Pathology - stomach Flashcards
what are two types of gastritis
acute- erosive
chornic - non erosive
what causes acute gastritis?
disruption of the mucosal barrier - inflammation
what type of patient would display acute gastritis
OHics
chronic NSAID users
burn victims
brain injury victims
how do NSAIDs lead to the development of gastritis?
decrease PGE2 - decrease mucosal barrier
what are curling ulcers?
burn victims - acute gastritis
how do burns lead to ulcers?
decrased plasma volume - sloughing of gastric mucosa
what are cushing ulcers?
brain injury - acute gastritis
how does a brain injury lead to an ulcer?
increased vagal stimulation - increased Ach - increased H secretion
what type of patient typical for acute gastritis
OHis and patients taking daily NSAIDs (ie rheumatoid arthritis)
type A chronic gastritis due to:
autoimmune disorders
pernicious anaemia
abs to parietal cells
achlorhydria
what part of the stomach does type A chronic gastritis hit?
fundus and body
what part of the stomach does type B chronic gastritis hit?
antrum
what causes type B chronic gastritis?
H pylor infection
what type of cancer does type B chronic gastritis increase the risk of?
MALToma
autoimmune disease
abs to parietal cells
pernicious anaemia
achlorhydria
type A chronic gastritis
body and fundus of stomach
what is achlorhydria?n
no Cl in gastric secretions
hypertrophies ruga
excess mucos production
protein loss
parietal cell atrophy
menetrier disease
describe how menetrier disease looks on CT?
rugaue are so hypertrophied that they look like brain gyri
describe menetrier disease
gastric hyperPLASIA of mucosa leads to hyperTROPHY of rugae, increased mucous production, protein loss and atrophy or parietal cells – decreased acid production
who cares about menetrier disease
precancerous
describe the s and sxs of stomach disorders
hematemesis: most common due to PUD, can be from varices or acute gastritis
melena: hb exposed to acid turns black – bleed proximal to fourth part of the duodenum
what surrounds the fourth part of the duodenum?
the ligament of trietz
what does H pylori infection cause?
type B chronic gastritis
duodenal > gastric ulcers
gastric adenocarcinoma
MALToma
what types of gastric cancer exist
adenocarcinoma
lymphoid
carcinoid (rare)
where is most common site of carcinoid tumour in the git?
small intestine
what needs to happen for a carcinoid tumour to present as carcinoid syndrome?
mets to the liver
describe prognosis of stomach cancer
early aggressive local spread with node/liver metastases
where does stomach cancer met to?
liver and nodes
weight loss
early satiety
acanthosis nigricans
stomach cancer
what causes intestinal form of gastric cancer?
H pylori dietary nitrosamines/smoked foods tobacco achlorhydria chronic gastritis
where is intestinal gastric cancer most common?
japan
incident of gastric cancer in USA?
decreasing
where does intestinal gastric cancer occur in stomach?
lesser curvature
what does intestinal gastric cancer look like?
ulcer with RAISED MARGINS
H pylori and diffuse stomach cancer?
not related
H pylori and intestinal stomach cancer?
related
histopathos of diffuse stomach cancer please
SIGNET RING CELLS
what is a signet ring cell?
diffuse stomach cancer
mucin filled cells with peripheral nuclei
describe gross presentation fo diffuse stomach cancer
linitus plastic: wall is grossly thickened and leathery as signet celsl invade
cachexia weight loss epigastric pain vomiting and melena acanthosis nigricans seborrhoeic keratosis
stomach cancer
what is Leser-Trelat sign?
multiple outcroppings of seborrheic keratosis associated with gastric cancer
name the lumps and bumps you’d see in gastric cancer
virchows node (also esophageal, cervical, pancreatic) sister mary joseph nodule SEBORRHEIC KERATOSIS acanthosis nigricans krukenberg tu;mour
what is vrichows node
gastric cancer, pancreatic, esophageal, cervical cancers
involvement of left supraclvicular node by mets from stomach
what is sister mary joseph nodule
subcutaneous periumbilical metastasis with gastric cancer
what is a krkenberg tumor
bilateral mets to ovaries
hematogenous spread
abundant mucin secreting signet ring cells
bilateral ovaries with abundant mucin secreting signet ring cells
krukenberg tumour
gastric cancer
which PUD: weight loss
pain with food - gastric
which PUS: weight gain
duodenal - pain relived by food
which PUD is associated with H pylori infection?
H pylori - intestinal gastric cancer, type B chronic gastricits, MALToma
gastric - 70%
duodeonal - 100%
mechanism of gastric ulcer pelase
decreased mucosal protection against gastric acid
mechanism of duodenal ulcer pelase
decreased mucosal protection
OR
increased gastric acid secretion
risk fo carcinoma with gastric ulcer
some
risk of carcinoma with duodenal ulcer
negligible
which type of ulcer needs to be biopsied?
gastric not duodenal
what happens in duodenal histology in duodenal ulcers
hypertrophy of brunner glands
what type of ulcers associated with zollinger Ellison syndrome
duodenal
what are complciatiosn of ulcers?
hemorrhage
perforation
what type of PUD associated with hemorrhage
gastric
duodenal
anterior ro posterior for hemorrhages associaedted with PUD?
posterior
list vessels to worry about in hemorrhage of PUD
gastric - left gastric
duodenal - gastroduodenal
which PUD worry about in perforation?
duodenal
describe what youd see if duodenal PUD perforates?
may see free air under diaphragm with referred pain to shoulder via phrenic nerve
anterior or posterior for perforation of PUD
anterior
free air under diaphragm
H pylori infection
referred pain to the shoulder
perforation of duodenal PUD
