Stomach patho Flashcards
types of pyloric stenosis (2)
- congenital hypertrophic pyloric stenosis
- acquired
congenital pyloric stenosis presentation
3-6th week of life (VERY YOUNG)
- onset regurgitation (stomach acid regurg)
- projectile (forceful) non-bilious (not green) vomiting AFTER FEEDING
- frequent demand for REFEEDING (baby still hungry as food is vomited out)
congenital pyloric stenosis morphology
- hyperplasia of pyloric muscularis propria -> obstruct gastric outflow tract
*treat with myotomy (surgical splitting of muscularis)
acquired pyloric stenosis pathology
benign
- antral gastritis/ peptic ulcers close to pylorus
malignant
- carcinoma of distal stomach/ pancreas -> narrow pyloric channel due to infiltration/ fibrosis
acute gastritis (acute & subacute mucosal injury)
- mucosal injury: damaging forces»_space; protective mechanisms
- gastritis: presence of NEUTROPHILS (injury with abscence of inflammatory cells = gastropathy)
acute gastritis presentation
- epigastric pain, N&V
- mucosal erosion, ulceration, haemorrhage
diseases that cause acute gastritis (2)
- acute erosive haemorrhagic gastritis
- stress related mucosal injury
what is acute erosive haemorrhagic gastritis
- acute gastritis + haemorrhage + congestion of mucosa/ deeper layers of stomach
- characterized by diffuse mucosal hyperemia
- associated with bleeding, erosions, ulcers
what is stress related mucosal injury
- PHYSIOLOGICAL stress: severe trauma, extensive burns, intracranial disease, major surgery, severe liver and renal
insufficiency, prolonged mechanical ventilation, - imbalance between injurious agents and protective factors
stress related mucosal injury morphology
macroscopic
- multiple erosions/ ulcers in stomach
- sharply demarcated, rounded, <1cm
microscopic
- lack chronic features in PUD (ie no scarring, no blood vessel thickening)
presentation of chronic gastritis
- less severe, more persistent
- nausea, epigastric pain
causes of chronic gastritis (3)
- H. PYLORI GASTRITIS #1
- autoimmune atrophic gastritis
- uncommon patterns of gastritis - eosinophilic gastritis; lymphocytic gastritis; granulomatous gastritis
H. pylori gastritis associated with:
- ALL pts with DUODENAL ULCERS
- most pts with GASTRIC ULCERS/ chronic gastritis
H. pylori gastritis pathogenesis
acute inflammation
- antral inflammation -> cause increase gastrin production & increase acid production -> GASTRIC/ DUODENAL PEPTIC ULCER
chronic/ long standing inflammation
- involve body and fundus -> atrophic gastritis with reduced parietal cell
mass and intestinal metaplasia -> reduces risk of gastric and duodenal ulcers but increases risk of
ADENOCARCINOMA
**lymphoid aggregates with germinal centres often present -> can develop into MALT (mucosa associated lymphoid tissue) LYMPHOMA
H. pylori gastritis diagnosis
- tissue biopsy
- serology for H. pylori antibody
- urea breath test
- faecal bacteria detection
*treat with PPI + antibiotics
autoimmune atrophic gastritis pathogenesis
- <10% of chronic gastritis
- CD4 T cells directed at parietal cell components (proton pumps etc) -> loss of parietal cell -> defective acid & intrinsic factor production
- Achlorhydria/ Hypochlorhydria →stimulates gastrin release → hypergastrinaemia and G-cell hyperplasia → neuroendocrine cell hyperplasia
- Loss of intrinsic factor → defective ileal vitamin B12 absorption → B12 deficiency and pernicious anaemia
- Loss of chief cells through gastric gland destruction → reduced serum pepsinogen I
autoimmune atrophic gastritis presentation
- associated with other autoimmune disease: grave’s, type 1 DM
- symptoms of B12 DEFICIENCY -> megaloblastic anaemia, atrophic glossitis, malabsorptive
diarrhoea, subacute combined degeneration of the spinal cord
autoimmune atrophic gastritis morphology
Macroscopic
- body and fundus mucosa appears thinned and rugal folds are lost (atrophic)
Microscopic
- deeper inflammation centered on gastric glands, paucity of oxyntic glands, intestinal metaplasia (checkerboard pattern), pseudopyloric metaplasia, neuroendocrine cell hyperplasia
*atrophy & intestinal metaplasia -> increase risk of ADENOCARCINOMA
what is eosinophilic gastritis associated with
- dense infiltrates of eosinophils in MUCOSA & MUSCULARIS, usually in antral/ pyloric region
- peripheral eosinophilia + increased IgE levels
what is associated with lymphocytic gastritis
- increase in intraepithelial T-lymphocytes
- females
- idiopathic
granulomatous gastritis
- gastritis that contains granulomas
- idiopathic
complications of chronic gastritis (4)
- peptic ulcer disease
- adenocarcinoma (due to mucosal atrophy + intestinal metaplasia)
- dysplasia -> due to inflammation related damage trigger regenerative response to injury thus accumulation of genetic alterations
- gastritis cystica
peptic ulcer disease presentations
- Chronic mucosal ulceration in duodenum or stomach
- PENETRATES the muscularis mucosae and deeper
PUD pathogenesis
- imbalance between defense mechanism & damaging factors causing chronic gastritis
