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Gastro > Stomach patho > Flashcards

Stomach patho Flashcards

1
Q

types of pyloric stenosis (2)

A
  • congenital hypertrophic pyloric stenosis
  • acquired
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2
Q

congenital pyloric stenosis presentation

A

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)

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3
Q

congenital pyloric stenosis morphology

A
  • hyperplasia of pyloric muscularis propria -> obstruct gastric outflow tract

*treat with myotomy (surgical splitting of muscularis)

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4
Q

acquired pyloric stenosis pathology

A

benign
- antral gastritis/ peptic ulcers close to pylorus

malignant
- carcinoma of distal stomach/ pancreas -> narrow pyloric channel due to infiltration/ fibrosis

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5
Q

acute gastritis (acute & subacute mucosal injury)

A
  • mucosal injury: damaging forces&raquo_space; protective mechanisms
  • gastritis: presence of NEUTROPHILS (injury with abscence of inflammatory cells = gastropathy)
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6
Q

acute gastritis presentation

A
  • epigastric pain, N&V
  • mucosal erosion, ulceration, haemorrhage
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7
Q

diseases that cause acute gastritis (2)

A
  • acute erosive haemorrhagic gastritis
  • stress related mucosal injury
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8
Q

what is acute erosive haemorrhagic gastritis

A
  • acute gastritis + haemorrhage + congestion of mucosa/ deeper layers of stomach
  • characterized by diffuse mucosal hyperemia
  • associated with bleeding, erosions, ulcers
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9
Q

what is stress related mucosal injury

A
  • 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
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10
Q

stress related mucosal injury morphology

A

macroscopic
- multiple erosions/ ulcers in stomach
- sharply demarcated, rounded, <1cm

microscopic
- lack chronic features in PUD (ie no scarring, no blood vessel thickening)

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11
Q

presentation of chronic gastritis

A
  • less severe, more persistent
  • nausea, epigastric pain
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12
Q

causes of chronic gastritis (3)

A
  • H. PYLORI GASTRITIS #1
  • autoimmune atrophic gastritis
  • uncommon patterns of gastritis - eosinophilic gastritis; lymphocytic gastritis; granulomatous gastritis
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13
Q

H. pylori gastritis associated with:

A
  • ALL pts with DUODENAL ULCERS
  • most pts with GASTRIC ULCERS/ chronic gastritis
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14
Q

H. pylori gastritis pathogenesis

A

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

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15
Q

H. pylori gastritis diagnosis

A
  • tissue biopsy
  • serology for H. pylori antibody
  • urea breath test
  • faecal bacteria detection

*treat with PPI + antibiotics

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16
Q

autoimmune atrophic gastritis pathogenesis

A
  • <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
17
Q

autoimmune atrophic gastritis presentation

A
  • 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
18
Q

autoimmune atrophic gastritis morphology

A

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

19
Q

what is eosinophilic gastritis associated with

A
  • dense infiltrates of eosinophils in MUCOSA & MUSCULARIS, usually in antral/ pyloric region
  • peripheral eosinophilia + increased IgE levels
20
Q

what is associated with lymphocytic gastritis

A
  • increase in intraepithelial T-lymphocytes
  • females
  • idiopathic
21
Q

granulomatous gastritis

A
  • gastritis that contains granulomas
  • idiopathic
22
Q

complications of chronic gastritis (4)

A
  • 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
23
Q

peptic ulcer disease presentations

A
  • Chronic mucosal ulceration in duodenum or stomach
  • PENETRATES the muscularis mucosae and deeper
24
Q

PUD pathogenesis

A
  • imbalance between defense mechanism & damaging factors causing chronic gastritis
25
Q

most common sites of PUD

A
  • antrum or duodenum
  • due ot chronic H. pylori induced antral gastritis -> increase gastric acid secretion + decrease duodenal bicarbonate secretion
26
Q

risk factors of PUD (3)

A
  • H pylori infection
  • NSAIDS
  • smoking
27
Q

PUD morphology

A
  • Solitary
  • Round to oval, sharply demarcated, punched-out defect
  • Usually level with surrounding mucosa
  • Mucosal margin may overhang the base slightly
  • Variable depth
  • Base is smooth and clean
  • Scarring and puckering of the wall
28
Q

PUD clinical presentation

A
  • Epigastric burning or aching pain -> occurs after food, worse at night, relieved by alkali or food
    -Referred pain to back, left upper quadrant, chest
  • Nausea, vomiting, bloating, belching, weight loss
29
Q

PUD complications

A
  • bleeding
  • perforation
  • obstruction -> usually in chronic pyloric ulcers, with edema and scarring
30
Q

what are vascular gastropathies

A
  • group of disorders characterized by alterations in gastric mucosal blood vessels (macro/ endoscopic)

microscopic
- little/ no inflammation

31
Q

types of vascular gastropathies (3)

A
  • gastric antral vascular ectasia (GAVE)
  • portal hypertensive gastropathy
  • dieulafoy lesions
32
Q

gastric antral vascular ectasia morphology

A

Macro/Endoscopic:
- longitudinal stripes of oedematous, erythematous mucosa, alternates with less severely injured, paler mucosa
- “watermelon stomach”
- erythematous stripes caused by ectatic mucosal vessels

Microscopic:
- reactive gastropathy
- dilated capillaries containing fibrin thrombi

33
Q

portal hypertensive gastropathy pathology

A
  • portal hypertension secondary to hepatic cirrhosis -> cause backpressure and congested mucosal capillaries in stomach
34
Q

portal hypertensive gastropathy morphology

A

macro/endoscopic:
- mosaic pattern, resemble snake skin

microscopic
- reactive gastropathy
- congested, dilated mucosal capillaries without fibrin thrombi
- most prominent in the corpus

35
Q

what are dieulafoy lesions

A
  • abnormal artery in SUBMUCOSA
  • most common in lesser curvature near gastroesophageal junction
  • erosion of mucosa -> RECURRENT bleeding
36
Q

what are hypertrophic gastropathies

A

UNCOMMON
- group of disease with giant “cerebriform” enlargement of rugal folds to to EPITHELIAL HYPERPLASIA
- linked to excessive growth factor release

37
Q

types of hypertrophic gastropathies (2)

A
  • menetrier disease
  • zollinger-ellison syndrome
38
Q

menetrier disease pathology

A
  • excessive TGF-a secretion
  • gastric rugae enlargement in BODY & FUNDUS, not found in antrum
  • foveolar hyperplasia
39
Q

zollinger-ellison syndrome pathology

A
  • gastrin secreting tumour in small intestine/ pancreas
  • increase in oxyntic mucosal thickness
  • parietal cell hyperplasia

Gastro (20 decks)

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