Unit 9: Minor 3: Peptic Ulcer to gastric bleeding

Question 1

What test is used to identify blood in stool?
How does this give a positive result?

Answer 1

Guaiac test: tests for blood in stool that is not visible to the naked eye
Often done on multiple stool samples from multiple different bowel movements
Guaiac regents react with heme products in the presence of H2O2, the resulting oxidation of guaiac resulting in a blue colour - positive result

Question 2

What are common causes of abdominal pain?

Answer 2

Appendicits - starts at T10 and migrates to right illiac fossa
Perforated organs - severe and intense pain
IBS or indigestion - chronic and dull pain
Peptic ulcer - gnawing or hunger pain

Question 3

What are some pathological causes of a distended abdomen?

Answer 3

Ascites - hepatic hypertension, fluid accumulation
IBS - gas build up
Severe chronic constipation

Question 4

What are the histological features of the patients condition?
Symptoms: abdominal pain (not related to food), distended abdomen.

Answer 4

Purple dominance
Indicates - chronic inflammatory infiltrate.

Question 5

What is shown in the following image?
What special stain would have been used?
Note patient is presenting with symptoms of a peptic ulcer

Answer 5

H.pylori - curved rods on the surface of the gastric mucosa
Uses a special silver stain: potentially Warthin-Starry Silver

Question 6

What inflammatory disorder dause H.pylori cause in the stomach?

Answer 6

Chronic active gastritis

Question 7

What are the symptoms of peptic ulcer bleeding? What is the reasoning behind this?

Answer 7

Vomiting blood - blood accumulates in the abdomen increases intrabdominal pressure
Low blood pressure - fluid loss
Elevated pulse - compensatory mechanism due to decreased SV, to increase CO
Increased respiratory rate - decreased oxygen in circulation (chemoreceptors)
Dark stools
Iron deficiency anaemia - iron from lost blood is not recycled

Question 8

What is a gastrectomy?

Answer 8

Where all or part of the stomach is removed.

Question 9

How can you distinguish between a benign and malignant ulcer on gross level?

Answer 9

Benign/acute - smooth, regular and rounded edges, regular borders
Malignant/chronic - margins are irregular or thickened

Question 10

What is shown in the image?

Answer 10

Characteristic ulceration of the mucosa
Radiating gastric folds
Base of the ulcer is grey owing to fibrin deposition
Smooth base and regulat borders

Question 11

What are the common micro features of the base of a peptic ulcer?

Answer 11

Surface necrotic layer
Acutely inflammed layer
Zone of granulation tissue
Extensive fibrosis of the base
Epithelium at the edge of the ulcer may show regenerative hyperplasia

Question 12

What is shown in the following histological image of a peptic ulcer?

Answer 12

Immune cell infiltrate
Granulation tissue - containing cengested and newly formed capillaries (sign of angiogenesis) and fibroblasts, alongside immune infiltrate
Exudate - white parts
Fibrosis
Ulceration of the epithelium

Question 13

What are the common causes of acute gastritis?

Answer 13

Irritant or infection - alcohol, spicy foods, pathogen, NSAIDs - typically quickly resolves
Anything that interferes with gastric mucosal protection

Question 14

What are the common causes of chronic gastritis?

Answer 14

H.pylori infection
Long term NSAID use
Autoimmune gastritis

Question 15

What gastric diseases have been associated with H.pylori infection?

Answer 15

Chronic active gastritis
Atrophic gastritis
Peptic Ulcers
Gastric cancer - particularly adenocarcinoma
MALT lymphoma

Question 16

What is atrophic gastritis?

Answer 16

Atrophic gastritis - chronic inflammation and loss/thinning of stomach lining.
Chronic atrophic gastritis - often replaced by cells that mimic intestinal cells.

Is often autoimmune or H.pylori associated

Question 17

What are the respective risk factors for duodenal and gastric ulcers?

Answer 17

Age - duodenal more common in younger individuals, incidence rising from age 20yrs, 50yrs for gastric ulcer

Question 18

What is the most common type of gastric cancer?

Answer 18

Adenocarcinoma (90-95%)
Cancer of the glandular tissue, including parietal cells, mucus neck cells and chief cells

Question 19

What are the risk factors for gastric adenocarcinoma?

Answer 19

H.pylori chronic active gastritis
GERD
Increasing age
Stomach polpys
Family history
Male
Diet - spicy foods, processed meat,
Alcohol and cigarette usage

Question 20

What does chronic active gastritis mean?

Answer 20

Show symptoms of acute and chronic gastritis

Question 21

What is gastric squamous cell carcinoma?

Answer 21

Characterised by keratin pearls
Pathogenesis is obscure
Very rare
Diagnosed at late stage - so poor prognosis

Question 22

What is primary gastric lymphoma?

Answer 22

Can be in MALT (extranodal), is often associated with H.pylori infection.
Is a type of non-Hodgkin lymphoma, lymphocytes proliferate in an abnormal way.
Can cause the patient to become immunosuppressed.