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Block 10 Week 4 > Usera: GI Tract 2 > Flashcards

Usera: GI Tract 2 Flashcards

1
Q

What are the four anatomical regions of the stomach?

A

cardia (junction of esophagus & stomach)
fundus
body
pylorus (junction of stomach & small intestine)

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2
Q

Describe the histology of the stomach - where are mucous cells found? Where are chief & parietal cells found? Where are enterochromaffin-like cells found? What do they secrete? Where are G cells, D cells, and enterochromaffin cells found? What does each of these secrete?

A

epithelial cells line the surface & pits of the entire stomach

chief & parietal cells are found in the body & fundus

enterochromaffin-like cells are found in the body & fundus & secrete histamine

G cells (secrete gastrin), D cells (secrete somatostatin), and enterochromaffin cells (secrete 5HT) - all found in the antrum of the stomach

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3
Q

What are the three layers of the stomach?

A

mucosa
submucosa
muscularis propria

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4
Q

The fundus/body of the stomach is comprised of (blank) that synthesize gastric juice. It is lined by (blank) and gastric pits. It contains (blank) & (blank) cells

A

straight tubular glands;
surface mucous cells;
parietal & chief cells

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5
Q

Parietal cells are eosinophilic & secrete (blank)

A

intrinsic factor

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6
Q

Chief cells are basophilic & secrete (blank)

A

pepsin

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7
Q

Describe the histology of the antrum/cardia

A

contains glands that are branches & coiled & the gastric pits occupy half the thickness of the mucosa
glands are lined by mucus-secreting cells
small number of parietal cells are present

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8
Q

The antrum/cardia contain (blank) that are branched & coiled and the (blank) occupy half the thickness of the mucosa. The glands are lined by (blank cells. Small number of (blank) are present.

A

glands;
gastric pits;
mucous-secreting cells;
parietal cells

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9
Q

The gastric lumen has an acidic pH of (blank); therefore there is the potential for damage to the (blank)

A

1; mucosa

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10
Q

What are some mechanisms for protection from the acidity of the stomach? What occurs when there is a breakdown of these mechanisms?

A

Mucin secreted from foveolar cells that prevents food from touching the epithelium
The mucus layer promotes the formation of a (neutral pH) layer of fluid over the epithelium
The rich vascular supply deliver O2, bicarbonate and nutrients and washes away acid that has back diffused into the lamina propria

**acute & chronic gastritis occur when there is a breakdown of these mechanisms

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11
Q

What is acute gastritis? How does it present?

A 
transient mucosal inflammatory process; 
usu asymptomatic
epigastric pain
nausea
vomiting
hematemesis
melena
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12
Q

What things can cause acute gastritis?

A 
NSAIDs (prevents prostaglandins - one of the major defense mechanisms)
H. pylori infection
aspirin
cigarettes (vasoconstriction)
alcohol (direct toxin)
gastric hyperacidity
duodenal-gastric reflux (bile reflux)
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13
Q

(blank) is the preferred term for acute gastritis

A

active inflammation

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14
Q

The presence of (blank) within the gastric mucosa denotes acute gastritis

A

neutrophils

**acute injury/inflammation

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15
Q

How do you differentiate between erosion & ulceration?

A

erosion: loss of superficial epithelium - defect limited to the lamina propria - doesn’t get down to the muscularis
ulceration: loss of epithelium deeper than an erosion - includes a layer of necrosis, inflammation & granulation tissue - can get down past muscularis into superficial vessels

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16
Q

What are the different types of gastric ulcers? What is each associated with?

A

stress ulcers - common in pts with SHOCK

curling ulcers - occur in the proximal duodenum, associated with SEVERE BURNS OR TRAUMA

cushing ulcers: gastric, duodenal or esophageal ulcers in patients with intracranial disease

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17
Q

How does chronic gastritis present?

A

nausea
vomiting
upper abdominal discomfort

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18
Q

What are some causes of chronic gastritis?

A 
H. pylori
psychological stress
caffeine
alcohol
tobacco
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19
Q

A spiral shaped or curved bacilli
Is present in almost all patients with duodenal ulcers and the majority of patients with gastric ulcers and chronic gastritis (90%)
Condition is the result of an imbalance between gastroduodenal mucosal defenses & damaging forces that overcome those defenses

A

H. pylori gastritis

20
Q

Which part of the stomach does H. pylori gastritis usually affect?

A

antrum

21
Q

What is the condition that occurs when H. pylori infects the fundus/body of the stomach? What are the symptoms?

A

multifocal atrophic gastritis;
reduced acid secretion
intestinal metaplasia
increased risk of gastric adenocarcinoma

22
Q

What will you see on histology with chronic gastritis?

A

plasma cells infiltrating

may see neutrophils if it is an “active” gastritis

23
Q

What part of the stomach is usually damaged by autoimmune gastritis? What are the symptoms?

A

body/fundus (this is where parietal cells are found);
antibodies to parietal cells & intrinsic factor
reduced pepsinogen concentration (some chief cell damage)
antral endocrine cell hyperplasia
Vit B12 deficiency (pernicious anemia)
achlorhydria

24
Q

What are some causes of reactive gastropathy?

A

chemical injury, NSAIDs, bile reflex, mucosal trauma

25
Q

Foveolar hyperplasia, mucosal edema and glandular regenerative changes

A

reactive gastropathy

26
Q

Dense infiltrates of eosinophils in the mucosa and muscularis

A

eosinophilic gastritis

27
Q

Causes of eosinophilic gastritis?

A

allergens, parasitic infection, H. pylori, collagen vascular disease

28
Q

What can cause granulomatous gastritis?

A 
Chron's disease
sarcoidosis
mycobacteria
fungi
CMV
H. pylori
29
Q

Peptic ulcer disease occurs in any portion of the GI tract exposed to (blank)
Is most often associated with (blank) gastritis and (blank) gastritis

A

gastric acid; H. pylori; chronic

30
Q

Where do peptic ulcers usually occur? What causes peptic ulcer disease?

A 
duodenum or antrum most commonly;
anything that increases gastric acidity
H. pylori infection
parietal cell hyperplasia
Zollinger-Ellison syndrome
NSAIDs
cigarette smoke
high-dose steroids
31
Q 
Nodules or masses that protrude above the level of the surrounding mucosa
May result due to 
Epithelial or stromal hyperplasia
Inflammation
Ectopia
Neoplasia
A

polyps

32
Q

75% of gastric polyps

Develop in association with CG (reactive hyperplasia)

A

inflammatory/hyperplastic polyps

33
Q

Seen in patients on long-term proton pump inhibitors

Occur sporadically and in those with familial adenomatous polyposis (FAP)

A

fundic gland polyps

34
Q

Occur in the background of chronic gastritis with atrophy and intestinal metaplasia
Increased incidence in FAP (familial adenomatous polyposis)
Low-grade dysplasia

A

adenoma

35
Q

Most common carcinoma of the stomach (90%)

A

adenocarcinoma

36
Q

Where does adenocarcinoma usu occur in the stomach?

A

antrum

lesser curvature

37
Q

2 major histological types of adenocarcinoma?

A 
intestinal type (arise from adenoma)
diffuse type (signet ring type - really lose, discohesive cells)
38
Q

What types of cells would you see in adenocarcinoma of the stomach - diffuse type?

A

signet ring cells

39
Q

What are lymphomas called in the gut? What usu caused em?

A

lymphomas derived from mucosa associated lymphoid tissue (MALToma)
H. pylori!!!

40
Q

What is the most common lymphoma? What would you call it when it occurs in the gut mucosa?

A

extra nodal marginal zone B-cell lymphoma; MALToma

41
Q

Where do MALToma lymphomas usu arise in the stomach? How do you treat em?

A

at sites of chronic inflammation (due to H. pylori); treat the H. pylori infection w antibiotics!

42
Q 
Another tumor of the stomach
Formerly called carcinoids
May be associated with 
Endocrine cell hyperplasia
Chronic atrophic gastritis
Zollinger-Ellison syndrome (gastrinoma)
May produce a syndrome depending on which hormone is produces
A

neuroendocrine tumors

43
Q

Most common mesenchymal tumor of the abdomen
Arise from the interstitial cells of Cajal in the GI tract
Derived from mesenchyme
Stain for CD117 (C-kit)

A

gastrointestinal stromal tumor

CD117 - overactive tyrosine kinase

44
Q

What will you see in atrophic gastritis?

A

you’ll see intestinal metaplasia

**goblet cells of intestine w/i stomach

45
Q

Where does the signet ring carcinoma of the stomach metastasize to most commonly?

A

to the ovary - called a Krukenberg tumor

Block 10 Week 4 (8 decks)

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