SM_138b: Pathology of Gastric Disorders Flashcards
Four anatomic regions of the stomach are the ____, ____, ____, and ____
Four anatomic regions of the stomach are the cardia, fundus, corpus, and pyloric antrum
Four histological layers of stomach are _____, _____, _____, and _____
Four histological layers of stomach are mucosa, submucosa, muscularis propria, and serosa
Histology of gastric surface epithelium involves ____
Histology of gastric surface epithelium involves cytoplasmic mucus globules in multiple small vacuoles
Histology of the deep/glandular gastric epithelium ____
Histology of the deep/glandular gastric epithelium varies between anatomic regions of the stomach
- Cardia: mucus-secreting glands only
- Fundus (oxyntic mucosa): parietal cells, chief cells, and endocrine cells (ECL) -> produce histamine -> binds to histamine-2 receptor on parietal cells -> increase acid production
- Antrum / pylorus: mucus-secreting glands and endocrine cells (gastrin-producing cells = G cells)
____ and ____ of the stomach
Cardia and antrum of the stomach
Immunostain for gastrin is ____ in the cardia and body/fundus
Immunostain for gastrin is negative in the cardia and body/fundus
____ and ____ cells are found in the fundus/body of the stomach
Parietal cells and chief cells cells are found in the fundus/body of the stomach
- Parietal cells: HCl, intrinsic factor
- Chief cells: pepsinogen
- Generally no inflammation should be seen in the glands in the fundus
____ protects against autodigestion by the stomach
Mucosal barrier protects against autodigestion by the stomach
(mucin production)
Stomach mucosa is superficially linked by ____
Stomach mucosa is superficially linked by gastric foveolar epithelium
___ is inflammation of gastric mucosa
Gastritis is inflammation of gastric mucosa
____ gastritis occurs when neutrophils are present
Acute / active gastritis occurs when neutrophils are present
____ gastritis occurs when chronic inflammation is present (lymphocytes and plasma cells)
Chronic gastritis occurs when chronic inflammation is present (lymphocytes and plasma cells)
____ is considered a type of chronic gastritis but is active chronic gastritis
Helicobacter pylori gastritis is considered a type of chronic gastritis but is active chronic gastritis
____ occurs when inflammatory cells are rare but reactive mucosal changes are present
Gastropathy occurs when inflammatory cells are rare but reactive mucosal changes are present
Describe causes of acute gastritis
Acute gastritis causes
- Acute hemorrhagic / erosive gastritis
- Infections (CMV)
- Medication injury (NSAIDs)
- Iatrogenic injury (gastrostomy tube, postsurgical setting, chemoradiation)
Asymptomatic or variable degree of pain, nausea / vomiting
____ is a sudden stress-induced imbalance between injurious and protective factors involved in the maintenance of mucosal integrity, causing diffuse mucosal hyperemia, bleeding, and erosions / ulcers
Acute hemorrhagic erosive gastritis is a sudden stress-induced imbalance between injurious and protective factors involved in the maintenance of mucosal integrity, causing diffuse mucosal hyperemia, bleeding, and erosions / ulcers
- Caused by NSAIDs, ethanol, bile acids, shock / vascular compromise
Stress related mucosal ulcers include ____ and ____
Stress related mucosal ulcers include curling ulcers and cushing ulcers
____ are stress-related mucosal ulcers located in the proximal duodenum and are associated with severe burns / trauma
Curling ulcers are stress-related mucosal ulcers located in the proximal duodenum and are associated with severe burns / trauma
(hypovolemia -> ischemia)
____ are gastric, duodenal, and esophageal ulcers in patients with intracranial disease and have a high incidence of perforation
Cushing ulcers are gastric, duodenal, and esophageal ulcers in patients with intracranial disease and have a high incidence of perforation
(vagal stimulation -> acid production)
Acute hemorrhagic / erosive gastritis involves ____ on gross anatomy and ____ on histology
Acute hemorrhagic / erosive gastritis involves diffuse erythema on gross anatomy and erosion of superficial mucous layer with lots of neutrophils and vascular congestion on histology
____ is the most common cuase of chronic gastritis
Helicobacter pylori is the most common cuase of chronic gastritis
____ is the most common form of chronic gastritis in patients without H. pylori infection and the most common cause of diffuse atrophic gastritis
Autoimmune gastritis is the most common form of chronic gastritis in patients without H. pylori infection and the most common cause of diffuse atrophic gastritis
Longstanding H. pylori infection can cause ____
Longstanding H. pylori infection can cause multifocal atrophic gastritis
Symptoms of chronci gastritis are ____ and include ____ and ____
Symptoms of chronci gastritis are less severe than acute gastritis but more persistent and include nausea and pain
(sometimes with vomiting)
Chronic gastritis histology includes ____ and ____
Chronic gastritis histology includes superficial plasmacytic infiltrate and lymphoid aggregates
Helicobacter pylori characteristically ____ but does not ____
Helicobacter pylori characteristically attaches to epithelium but does not penetrate the surface of mucous cells
(gramp-negative curved rod)
Helicobacter pylori gastritis is diagnosed via ____, ____, or ____
Helicobacter pylori gastritis is diagnosed via biopsy, urea breath test, or serologic test
- Biopsy: pathology
- Urea breath test: conversion of 14C-labeled urea to labeled CO2
- Serologic test for antibodies to H. pylori: does not distinguish current from past infection
Helicobacter pylori gastritis pathology involves ____ and ____
Helicobacter pylori gastritis pathology involves lymphoid infiltrate of the lamina propria and inflammation in the mucosa
Helicobacter pylori are ____-shaped
Helicobacter pylori are spiral-shaped
Autoimmune gastritis is caused by ____
Autoimmune gastritis is caused by destruction of parietal cells by antibodies against parietal cells and intrinsic factor
- Autoimmune metaplastic atrophic gastritis
- Hypochlorhydria (due to severe parietal cell loss) and high serum gastrin levels
- Increased risk for dysplasia / carcinoma and gastric neuroendocrine tumors
- Associated with other autoimmune disease
Describe pathogenessis of autoimmune gastritis
Autoimmune gastritis pathogenesis
- Loss of parietal (acid-making) cells
- Hyperplasia of G-cells in antrum
- Increase gastrin secretion
- Acts on ECL cells in fundus (not destroyed by antibodies in autoimmune gastritis) to become hyperplastic
- Secrete histamine to stimulate parietal cells (no longer there or very diminished)
Histology of autoimmune gastritis involves ____, ____, ____, and ____
Autoimmune gastritis histology
- Atrophy of body / fundus glands with deep or diffuse lymphoplasmocytic infiltrates with gland infiltration and damage
- Other extensive metaplasia with different types seen: intestinal (goblet) cells, pancreatic acinar metaplasia
- Neuroendocrine cell hyperplasia (enterochromaffin cell-like/ECL) hyperplasia
- No H. pylori
Complications of chronic gastritis are ____, ____, and ____
Complications of chronic gastritis are peptic ulcer disease, gastric adenocarcinoma, and gastric lymphoma (MALT lymphoma)
- Peptic ulcer disease: duodenal and gastric ulcers
___ is disease caused by the action of acid and pepsin on the gastrointestinal mucosa leading to ulceration
Peptic ulcer disease is disease caused by the action of acid and pepsin on the gastrointestinal mucosa leading to ulceration
- Common sites: duodenum (1st part), stomach (antrum), esophagus (lower end), Meckel’s diverticulum
Pathogenesis of peptic ulcer disease involves ____
Pathogenesis of peptic ulcer disease involves imbalances between mucosald efense mechanisms and damaging factors
- Usually secondary to H. pylori gastritis
H. pylori gastritis induces ____ that can given rise to B cell lymphomas ____
H. pylori gastritis induces mucosa-associated lymphoid tissue (MALT) that can given rise to B cell lymphomas (MALTomas)
Hypertrophic gastropathies are characterized by ____
Hypertrophic gastropathies are characterized by giant cerebriform enlargement of the rugal folds due to epithelial hyperplasia without inflammation
- Menetrier disease and Zollinger-Ellison syndrome
- Linked to growth factor release
____ is a hypertrophic gastropathy characterized by diffuse hyperplasia of the foveolar epithelium of the body / fundus and hypoproteinemia due to protein-losing enteropathy
Menetrier disease is a hypertrophic gastropathy characterized by diffuse hyperplasia of the foveolar epithelium of the body / fundus and hypoproteinemia due to protein-losing enteropathy
- Associated with excessive secretion of TGF-beta
Zollinger-Ellison syndrome is a hypertrophic gastropathy caused by ____
Zollinger-Ellison syndrome is a hypertrophic gastropathy caused by gastrin-secreting tumors
- Symptoms: duodenal ulcers or chronic diarrhea, doubling of oxyntic mucosal thickness due to increase in number of parietal cells
Zollinger-Ellison syndrome involves ____ on gross anatomy and ____ on histology
Zollinger-Ellison syndrome involves enlarged gastric folds on gross anatomy and marked oxyntic gland hyperplasia on histology
____ are nodules that project above the level of the surrounding mucosa
Polyps are nodules that project above the level of the surrounding mucosa
- Inflammatory and hyperplastic polyps, fundic gland polyps, and gastric adenoma
____ comprise 75% of all gastric polyps and are often caused by chronic inflammation and H. pylori infection
Inflammatory and hyperplastic polyps comprise 75% of all gastric polyps and are often caused by chronic inflammation and H. pylori infection
Hyperplastic polyp histology involves ____
Hyperplastic polyp histology involves irregular, cystically dilated, and elongated foveolar glands
- Lamina propria edema, variable degrees of inflammation, surface erosion
Fundic polyps occur ____ and ____ and have increased prevalence due to increased use of ____
Fundic polyps occur sporadically and in individuals with familial adenomatous polyposis and have increased prevalence due to increased use of PPI
- PPI inhibits acid production -> increased gastrin secretion and oxyntic gland growth
- Often asymptomatic
Fundic gland polyp histology involves ____
Fundic gland polyp histology involves irregular glands lined by flattened parietal and chief cells
Gastric adenoma occurs on a background of ____
Gastric adenoma occurs on a background of chronic gastritis with atrophy and intestinal metaplasia
- 50-60 years of age, M:F = 3:1
Solitary lesion in the antrum less than 2 cm is likely a ____
Solitary lesion in the antrum less than 2 cm is likely a gastric adenoma
- Intestinal columnar epithelium, elongated nuclei (cigar shaped), high nuclear / cytoplasmic ratio
____ early symptoms resemble chronic gastritis and peptic ulcer disease and are often discovered at advanced stages
Gastric adenocarcinoma early symptoms resemble chronic gastritis and peptic ulcer disease and are often discovered at advanced stages
(most common polyp)
Gastric carcinoma etiology is ___
Gastric carcinoma etiology is multifactorial
- Dietary factors: contamination of grains with mold, reduced intake of fresh vegetables and fruits, high nitrate content
- Tobacco and alcohol
- Generation of nitrosamines in the stomach
- Role of H. pylori
- CDH1 mutation
CDH-1 mutation causes high likelihood of ____
CDH-1 mutation causes high likelihood of familial gastric cancer
- Prophylactic gastrectomy between 20-30 years old
Describe the proposed pathogenesis of gastric carcinogenesis
Proposed pathogenesis of gastric carcinogenesis
Gastric adenocarcinoma most commonly involves the ____, is more common in the ____ curvature than the ____ curvature, and has subtypes of ____ and ____
Gastric adenocarcinoma most commonly involves the antrum, is more common in the lesser curvature than the greater curvature, and has subtypes of intestinal type and diffuse type
Intestinal type of gastric adenocarcinoma forms ____, is composed of ____, occurs in ____, and develops from ____
Intestinal type of gastric adenocarcinoma forms bulky masses, is composed of glands, occurs in high risk areas, and develops from precursor lesions (flat dysplasia, adenoma)
Diffuse type of gastric adenocarcinoma ____ and is composed of ____
Diffuse type of gastric adenocarcinoma infiltrates / thickens the wall diffusely (linitis plastica) and is composed of signet ring cells
____ type of gastric adenocarcinoma
Intestinal type of gastric adenocarcinoma
____ type of gastric adenocarcinoma
Diffuse type of gastric adenocarcinoma
Intestinal type of gastric adenocarcinoma tends to form ____, while diffuse type of gastric adenocarcinoma contains ____ cells that display a ____ pattern
Intestinal type of gastric adenocarcinoma tends to form bulky tumors, while diffuse type of gastric adenocarcinoma contains signet-ring cells cells that display a diffuse infiltrative growth pattern
