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GI - Week 1 > Stomach pathology > Flashcards

Stomach pathology Flashcards

1
Q

This occurs when abdominal contents or adipose protrudes
Is due to periumbilical or linea alba weakness

A

Umbilical hernia

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2
Q

Is an umbilical hernia covered by skin?

A

Yes
Skin and peritoneum

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3
Q

Is an omphalocele covered by skin?

A

No
But covered by peritoneum

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4
Q

Does an umbilical hernia require surgery?

A

Most close spontaneously by 4-5 years
Surgery if persistent or strangulation results

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5
Q

This is a herniation of abdominal contents into base of umbilical cord

A

Omphalocele

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6
Q

This is herniation of small/large intestine through abdominal wall opening

A

Gastroschisis

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7
Q

Does a Gastroschsis occur on the left or right side of the umbilical insertion?

A

Right

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8
Q

Are omphaloceles associated with syndromic / karyotypic abnormalities?

A

Yes; some

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9
Q

Are gastroschisis associated with syndromic / karyotypic abnormalities?

A

Rarely
Thought to be ischemic insult

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10
Q

Is Gastroschisis covered by skin?

A

No
No skin or peritoneal covering

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11
Q

Neonatal gastric outlet obstruction caused by hypertrophic pyloric sphincter
More common in first born males
Begins at about 3 weeks

A

Pyloric stenosis

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12
Q

A baby that eats, progresses to projectile vomiting, and then quickly hungry again may have this condition

A

Pyloric stenosis

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13
Q

These three molecules are lost in Pyloric stenosis

A

H+, H2O, Cl-

Leading to hypochloremic metabolic alkalosis, dehydration, malnutrition

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14
Q

A firm, movable, 2cm olive-shaped mass that is above/right on the umbilicus indicates this condition

A

Pyloric stenosis

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15
Q

What is the treatment for Pyloric stenosis?

A

Pyloromyotomy

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16
Q

Impaired mucosal integrity of gastric or duodenal mucosa resulting in exposure of underlying tissue
More common in men

A

Peptic ulcer disease

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17
Q

This type of peptic ulcer disease is sometimes benign, sometimes malignant

A

Gastric

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18
Q

Most gastric peptic ulcer disease occurs in this part of the stomach

A

Antrum / pylorus

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19
Q

This type of peptic ulcer disease has pain that worsens with eating

A

Gastric

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20
Q

This type of peptic ulcer disease is almost always benign

A

Duodenal

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21
Q

Most duodenal peptic ulcer disease occurs in this part of the duodenum

A

Proximal

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22
Q

This type of peptic ulcer disease has pain that improves with eating

A

Duodenal

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23
Q

This type of peptic ulcer disease is associated with H+ hypersecretion
(like ZE syndrome)

A

Distal duodenum / jejunum

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24
Q

With gastric peptic ulcer disease, is pain worse or better with eating?

A

Worse

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25
Q

With duodenal peptic ulcer disease, is pain worse or better with eating?

A

Improves

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26
Q

Distal duodenum / jejunum peptic ulcer disease is associated with hypersecretion of this

A

H+

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27
Q

What effect do prostaglandins have on acid secretion?

A

Decrease

(also increase blood flow, increase bicarb, increase mucus)

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28
Q

Chronic use of these two compounds can result in multiple shallow ulcers/erosions

A

NSAIDS and ethanol

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29
Q

Morphology of acute gastritis caused by chronic use of either of these two compounds will show reactive gastropathy

A

NSAIDS and ethanol

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30
Q

This type of ulcer is caused by stress, and etiologies like burns, shock, and critical illness (ICU patients)

A

Curling ulcers

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31
Q

Why are ICU patients usually placed on prophylactic PPI or H2 antagonists?

A

Because they can have stress ulcers (Curling ulcers)

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32
Q

This type of ulcer is caused by increased intracranial pressure, seen in head trauma/bleed

A

Cushing ulcer

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33
Q

In a Cushing ulcer, vagal stimulation releases this

A

Acetylcholine
(which stimulates parietal cells to secrete acid)

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34
Q

Is Cushing ulcer more severe than ulcers from NSAID/EtOH?

A

Yes; often more severe

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35
Q

This condition is caused by a gastrin secreting tumor of the pancreas/duodenum

A

Zollinger-Ellison syndrome

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36
Q

Zollinger-Ellison syndrome is caused by a tumor of pancreas/duodenum that secretes this compound

A

Gastrin
results in acid hypersecretion = multiple ulcers that tend to be refractory; often in distal locations

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37
Q

Multiple ulcers that tend to be refractory, often in distal locations like the jejunum, could be caused by this condition

A

Zollinger-Ellison syndrome

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38
Q

This is the most common cause of gastric and duodenal ulcers

A

Helicobacter pylori gastritis

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39
Q

Zollinger-Ellison syndrome typically presents with multiple ulcers in this location

A

Distal locations - like jejunum

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40
Q

Is H. pylori gram positive or negative?

A

Negative

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41
Q

Antral-predominant H. pylori infections are associated with this type of ulcer

A

Duodenal

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42
Q

Corpus-predominant H. pylori infections are associated with this type of ulcer

A

Gastric

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43
Q

Band of lymphoplasmacytic inflammation in superficial mucosa (chronic) and Intraepithelial neutrophils (active) are seen in this condition

A

Chronic superficial/active gastritis
(caused by H. pylori)

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44
Q

H. pylori of this part of the stomach causes inflammation that results in D cells damage and loss of gastrin inhibition

A

Antrum

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45
Q

H. pylori of this part of the stomach causes hyperacidity that is passed to duodenum, leading to peptic duodenitis, duodenal ulcer, and foveolar metaplasia and inflammation

A

Antrum

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46
Q

H. pylori of this part of the stomach causes tissue damage and repair, resulting in gastric atrophy and hypochlorhydria

A

Corpus

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47
Q

What causes metaplasia (and subsequent dysplasia; carcinoma sequence) in H. pylori infection?

A

Free radicals, reactive oxygen species

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48
Q

How can iron deficiency result from H. pylori infection?

A

Peptic ulcer disease –> bleeding

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49
Q

This complication of H. pylori infection is protective against GERD

A

Chronic atrophic gastritis
(but this can cause lymphoma and adenocarcinoma)

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50
Q

Is Autoimmune gastritis more common in males or females?

A

Females

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51
Q

Autoimmune gastritis is destruction of these cells

A

Parietal cells

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52
Q

This autoimmune condition that results in the destruction of parietal cells is associated with diabetes and hypothyroidism

A

Autoimmune gastritis

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53
Q

Parietal cells are present in this part of the stomach

A

Fundus / body

54
Q

This condition is a loss of H+

A

Achlorhydria

55
Q

Achlorhydria is a loss of this

56
Q

How does autoimmune gastritis cause macrocytic anemia?

A

Destruction of parietal cells, which leads to loss of intrinsic factor and low B12

57
Q

How can Autoimmune gastritis cause carcinoid tumors?

A

Decreased H+ = hypochlorhydria –> enterochromaffin cell stimulation and hyperplasia –> neoplasia

58
Q

Can Autoimmune gastritis cause adenocarcinoma?

A

Yes
chronic inflammation –> intestine metaplasia

59
Q

Are there goblet cells in the stomach?

60
Q

Morphology of Autoimmune gastritis involves both of these parts of the stomach

A

Body and fundus

61
Q

Lymphocytes and plasma cells in deep layers, that are centered on glands, and mucosal atrophy are seen in this condition
Also intestinal metaplasia and ECL hyperplasia

A

Autoimmune gastritis

62
Q

Subacute combined degeneration is a late manifestation of this autoimmune stomach condition

A

Autoimmune gastritis

63
Q

This condition is hypertrophic gastropathy with hypermucinous change

A

Menetrier disease

64
Q

This condition is also known as hypertrophic gastropathy

A

Menetrier disease

65
Q

Rare idiopathic disorder resulting in prominent fundic/body folds
Results in hypochlorhydria
Protein loss due to hypersecretion
Weight loss

A

Menetrier disease

66
Q

What causes hypoproteinemia / albuminemia in Menetrier disease?

A

Excess mucus secretion

67
Q

What causes hypochlorhydria in Menetrier disease?

A

Crowds out parietal cells

68
Q

Morphology of this condition will show thick folds in fundus/body of the stomach, and thickened surface/neck mucus epithelium

A

Menetrier disease

69
Q

This condition is hypergastrinemia driven hyperchlorhydria

A

Zollinger Ellison syndrome

70
Q

This condition is ectopic autonomous gastrin secretion from neuroendocrine tumor

A

Zollinger Ellison syndrome

71
Q

Zollinger Ellison syndrome causes increased secretion from these cells

A

Parietal cells

72
Q

There is hyperplasia of these two cell types in Zollinger Ellison syndrome

A

Parietal cells
Enterochromaffin cells

73
Q

A patient with refractory, recurrent ulcers that is H. pylori negative may have this condition characterized by thick gastric folds, gastroesophageal reflux, and diarrhea from small bowel damage

A

Zollinger Ellison syndrome

74
Q

A patient with a secretin test resulting in gastrin that remains high or increases has this condition

A

Zollinger Ellison syndrome

75
Q

What is the result of the secretin test in Zollinger Ellison syndrome?

A

Increased serum gastrin with secretin administration

76
Q

What is the normal result of the secretin test?

A

Secretin should decrease gastrin secretion

77
Q

This is a gastric polyp with elevated carcinoma risk
Dysplastic; risk of developing adenocarcinoma

A

Gastric adenoma

78
Q

Gastric adenoma occurs in these two settings

A

Background of inflammation and atrophy
Polyposis syndromes (APC gene in familial adenomatous polyposis, MUTYH mutations in MUTYH-associated polyposis)

79
Q

These two genes are involved in two conditions that can cause Gastric adenoma

A

APC gene (in familial adenomatous polyposis)
MUTYH mutations in MUTYH-associated polyposis

80
Q

This is a malignant glandular tumor of gastric epithelium
Associated with cultural/dietary factors
High incidence in Japan, Eastern Europe, some South/Central America

A

Gastric adenocarcinoma

81
Q

These two conditions are at risk for Gastric adenocarcinoma

A

Autoimmune gastritis
Long-term atrophic gastritis

82
Q

Is there a high incidence of Gastric adenocarcinoma in the Western world?

A

No
(due to less salt, nitrate preservation, H. pylori eradication programs)

83
Q

What are the two types of Gastric adenocarcinoma?

A

Intestinal
Diffuse (aka signet ring cell)

84
Q

This mutation pathway is at risk for the intestinal type Gastric adenocarcinoma

A

WNT mutation pathway
(APC loss of function; Beta catenin gain of function)

85
Q

Loss of function of this gene is seen in intestinal type Gastric adenocarcinoma

86
Q

Gain of function of this gene is seen in intestinal type Gastric adenocarcinoma

A

Beta catenin

87
Q

APC loss and Beta catenin gain of function can cause this type of Gastric adenocarcinoma

A

Intestinal type

88
Q

CDH mutations result in loss of this molecule, which can cause diffuse type Gastric adenocarcinoma

A

E-cadherin adhesion molecule

89
Q

CDH mutations resulting in E-cadherin adhesion molecule loss can cause this type of Gastric adenocarcinoma

A

Diffuse type (aka signet ring cell)

90
Q

Mutations in this gene result in loss of E-cadherin adhesion molecule, and can cause diffuse type Gastric adenocarcinoma

A

CDH mutations

91
Q

This type of Gastric adenocarcinoma is also known as linitis plastica

A

Diffuse type

92
Q

This type of Gastric adenocarcinoma involves signet ring cells

A

Diffuse type

93
Q

This tumor is often stage IV at diagnosis, and spread to liver and peritoneum
Can show Sister Mary Joseph nodule (periumbilical metastasis), Virchow node (supraclavicular node), and Krukenberg tumor (bilateral ovarian metastases)

A

Gastric adenocarcinoma

94
Q

Gastric adenocarcinoma spreads to these two locations

A

Liver, peritoneum

95
Q

This tumor is often large/deep before symptomatic
Can have blood loss, early satiety, obstruction, perforation, and metastatic spread

A

Gastric adenocarcinoma

96
Q

This is a periumbilical metastasis that can occur with Gastric adenocarcinoma

A

Sister Mary Joseph nodule

97
Q

This is a supraclavicular node that can occur with Gastric adenocarcinoma

A

Virchow node

98
Q

This is bilateral ovarian metastases that can occur with Gastric adenocarcinoma

A

Krukenberg tumor

99
Q

Is Gastric adenocarcinoma intestinal type single or multiple polypoid, exophytic mass(es)?

100
Q

This type of Gastric adenocarcinoma tends to ulcerate, and should be part of the differential along with peptic ulcer disease

A

Intestinal

101
Q

This type of Gastric adenocarcinoma has heaped up margins
Is larger than benign ulcers
Produces bleeding more often

A

Intestinal

102
Q

Does intestinal or diffuse type of Gastric adenocarcinoma produce bleeding more?

A

Intestinal

103
Q

This type of Gastric adenocarcinoma will have recognizable glands, nuclear atypia, lack of polarity, mucin depletion, nucleoli, and dirty necrosis

A

Intestinal

104
Q

This type of Gastric adenocarcinoma involves infiltration of gastric wall, wall thickening and rigidity (desmoplasia), leading to early satiety

105
Q

This type of Gastric adenocarcinoma will have invasive signet ring cells

A

Diffuse type

106
Q

This is a neuroendocrine tumor of the stomach
Low or intermediate grade neoplasms

A

Gastric carcinoid

107
Q

Do patients with underlying predisposition or sporadic Gastric carcinoid have a better prognosis?

A

Good prognosis with underlying predisposition
(sporadic has worse prognosis)

108
Q

These types of Gastric carcinoid are due to feedback loops
Majority of tumors
Constant lack of inhibition of ECL cells
Eventual autonomous growth

A

Type I and II

109
Q

Type I and II Gastric carcinoid involve a constant lack of inhibition of these cells

110
Q

These types of Gastric carcinoid are present in fundus and body

A

Type I and II

111
Q

These types of Gastric carcinoid are present in pylorus

112
Q

Type I and II Gastric carcinoid tumors are present in this part of the stomach

A

Fundus and body

113
Q

Type III Gastric carcinoid tumors are present in this part of the stomach

114
Q

10% of patients with this tumor have carcinoid syndrome from serotonin secretion (flushing, diarrhea, asthma, facial edema, headache)

A

Gastric carcinoid

115
Q

Some patients with Gastric carcinoid have carcinoid syndrome from secretion of this

116
Q

Gastric carcinoid involves this layer initially

A

Submucosal

117
Q

This tumor is morphologically submucosal initially, has round nests of epithelioid cells, and salt and pepper chromatin

A

Gastric carcinoid

118
Q

This stomach tumor is chromogranin positive and synaptophysin positive

A

Gastric carcinoid

119
Q

Gastric carcinoid is positive for these two proteins

A

Chromogranin
Synaptophysin

120
Q

This is a mesenchymal tumor of interstitial cells of Cajal

A

Gastrointestinal stromal tumor

121
Q

Gastrointestinal stromal tumor is a mesenchymal tumor of these cells

A

Interstitial cells of Cajal

122
Q

Gastrointestinal stromal tumors are positive for these two proteins

A

CD117 (c-kit) and DOG-1

123
Q

This tumor is CD117 (c-kit) and DOG-1 positive

A

Gastrointestinal stromal tumor

124
Q

Half of cases of Gastrointestinal stromal tumors are in this location

125
Q

Are most cases of Gastrointestinal stromal tumor sporadic?

126
Q

This tumor is seen in Carney Triad patients
(Pulmonary hamartoma, and paragangliomas)

A

Gastrointestinal stromal tumor

127
Q

What is the Carney Triad?

A

Pulmonary hamartoma
Gastric Gastrointestinal stromal tumor
Paragangliomas

128
Q

Mutations in these two genes determine the prognosis of Gastrointestinal stromal tumor

A

CD117 and PDGFR

129
Q

CD117 and PDGFR mutations correlate with prognosis and response of this stomach tumor to therapy

A

Gastrointestinal stromal tumor

130
Q

This is a submucosal mass with spindles or epithelioid cells
Invades locally

A

Gastrointestinal stromal tumor

131
Q

Gastrointestinal stromal tumor metastasizes to these two locations mainly

A

Liver, peritoneum

GI - Week 1 (11 decks)

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