antibodies?

Answer 7

lamina propria

Question 8

What does H.pylori gastritis cause?

Answer 8

Increases risk of Duodenal ulcer

Increases risk of Gastric Ulcer

Increases risk of Gastric carcinoma

Increases risk of Gastric lymphoma

Question 9

Describe chemical gastritis?

Answer 9

Due to: NSAIDs, alcohol, bile reflux

Direct injury to mucus layer by fat solvents - takes away the membrane of gastric epithelial cells

Marked epithelial regeneration, hyperplasia, congestion and little inflammation

May produce erosions or ulcers

Question 10

What is peptic ulceration due to? what is it?

Answer 10

acid and pepsin attack

breach in the gastrointestinal mucosa

Question 11

What sites are predisposed to developing peptic ulceration?

Answer 11

Duodenum (Ist. part) - first part hit by stomach acid

Stomach ( junction of body and antrum)

Oesophago-gastric Junction

Stomal ulcers

Question 12

What are chronic duodenal ulcers due to?

Answer 12

Increased attack and failure of defence

Question 13

What does excess acid in the duodenum do?

Answer 13

produces gastric metaplasia and leads to:
H.Pylori infection
inflammation
epithelial damage
ulceration

Question 14

What are the complications of peptic ulcers?

Answer 14

Perforation
Penetration
Haemorrhage
Stenosis
Intractable pain

Question 15

Name benign gastric tumours?

Answer 15

Hyperplastic polyps

Cystic fundic gland polyps

Question 16

Name some malignant gastric tumours?

Answer 16

Carcinomas (adenocarcinomas)
Lymphomas
Gastrointestinal Stromal tumours (GISTs)

Question 17

What are gastric adenocarcinomas linked to?

Answer 17

smoked fish

Question 18

What is the gastric adenocarcinoma pathway?

Answer 18

H.pylori infection ->
Chronic gastritis ->
Intestinal metaplasia/atrophy ->
Dysplasia ->
Carcinoma

Question 19

What are the two types of gastric adenocarcinomas?

Answer 19

Intestinal type = well defined tumor in the stomach (better prognosis)
Diffuse type = spreads out

Question 20

What can also cause gastric adenocarcinoma?

Answer 20

Pernicious anaemia

Partial gastrectomy

HNPCC / Lynch syndrome

Menetrier’s Disease

Question 21

Where do gastric adenocarcinomas spread to?

Answer 21

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

Lymph nodes

Haematogenous: to the liver

Question 22

Describe gastric lymphoma (maltoma)?

Answer 22

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