Stomach & Duodenal Pathology Flashcards
What inflammatory disorders can present in the stomach?
Acute or Chronic gastritis
What can cause an acute gastritis?
- irritant chemical injury
- Severe burns
- Shock
- Severe trauma
- Head Injury
What can cause chronic gastritis?
- Autoimmune
- Bacterial (H. Pylori)
- Chemical
What antibodies are directed against the stomach lining in chronic gastritis?
Anti-parietal Ab
Anti-intrinsic factor(IF) Ab
What happens to the stomach lining in chronic gastritis?
- Atrophy and intestinal metaplasia
- Causes Pernicious Anaemia (B12 deficiency)
- Increased risk of malignancy
How does H.Pylori cause chronic gastritis?
- 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
Chronic gastritis due to H.Pylori increases the risk of what complications?
Increases risk of:
- Duodenal ulcer
- Gastric Ulcer
- Gastric carcinoma
- Gastric lymphoma
What substances can cause a chemical gastritis?
- NSAIDs
- alcohol
- bile reflux
How do chemicals cause injury to the stomach lining?
- Direct injury to mucus layer by fat solvents
- epithelial regeneration/ hyperplasia
- May produce erosions or ulcers
What is a peptic ulcer?
- breach in the GI mucosa as a result of acid and pepsin attack
Where can peptic ulcers arise?
- Duodenum
- Stomach (junction of body and antrum)
- Oesophago-gastric Junction
- Stomal ulcers
50% of patients with duodenal ulceration have increased acid secretion. How does this increased acid secretion lead to ulceration?
- Excess acid = gastric metaplasia
- leads to H.Pylori infection/ inflammation and ulceration
Describe the morphology of a peptic ulcer visualised on endoscopy?
- Roughly 2-10 cm across
- Edges are clear cut, punched out
Describe how peptic ulcers appear microscopically?
- Layered Appearance
- Floor of necrotic fibrinopurulent debris
- Base of inflamed Granulation tissue
- Deepest layer is fibrotic scar tissue
What are the main complications of peptic ulcers?
Perforation Penetration Haemorrhage Stenosis Intractable pain
What benign tumours can appear in the stomach?
Benign (polyps)
- Hyperplastic polyps
- Cystic fundic gland polyps
What malignant tumours can arise in the stomach?
- Carcinomas
- Lymphomas
- Gastrointestinal Stromal tumours (GISTs)
In the UK, proximal tumours of the cardia/GOJ are increasing and distal tumours of the stomach are decreasing. TRUE/FALSE?
TRUE
What is the main risk factor for gastric adenocarcinomas?
H. Pylori infection leading to chronic gastritis
What other conditions are considered pre-malignant to gastric adenocarcinoma?
- Pernicious anaemia
- Partial gastrectomy
- HNPCC / Lynch syndrome
- Menetrier’s Disease
What are the two types of gastric adenocarcinoma?
- Intestinal type (exophytic/polypoid mass)
- Diffuse type
=> this type expands/infiltrates stomach wall
What can be identified on histology to differentiate between Intestinal and Diffuse Gastric adenocarcinoma?
Intestinal - shows gland formation
Diffuse - “signet ring cells” or sclerosis
Which type of gastric adenocarcinoma has the best prognosis?
Intestinal = slightly better
A small percentage of gastric adenocarcinomas are “mixed” type. TRUE/FALSE?
TRUE
15% are mixed
