Stomach Pathology Flashcards
What is the most common congenital disorder of the stomach?
Congenital pyloric stenosis
A 5 month old male infant presents to the hospital with his mother. His mother reports that the baby is throwing up any milk roughly 30 minutes after consumption. Upon palpation the child presents with a palpable mass in the upper left quadrant of the abdomen. What is the likely diagnosis?
Congenital pyloric stenosis
What is gastritis?
Inflammation of the gastric mucosa
What are possible etiologies of gastritis?
Trauma, severe burns, increased intracranial pressure or sepsis, ingestion of alcohol or NSAIDs
What are ulcers in burn victims known as?
Curling ulcers
What is the most common etiology of both acute and chronic gastritis?
Helicobacter pylori
What is the pathogenesis of chronic autoimmune gastritis?
Autoimmune destruction of gastric parietal cells by T cells (Type IV HSN RXN) leading to decreased intrinsic factor and HCL causing high levels of gastrin
What type of hypersensitivity reaction is chronic autoimmune gastritis most closely related to?
Type IV T-Cell mediated
What form of anemia results from chronic autoimmune gastritis?
Megaloblastic (pernicious) anemia
Chronic autoimmune gastritis can predispose a person to what type of gastric adenocarcinoma?
Intestinal
What are the clinical features of chronic autoimmune gastritis?
- atrophy of mucosa w/ intestinal metaplasia
- coffee ground stools
- achlorhydria w/ ^gastrin & antral G-cell hyperplasia
- megaloblastic (pernicious) anemia (lack of intrinsic factor)
What is the most common form of gastritis?
Chronic H Pylori gastritis
What is the pathogenesis of chronic H Pylori gastritis?
Helicobacter pylori ureases and proteases along with inflammation weaken mucosal defenses
What part of the stomach is most commonly affected by chronic H pylori gastritis?
Antrum
What are the clinical features of chronic H pylori gastritis?
- left hypochondrial / epigastric abdominal pain
- food avoidance —> wt loss
- coffee ground stools
- ^risk of peptic ulcer disease, gastric adenocarcinoma, and MALT lymphoma
33 year old female patient presents to your office complaining of fatigue and indigestion. The patient has waited almost 6 months to report this problem out of embarrassment. The main thing that brought her in today was fatigue, indigestion, and the presence of coffee grounds in her stool for the last few months of her indigestion. A CBC is performed and shows elevated levels of cytotoxic CD8+ T cells. An endoscopy of the stomach shows inflammation and atrophy of the stomach mucosa. The patient is also anemic. What is the likely diagnosis?
Chronic autoimmune gastritis
What form of bleeding is present in the mucosal layer of a patient with gastritis?
Splinter (petechial) hemorrhages
32 year old female patient presents to your office complaint of stomach pain of 5 months duration that has recently gotten worse. She points to her pain which is primary located above the belly button and slightly to the left. Endoscopy shows inflammation along the mucosa of the stomach. A culture of the tissue shows heightened levels of H. Pylori in the antrum of the stomach. A small ulcer is also noted at the antrum of the stomach. What is the likely diagnosis and what is this patient at a higher risk of?
Chronic H pylori gastritis with increased risk of gastric adenocarcinoma
23 year old female patient presents to your office with stomach pain. She reports throwing up her last meal and stating that it looked like coffee. She also reports recently seeing some black stuff in her stool. An endoscopy shows splinter-like hemorrhages in the mucosa of the stomach. What is the likely diagnosis?
Acute gastritis
What is melena?
Black tar stool indicative of an upper GI bleed
Where is a peptic ulcer most common?
Proximal duodenum
What is the most common cause of a peptic ulcer?
Helicobacter pylori
What can cause a duodenal peptic ulcer?
H. Pylori, excess caffeine, excess NSAID use
A patient with a duodenal peptic ulcer will have (Increased/Decreased) pain after a meal?
Decreased
A patient with a gastric peptic ulcer will have (Increased/Decreased) pain after a meal?
Increased
What glands hypertrophy in a patient with a duodenal peptic ulcer?
Brunner’s glands
33 year old male patient presents to your office complaining of severe stomach pain before eating. The patient reports drinking 4-5 cups of coffee a day to stay awake at work. He reports that his stomach aches calm down after he eats but get worse a few hours after dinner. He has recently reported gaining 15 pounds that he attributed to his excessive snacking in order to alleviate his stomach pains. What is the likely diagnosis?
Duodenal peptic ulcer
What cell produces intrinsic factor?
Parietal cells
What cell produces hydrochloric acid (HCL)?
Parietal cells
Where is a gastric peptic ulcer most common?
Lesser curvature of the antrum
What artery is at risk in a patient with a gastric peptic ulcer?
Left gastric artery
Gastric ulcers can be caused by what neoplasia?
Gastric carcinoma
32 year old female patient presents to your office complaining of pain in her gut. Your patient reports pain that is worse when thinking about food or just after eating a meal. Due to her lack of appetite, she has recently reported a weight loss of 12 pounds in the last couple weeks. An endoscopy shows a lesion on the lesser curvature of the antrum of the stomach. What is the likely diagnosis?
Gastric peptic ulcer
32 year old Korean female patient presents to your office complaint of pain in her gut. Your patient reports that her pain is fairly constant. She has a history of gastric ulcers in the past. A biopsy of the stomach shows a signet ring cell in the gastric wall, which is markedly thickened. The patient also notes recent weight loss due to feeling full quicker. The biopsy also shows cells in a fern leaf pattern. What is the likely diagnosis?
Gastric adenocarcinoma
What is the most common malignancy of the stomach?
gastric adenocarcinoma
What is correlated heavily with gastric adenocarcinoma?
Helicobacter pylori and pickled foods (nitrosamines)
What blood type is more susceptible to gastric adenocarcinoma?
Type A
Which type of gastric adenocarcinoma is the most common?
Intestinal
What cell is seen in diffuse gastric adenocarcinoma?
Signet ring cells
Linitis plastica is a sign of what type of gastric adenocarcinoma?
Diffuse gastric adenocarcinoma
What is the most common Mets pattern of gastric adenocarcinoma generally?
Liver (in cannon ball fashion)
What is the most common Mets pattern of an intestinal gastric adenocarcinoma?
Periumbilical region
What is the most common Mets pattern of a diffuse gastric adenocarcinoma?
Bilateral ovaries
What is the characteristic sign of an intestinal gastric adenocarcinoma that has Mets to the periumbilical region?
Sister Mary Joseph nodule
What is the names given to a diffuse gastric adenocarcinoma that has Mets to both ovaries?
Krukenburg tumor
What is a Krukenburg tumor?
Diffuse gastric adenocarcinoma that has metastasized to the ovaries bilaterally
What type of hypersensitivity reaction is Celiac’s disease most closely associated with?
Type III
What is Celiac’s disease?
Type III Hypersensitivity reaction resulting in gas and blasting with wheat foods and a gluten/gliadin intolerance.
A patient with celiacs will have what signs on the skin?
Dermatitis herpetiformis
What will be evident in the blood of a patient with undiagnosed Celiacs?
^IgA & lymphocytes
19 year old female patient presents to your office complaining of recent bouts of diarrheas, gas, and bloating after eating. She recently went away to college and her meals have consisted of instant noodles, pasta, and pizza as of late. A blood panel is performed and shows high levels of IgA and lymphocytes in the blood. Upon palpation you notice that the patient has vesicles of the skin that do not seem to run in any sort of dermatomal pattern. What is the likely diagnosis for this patient?
Celiac’s disease
Dermatitis herpetiformis in patients with Celiacs disease follows a dermatomal pattern (TRUE/FALSE)?
F
What is Menetrier disease?
Massive foveolar (non-glandular epithelial cells) hyperplasia with no increase in underlying glands of idiopathic etiology
Menetrier’s disease predisposes a patient for developing gastric carcinomas (TRUE/FALSE)?
t
What pathology presents with “Brain-like” or “Coral-like” rugae?
Menetrier’s disease
What is Z-E syndrome?
Zollinger-Ellison syndrome; A gastrin-secreting tumor with heightened levels of HCl and gastrin leading to excess stomach acid and severe intractable peptic ulcers
What pathology presents with severe intractable peptic ulcers in the esophagus, stomach, and duodenum?
Z-E syndrome (Zollinger-Ellison)
39 year old male patient presents to your office complaining of indigestion, nausea, a sore throat, and pain after eating. The patient cannot tell if eating makes the pain better or worse. He recently has lost weight because he refuses to eat solid foods. An endoscopy of the patient’s GI tract shows multiple ulcers on the esophagus, antrum of the stomach, and the proximal duodenum. Furthermore, a mass is noted on the lesser curvature of the stomach. There is also an excess of stomach acid noted in the stomach. What is the likely diagnosis?
Z-E Syndrome (Zollinger-Ellison)
All digestive cancers preferentially Mets to the ____ due to venous drainage
Liver
What form of stomach cancer presents with a linitis plastica “Leather bag” appearance?
Diffuse gastric adenocarcinoma
What is the histological pattern of an adenocarcinoma in the GI tract?
Fern-leaf pattern
32 year old female patient presents to your office with a past Hx of stomach cancer that she has been receiving treatment for. Her chief complaint today is lower abdominopelvic pain. The patient also reports missing her period for the last few months and has failed three pregnancy tests. A CT of the abdominopelvic region shows masses bilaterally on both ovaries. A biopsy of the tissue shows a glandular architecture resembling gastric glands of the stomach. What is the likely diagnosis for this patient?
Krukenburg tumor
