Stomach Pathology

Question 1

____ (Acute/Chronic) gastritis is erosive, whereas ____ (acute/chronic) gastritis is nonerosive.


Answer 1

Acute; chronic


Question 2

Where does type A chronic gastritis occur? Where does type B occur?


Answer 2

Fundus/body; antrum


Question 3

Name some causes of acute gastritis.


Answer 3

NSAIDs, alcohol, stress, uricemia, burns, brain injury


Question 4

A patient with severe burns develops which complication of acute gastritis?


Answer 4

Curling ulcer (burned by the Curling iron)


Question 5

A man with brain injury acutely develops raw, burning epigastric pain. He should be treated to prevent which complication?


Answer 5

Cushing ulcers (remember, always cushion the brain)


Question 6

In a patient with type A (fundal) gastritis, the autoantibodies are directed against what?


Answer 6

Parietal cells


Question 7

Type A (fundal) gastritis is characterized by what two pathologic states?


Answer 7

Type A is caused by pernicious Anemia and Achlorhydria (A comes before B—pernicious Anemia is Autoimmune in first part of stomach)


Question 8

Type B (antral) gastritis is caused by infection with what organism?


Answer 8

Type B is caused by Helicobacter pylori (H. pylori Bacteria in second part of stomach)


Question 9

Type ____ gastritis is autoimmune related, whereas type ____ gastritis is caused by infectious diseases (e.g., H. pylori).


Answer 9

A; B


Question 10

____ (Acute/Subacute/Chronic) gastritis carries an increased risk of gastric carcinoma.


Answer 10

Chronic


Question 11

Chronic gastritis carries an increased risk of what kind of gastric carcinoma(s)?


Answer 11

Mucosa-associated lymphoid tissue (MALT) lymphoma and gastric adenocarcinoma


Question 12

A patient on chronic NSAID therapy complains of stomach pain and is found to be anemic. What is the pathophysiology of his condition?


Answer 12

NSAIDs reduce prostaglandin E2, causing erosive gastritis (this is erosive gastritis), which causes occult blood loss and mild anemia


Question 13

By what mechanism do severe burns cause acute gastritis?


Answer 13

Curling ulcers are caused by a decrease in plasma volume, leading to a sloughing of gastric mucosa


Question 14

How can brain injury cause acute gastritis?


Answer 14

Cushing ulcers are caused by increased vagal stimulation, which increases acetylcholine and, in turn, acid production by parietal cells


Question 15

A woman with Graves disease is anemic with a high MCV despite taking iron. She has bad abdominal pain. What part of her stomach is affected?


Answer 15

Fundus/body (this is chronic type A gastritis of the stomach, with pernicious anemia, associated with other autoimmunity such as Graves)


Question 16

In acute gastritis, there is disruption of what type of barrier?


Answer 16

Disruption of mucosal barrier


Question 17

What type of gastritis is an alcoholic most at risk for?


Answer 17

Acute gastritis


Question 18

A patient with rheumatoid arthritis, adherent to his medications, has nausea and abdominal pain. What type of gastritis are you considering?


Answer 18

Acute gastritis (the patient is likely taking NSAIDs daily)

Question 19

What is the most common histologic subtype of stomach cancer?


Answer 19

Adenocarcinoma


Question 20

Where are intestinal stomach cancers most commonly located in the stomach: lesser curvature, greater curvature, fundus, or cardiac region?


Answer 20

Lesser curvature


Question 21

A patient with stomach cancer is at risk of metastasis to what organ?


Answer 21

The liver (this is the next downstream organ)


Question 22

Name at least three risk factors for stomach cancer.


Answer 22

Nitrosamines (from smoked foods), achlorhydria, chronic gastritis, smoking, H. pylori (the intestinal kind) infection


Question 23

What is meant when stomach cancer is termed linitis plastica?


Answer 23

Diffuse infiltrative cancer makes the stomach rigid


Question 24

A man has 1 month of fatigue, weight loss, and early satiety. If he has palpable lymph nodes (from metastases), where are they likely found?


Answer 24

Left-sided supraventricular nodes (also called Virchow nodes) (metastasis from stomach cancer classically spreads to these nodes)


Question 25

A woman has bilateral ovarian cancer with abundant mucus & signet ring cells. Could this cancer in fact be a metastasis?


Answer 25

Yes, as this could represent metastasis from the stomach to both ovaries (Krukenberg tumor)


Question 26

A patient has dark leathery patches on the nape of his neck and in the axillae. It is from malignancy. What might you see on his umbilicus?


Answer 26

One may see Sister Mary Joseph nodules (subcutaneous periumbilical metastasis) (this is acanthosis nigricans, suggesting stomach cancer)


Question 27

What is the histologic appearance of the Krukenberg tumor?


Answer 27

Metastatic gastric adenocarcinoma often has mucus-filled cells termed signet ring cells


Question 28

What is the Sister Mary Joseph nodule, and where is it located?


Answer 28

It is a metastasis of gastric cancer located in the subcutaneous periumbilical area


Question 29

A 65-year-old man has a growing periumbilical mass and abdominal fullness. What umbilical finding might be present on exam?


Answer 29

Sister Mary Joseph nodules (palpable and bulging due to metastases of various GI cancers)

Question 30

Does the pain associated with duodenal ulcers increase, decrease, or remain the same with food?


Answer 30

Decrease (Duodenal ulcer pain is Decreased with food)


Question 31

This type of gastrointestinal ulcer is more likely to be associated with weight gain.


Answer 31

Duodenal ulcer (the pain associated with duodenal ulcers decreases with meals, thereby resulting in weight gain)


Question 32

Patients with duodenal ulcers tend to have hypertrophy of these glands.


Answer 32

Brunner glands


Question 33

A man with stomach pain is found on endoscopy to have a lesion with irregular, raised margins. Is this more likely an ulcer or a malignancy?


Answer 33

Malignancy (carcinoma)—peptic ulcers have clean margins and a punched-out appearance


Question 34

In a patient with Zollinger-Ellison syndrome, what type of ulcer is the patient at risk for?


Answer 34

Duodenal ulcer (Zollinger-Ellison syndrome is associated with increased gastric secretions, resulting in ulcer formation)


Question 35

An elderly patient who takes high-dose NSAIDs is likely to at increased risk for what type of ulcer?


Answer 35

Gastric ulcer


Question 36

What is the pathology of duodenal ulcers?


Answer 36

Decrease in mucosal protection or increase in gastric acid secretion


Question 37

Which type of peptic ulcer disease puts the patient at a higher risk of developing a carcinoma?


Answer 37

Gastric ulcer


Question 38

Peptic ulcer disease affects what two regions of the gastrointestinal tract?


Answer 38

The stomach (gastric ulcers) and the duodenum (duodenal ulcers)


Question 39

A patient has significant weight loss and abdominal pain after eating. Endoscopy shows ulcers. What kind of ulcers are they likely to be?


Answer 39

Gastric ulcers, which generally result in increased pain after meals (Gastric ulcer pain is Greater with meals)


Question 40

What etiologic factor is associated with 70% of gastric ulcers?


Answer 40

Helicobacter pylori infection


Question 41

A patient on NSAIDs for back pain presents with abdominal pain exacerbated by meals. What is the most likely cause of his abdominal pain?


Answer 41

Chronic use of NSAIDs leading to gastric ulcers


Question 42

What is the pathophysiology of gastric ulcers?


Answer 42

Decreased mucosal production leading to destruction of tissue by gastric acid due to decreased protection

Question 43

What artery is most likely to hemorrhage with a ruptured gastric ulcer on the lesser curvature of the stomach?


Answer 43

Left gastric artery


Question 44

What artery is most likely to hemorrhage secondary to a ruptured duodenal ulcer on the posterior wall of the duodenum?


Answer 44

Gastroduodenal artery


Question 45

Ulcer hemorrhages are likely to occur ____ (anteriorly/posteriorly); ulcer perforations are likely to occur ____ (anteriorly/posteriorly).


Answer 45

Posteriorly; anteriorly


Question 46

Where do perforations from ulcers typically take place?


Answer 46

The duodenum