Pathoma: Stomach

Question 1

Gastroschisis results from __________.

Answer 1

congenital malformation of the abdominal wall, leading to exposure of abdominal contents that are NOT covered by amniotic sac (as is found in omphalocele)

Question 2

Omphalocele results from __________.

Answer 2

persistent herniation of the bowel into the umbilical cord, resulting in exposure of the intestines covered by the amnion of the umbilical cord

Question 3

Pyloric stenosis results from ____________.

Answer 3

hyperplasia of smooth muscle AFTER birth (generally two to three weeks after)

Question 4

You can sometimes see the ____________ in babies with pyloric stenosis on physical exam.

Answer 4

excess gastric peristalsis

Question 5

What are the main causes of acute and chronic gastritis?

Answer 5

Acute: increased acid production or decreased mucus production

Chronic: autoimmune gastritis and H. pylori gastritis

Question 6

Foveolar cells produce ______.

Answer 6

mucus

Question 7

Normal blood supply to the gastric mucosa is important for two reasons: ___________.

Answer 7

supplying mucus-producing cells with nutrients and washing away any acid that seeps into the blood

Question 8

Why do people get ulcers with severe burns?

Answer 8

Because burns cause hypovolemia, which leads to decreased blood supply to the gastric mucosa

Question 9

Why does chemotherapy increase risk for acute gastritis?

Answer 9

Because it limits the turnover of protective mucosal cells

Question 10

Cushing’s ulcer result from __________.

Answer 10

increased ICP, which increases vagal stimulation on parietal cells

Question 11

What is the difference between erosion and ulceration?

Answer 11

Erosion: destruction of epithelium

Ulceration: destruction of mucosal layer

Question 12

Parietal cells are predominantly found in the __________.

Answer 12

body and the fundus

Question 13

Autoimmune gastritis mostly affects the __________.

Answer 13

parietal cells in the body and the fundus

Question 14

True or false: autoimmune gastritis results from antibodies against parietal cells.

Answer 14

False. It is a T-cell mediated response, and the antibodies are just a byproduct of the contents released into the blood.

Question 15

Achlorhydria is a symptom of ___________.

Answer 15

autoimmune gastritis

Question 16

Increased gastrin level with G-cell hyperplasia is a consequence of _____________.

Answer 16

autoimmune gastritis

Question 17

Which cancer is more likely in someone with autoimmune gastritis?

Answer 17

Gastric adenocarcinoma, because gastric epithelium transitions to intestinal metaplasia in response to proximity to lymphocytes.

Question 18

The most common site of H. pylori colonization is __________.

Answer 18

the antrum

Question 19

Which part of the lymph node is likely to develop cancerous proliferation in response to chronic inflammation?

Answer 19

The marginal zone (this is the type found in MALTomas)

Question 20

90% of the time, ______ presents in the proximal duodenum.

Answer 20

PUD

Question 21

Zollinger-Ellison syndrome results from __________.

Answer 21

gastrinomas (usually presents with multiple ulcers)

Question 22

Epigastric pain that improves with meals is a symptom of PUD. Why?

Answer 22

Because the duodenum secretes bicarb upon eating, which relieves the symptoms; this is in contrast to gastric ulcers, which become more painful with eating

Question 23

Hypertrophy of Brunner’s glands is a consequence of ____________.

Answer 23

PUD (because they’re trying to overcome the excess acid)

Question 24

What artery runs posterior to the duodenum?

Answer 24

Gastroduodenal artery (can bleed if duodenal ulcers are posterior)

Question 25

Bile reflux can cause ______.

Answer 25

gastric ulcers

Question 26

What artery is most likely to rupture with gastric ulcers?

Answer 26

The left gastric artery, because most gastric ulcers are on the lesser curvature of the stomach

Question 27

Benign ulcers present with ____________.

Answer 27

a “punched-out” look with NO heaping of the surrounding mucosa

Question 28

Gastric carcinoma is an __________ carcinoma.

Answer 28

adenocarcinoma

Question 29

Gastric adenocarcinoma most often presents on the ____________ side of the stomach.

Answer 29

lesser curvature (because of the common location of ulcers)

Question 30

What two lifestyle factors increase risk of gastric adenocarcinoma?

Answer 30

Nitrosamines in smoked food

Blood type A

Question 31

True or false: H. pylori increases risk of diffuse carcinoma.

Answer 31

False.

Question 32

Desmoplastic thickening (linitus plastica) is a consequence of ___________.

Answer 32

diffuse type gastric carcinoma (because of the frequency of invasion)

Question 33

__________ can present with acanthosis nigricans.

Answer 33

Gastric carcinoma

Question 34

There are two dermatologic findings that present with gastric carcinoma: ___________ and acanthosis nigricans.

Answer 34

Leser-Trélat sign (lots of seborrheic keratoses)

Question 35

Gastric carcinoma frequently spreads to the __________ lymph node.

Answer 35

leftsupraclavicular

Question 36

Diffuse-type gastric carcinomas spread to the __________ in Krukenburg tumor.

Answer 36

bilateral ovaries (“some KrooK stole my ovaries”)