Wk2 Gastric Pathology Flashcards
Two normal damaging forces of gastric mucosa:
- Gastric acid
2. peptic enzymes
Six normal defensive forces of gastric mucosa:
- surface mucous secretion
- bicarb secretion into mucous
- mucosal blood flow
- apical surface transport
- epithelial regeneration
- elaboration of prostaglandins
Seven main mechanisms of gastric mucosal injury:
- H. pylori
- cigarette smoke
- alcohol
- NSAIDs
- Aspirin
- gastric hyperacidity
- duodenal gastric reflux
loss and necrosis of surface epithelium, confined to the lamina propria, i.e. mucosa
mucosal erosion
necrotizing process extends beyond the mucosa into the submucosa and even into and through the muscle wall
mucosal ulcer
Most common finding in H. pylori gastritis:
active chronic gastritis
antrum —> fundus
Two complications of H. pylori infection:
- MALT lymphoma
2. gastric adenocarcinoma
How do humans acquire H. helmannii gastritis?
letting dogs lick your face
Stain to help visualize H. pylori?
diff quick blue
Dx test for active H. pylori:
H. pylori stool antigen
urea breath test
rapid urease test on fresh tissue biopsy
Pathogenesis of autoimmune gastritis:
CD4+ T-cell mediated destruction of parietal cells
chief cells also lost during destruction of the gastric glands (“bystander damage”).
Antibodies to parietal cells and intrinsic factor are also produced as part of the autoimmune response, but are not pathogenic (can be used as a diagnostic test).
Findings in autoimmune gastritis:
Decreased gastric acid secretion (achlorhydria).
Compensatory hypergastrinemia and hyperplasia of antral gastrin-producing G cells
endocrine cell hyperplasia in the fundus and body of the stomach.
Vitamin B12 deficiency due to loss of secreted intrinsic factor (pernicous anemia with increased RBC MCV).
Reduced serum pepsinogen I concentration.
Inflammatory mucosal damage
atrophy of the gastric mucosa in the body and fundus with sparing of the antrum and cardia
Causes of chronic reactive gastropathy:
chemical mucosal injury
NSAIDs
aspirin
bile reflux
alcohol ingestion
Two common causes of peptic ulcer disease:
- H. pylori
2. NSAIDs
Three complications of PUD:
Bleeding
perforation
obstruction
eosinophilic inflammation
usually multiple GI sites
maybe food or other allergy
eosinophilic gastritis
characterized by marked intraepithelial inflammation (CD8+ T cells).
Can be seen as an isolated finding, or in patient’s with either co-existing celiac disease or in patients with co-existing ________/collagenous colitis
lymphocitic gastritis
granulomatous inflammation.
Most cases are secondary to an underlying disorder, such as Crohn’s disease, sarcoidosis, mycobacterial or fungal infections.
granulomatous gastritis
excessive secretion of transforming growth factor alpha (TGF-α).
marked diffuse hyperplasia of the foveolar epithelium of the body and fundus of the stomach
protein losing enteropathy and hypoproteinemia, with diarrhea, weight loss, and peripheral edema
Some cases of are associated with an infection (e.g. CMV in children).
Patients are also at risk for gastric adenocarcinoma.
Menetrier’s disease
Caused by gastrin secreting tumors:
Zollinger-Ellison syndrome
exaggerated mucosal response to chronic gastritis:
hyperplastic polyp
associated with PPI
increased gastrin in response to decrease acid
cystic fundic gland polyp
Neoplasm morphologically similar to other GI adenomas:
gastric adenoma
Mesenchymal polypoid proliferation
stromal spindle cells
small blood vessels,
inflammatory cells, particularly eosinophils.
middle aged females
inflammatory fibroid polyp
