Pathology: Stomach

Question 1

What is a Bochdalek Hernia?

Answer 1

Congenital opening on the left side of the diaphragm often allowing stomach and intestines to herniate into the chest cavity.

Question 2

What is a Morgagni hernia?

Answer 2

Congenital opening on the right side of the diaphragm leading to liver and intestines herniating into the chest cavity.

Question 3

What are the two biggest causes of chronic gastritis?

Answer 3

1. H. pylori infection

2. Autoimmune destruction of mucosa which leads to pernicious anemia

Question 4

Why is Vitamin B12 so important?

Answer 4

Plays a major role in the metabolism of folic acid. Without B12 cells that undergo high levels of protein synthesis do not work properly. Nerves cannot produce neurotransmitter and marrow cells cannot produce new RBCs which is why neuro and anemia symptoms manifest earliest.

Question 5

What is pangrastritis?

Answer 5

The entire stomach is enflamed.

Question 6

Name two malignancies that can occur as a result of chronic gastritis caused by H. pylori infection.

Answer 6

1. Gastric adenocarcinoma

2. MALT lymphoma

Question 7

What is the most common complication of autoimmune gastritis?

Answer 7

Pernicious anemia. Autoantibodies are generated against parietal cells or even directly against intrinsic factor leading to a lack of B12 absorption.

Question 8

What is a special type of gastritis that involves granulomas?

Answer 8

Crohn Disease. It rarely happens but CD can manifest all the way up to the mouth.

Question 9

Top two causes of duodenal ulcers.

Answer 9

1. H. pylori (95%)

2. Zollinger Ellison (5%)

Question 10

How can you differentiate an ulcer caused by H. pylori vs. ZE syndrome?

Answer 10

Normal gastrin levels = H. pylori

High gastrin levels = ZE tumor

Question 11

Most common cause of acute gastric ulceration.

Answer 11

Prolonged NSAID use

H. pylori is most common chronic cause

Question 12

What is Ménétrier Disease?

Answer 12

Gastric mucosal hyperplasia with glandular atrophy.

Question 13

What are common symptoms of Ménétrier disease?

Answer 13

Hypoalbuminemia due to decreased Pepsin and acid secretion in the stomach. Proteins from the diet are not properly broken down in the stomach and therefore not absorbed in the small bowel. Low protein leads to anasarca (generalized edema).

Question 14

Most important determinant of the outcome of a Gastric Carcinoma.

Answer 14

Depth of Invasion in mucosa

Question 15

Name the 3 most common sites gastric carcinomas spread.

Answer 15

1. Supraclavicular Nodes: Virchow Node
2. Periumbilical Region: Sister Mary Joseph nodule
3. Ovary: Krukenberg Tumor