Quiz 3 Stomach Flashcards
Congenital diaphragmatic hernia
anatomical defect
see air above diaphragm on x-ray
congenital hypertrophic pyloric stenosis
- pyloris thickened
- mucosal hyperplasia
- elongated branched distorted pits
- abundant edematous lamina propria
- hypertrophy of smooth muscle of pylorus, causing thickening of the wall and decreased lumen size
- gastric peristalsis increased so backup of food and vomitting
- 2-3 weeks after birth
What causes gastric varices
hep b or c, alcohol, cirrhosis
gastric volvulus
twisted causing obstruction so everything proximal gets stuck
what causes gastric volvulus?
- fibrous adhesions
- laxity of ligamentous structures that hold things in place
where is most common volvulus?
sigmoid
what causes gastritis?
h. pylori, alcohol, drugs, infections
Hist of atrophic gastritis
- nuetrophils, white cells in lamina propria
- intestinal metaplasia
- loss of gastric glands
what type of ulcer is h. pylori most associated with?
duodenal peptic ulcers
h. pylori
rod shaped (spirochetes) lives in mucus gm- flagellated releases urease to get into
What is most sensitive and most specific test for h. pylori?
- which is best for ease and accuracy?
serology (ELISA)
carbon breath test (urea broken down to CO2)
H pylori is found in pt with?
duodenal ulceration (90%) gastric ulceration (70%) gastric cancer (60%) gastritis PUD
what causes peptic ulcers?
h pylori
stress
nsaids
how do you differentiate benign ulcers from malignant ulcers?
benign: smooth, regular, round edges, with flat smooth base, no blood
malignant: irregular, heaped borders, nodular, irregular mass that can be ulcerated and protrudes from lumen of stomach, fungating
What is number one cause of gastritis and PUD?
h. pylori
what is most common type of ulcer?
duodenal (2X)
- usually benign
Potential complications of PUD
GI bleeding
perforation of gastric or duodenal wall
scarring can lead to gastric outlet obstruction
ulcer into cancer
What is worse area for ulcer?
posterior and inferior because near aorta and pancreas
what is treatment for ulcers?
2 antibiotics and pepto bismo
how do you detect a peptic ulcer perforation?
free air under diaphragm in x-ray
what is referred to as an olive?
enlarged pyloric muscle in hypertrophic pyloric stenosis
what is triad in zollinger-ellison syndrome
- gastric acid hypersecrtion
- severe peptic ulceration
- non-beta cell islet tumor or pancreas (gastrinoma)
what does a gastrinoma do?
produces increased gastrin causing increased hydrochloric acid
Multiple endocrine neoplasia type 1 (MEN 1) is associated with what?
ZE
where are ZE primary tumors located?
pancreas (usually here)
duodenum
abdominal lymph nodes
Menetriers disease
- hyperplastic hypersecretory gastropathy
- enlarged gastric folds (rugae)
- giant stomach cells, thickened rugae, main polypoid
- increased mucin
- achlorhidria (decreased acid)
- can’t absorb protein
what causes childhood menetriers
CMV or h pylori
what causes adult form of menetriers
over expression of protein, transforming growth factor alpha (TGF- alpha)
atrophic gastritis
- chronic inflammation of stomach mucosa leading to loss of gastric glandular cells and replacement by fibrous tissue and numerous goblet cells
- decreased gastric glands
- decreased acid production
what causes atrophic gastritis?
h. pylori or autoimmune
if autoimmune cause of atrophic gastritis, what are the ab against? What does this lead to?
gastric parietal cells which release Intrinsic factor. This leads to pernicious anemia due to non absorption of B12
what are autoimmune atrophic gastritis patients more likely to develop?
achlorhydria and gastric carcinoma
autoimmune metaplastic atrophic gastritis
immune response directed towards parietal cells and intrinsic factor
hypocholrhydria due to decreased parietal cells can lead to what?
carcinoid tumors
what are early signs of neoplasia?
- increased nucleus to cytoplasm ratio
- increased size of nuclei
- more mitotic bodies
gastric adenocarcinoma
neoplastic glands
better prognosis
same cellular changes seen in all caner
signet ring (nucleus pushed against wall)
linitis plastica
leather bottle stomach
originates in glandular tissue
have to remove stomach
MALT (mucosal associated lymphoid tumor)
GI lining only
sheets in wave pattern
most frequent stomach malignancy after adenocarcinoma
gastric leiomyoma
smooth muscle tumor
most common in esophagus
carcinoid tumor
neuro endocrine neoplasm
from enterochromaffin cells
serotonin producing
cells look like soccer balls
