Upper GI: Path of Stomach and Small Bowel

Question 1

A three-week-old infant presents with poor feeding. On exam you palpate a firm, ovoid mass in his abdomen. What pathologic process led to this process?

Answer 1

Hyperplasia of pyloric muscularis propria; treat with splitting of the muscle (myotomy).

This is more common in males (4:1) and usually presents in the second or third week of life.

Question 2

Stress-related mucosal disease morphologically resembles ___________.

Answer 2

acute gastritis (resulting most often from vasoconstriction ischemia)

Question 3

In general, ______________ disease is more widespread.

Answer 3

stress-related mucosal

Question 4

In which patients is stress-related mucosal disease common?

Answer 4

• Critically ill patients
• CNS-injured patients (Cushing’s ulcers)
• Burns (Curling’s ulcers)

Question 5

Eosinophilic gastropathy results from exposure to _______________.

Answer 5

allergens (e.g., cow’s milk)

Question 6

What category of disease does celiac cause?

Answer 6

Lymphocytic gastropathy

Question 7

___________ gastritis can lead to intestinal metaplasia.

Answer 7

Autoimmune

Question 8

The most common type of benign gastric mass is ___________.

Answer 8

inflammatory polyp

Question 9

Most MALT tumors are _________ and will transition to ____________.

Answer 9

B-cell lymphomas; DLBCL

Question 10

Most ___________ tumors contain the c-kit oncogene.

Answer 10

GIST

Question 11

What are the most common sources of damage to the stomach mucosal layer?

Answer 11

H. pylori
NSAIDs
Smoking
Alcohol

Question 12

What features of H. pylori make it effective in gastric invasion?

Answer 12

(1) Urease to neutralize pH
(2) Flagella to move through mucus
(3) Adhesion proteins that bind to gastric foveolar cells

Question 13

Adenocarcinoma and ulcers appear similar, but they have an important distinction. What is it?

Answer 13

Adenocarcinomas have a “heaped up” border with a non-purulent base, while ulcers have a cliff-edge (i.e., not heaped up) border with a purulent base.

Question 14

Diffuse adenocarcinoma presents with the ___________ cell on histologic exam.

Answer 14

signet-ring

Question 15

What molecular mutation is common in adenocarcinoma?

Answer 15

Wnt activation with loss of APC

Question 16

True or false: trastuzumab can treat some adenocarcinomas.

Answer 16

True (drug targets Her2/neu found in breast cancer)

Question 17

Helicobacter elimination can cure _____________!

Answer 17

MALTomas

Question 18

What is the classic histologic presentation of carcinoid cancer?

Answer 18

Nests of monomorphic cells

Question 19

True or false: GIST tumors are diffuse.

Answer 19

False. They are localized expansions of interstitial cells of Cajal.

Question 20

How do GIST tumors appear under the microscope?

Answer 20

Because they are mesenchymal cells, they are spindly and elongated –almost like smooth muscle cells with large nuclei.