Stomach & Duodenal Pathology

Question 1

What inflammatory disorders can present in the stomach?

Answer 1

Acute or Chronic gastritis

Question 2

What can cause an acute gastritis?

Answer 2

• irritant chemical injury
• Severe burns
• Shock
• Severe trauma
• Head Injury

Question 3

What can cause chronic gastritis?

Answer 3

• Autoimmune
• Bacterial (H. Pylori)
• Chemical

Question 4

What antibodies are directed against the stomach lining in chronic gastritis?

Answer 4

Anti-parietal Ab

Anti-intrinsic factor(IF) Ab

Question 5

What happens to the stomach lining in chronic gastritis?

Answer 5

• Atrophy and intestinal metaplasia
• Causes Pernicious Anaemia (B12 deficiency)
• Increased risk of malignancy

Question 6

How does H.Pylori cause chronic gastritis?

Answer 6

• Bacteria inhabits a niche between the epithelial cell surface and mucous barrier
• Excites early acute inflammatory response
• If infection isn’t cleared, inflammation becomes chronic
• IL8 plays a role

Question 7

Chronic gastritis due to H.Pylori increases the risk of what complications?

Answer 7

Increases risk of:

• Duodenal ulcer
• Gastric Ulcer
• Gastric carcinoma
• Gastric lymphoma

Question 8

What substances can cause a chemical gastritis?

Answer 8

• NSAIDs
• alcohol
• bile reflux

Question 9

How do chemicals cause injury to the stomach lining?

Answer 9

• Direct injury to mucus layer by fat solvents
• epithelial regeneration/ hyperplasia
• May produce erosions or ulcers

Question 10

What is a peptic ulcer?

Answer 10

• breach in the GI mucosa as a result of acid and pepsin attack

Question 11

Where can peptic ulcers arise?

Answer 11

• Duodenum
• Stomach (junction of body and antrum)
• Oesophago-gastric Junction
• Stomal ulcers

Question 12

50% of patients with duodenal ulceration have increased acid secretion. How does this increased acid secretion lead to ulceration?

Answer 12

• Excess acid = gastric metaplasia

- leads to H.Pylori infection/ inflammation and ulceration

Question 13

Describe the morphology of a peptic ulcer visualised on endoscopy?

Answer 13

• Roughly 2-10 cm across

- Edges are clear cut, punched out

Question 14

Describe how peptic ulcers appear microscopically?

Answer 14

• Layered Appearance
• Floor of necrotic fibrinopurulent debris
• Base of inflamed Granulation tissue
• Deepest layer is fibrotic scar tissue

Question 15

What are the main complications of peptic ulcers?

Answer 15

Perforation
Penetration
Haemorrhage
Stenosis
Intractable pain

Question 16

What benign tumours can appear in the stomach?

Answer 16

Benign (polyps)

• Hyperplastic polyps
• Cystic fundic gland polyps

Question 17

What malignant tumours can arise in the stomach?

Answer 17

• Carcinomas
• Lymphomas
• Gastrointestinal Stromal tumours (GISTs)

Question 18

In the UK, proximal tumours of the cardia/GOJ are increasing and distal tumours of the stomach are decreasing. TRUE/FALSE?

Answer 18

TRUE

Question 19

What is the main risk factor for gastric adenocarcinomas?

Answer 19

H. Pylori infection leading to chronic gastritis

Question 20

What other conditions are considered pre-malignant to gastric adenocarcinoma?

Answer 20

• Pernicious anaemia
• Partial gastrectomy
• HNPCC / Lynch syndrome
• Menetrier’s Disease

Question 21

What are the two types of gastric adenocarcinoma?

Answer 21

• Intestinal type (exophytic/polypoid mass)
• Diffuse type
  => this type expands/infiltrates stomach wall

Question 22

What can be identified on histology to differentiate between Intestinal and Diffuse Gastric adenocarcinoma?

Answer 22

Intestinal - shows gland formation

Diffuse - “signet ring cells” or sclerosis

Question 23

Which type of gastric adenocarcinoma has the best prognosis?

Answer 23

Intestinal = slightly better

Question 24

A small percentage of gastric adenocarcinomas are “mixed” type. TRUE/FALSE?

Answer 24

TRUE

15% are mixed

Question 25

How does gastric adenocarcinoma spread?

Answer 25

Local:

• neighbouring organs
• peritoneal cavity
• Ovaries (Kruckenberg tumour)

Lymph nodes

Haematogenous:
(To the liver)

Question 26

What is the other name for a gastric lymphoma and why is it called this?

Answer 26

Maltoma:

Derived from Mucosa Associated Lymphoid Tissue (MALT)

Question 27

How does gastric lymphoma form in the stomach?

Answer 27

• Associated with H.Pylori infection
  => chronic inflammation
  => clonal B cell proliferation (low grade lymphoma)
  => If unchecked evolves into a high grade B-cell lymphoma

Question 28

How can a low grade gastric lymphoma be identified on histology?

Answer 28

• Lymphocytes can be seen attacking the gastric epithelium