Gastric Pathology

Question 1

what are normal mechanisms of mucosal injury?

Answer 1

h. pylori, NSAID, ASA, cigarettes, alcohol, gastric hyperactivity, GERD

Question 2

How doe the mucosa protect itself?

Answer 2

mucus, bicard, blood flow, regeneration, apical surface membrance transport

Question 3

What are the main causes of acute gastric ulceration?

Answer 3

h. pylori, NSAIDs, lots of alchohol, shock, trauma, sepsis, uremia, severe burns and intercranial ds.

Question 4

The most common pathologic finding in H. Pylori gastritis

Answer 4

active chronic gastritis

Question 5

Letting your dog lick your face is not only gross it can lead to this gastric infection

Answer 5

H. helmannii

Question 6

These tests can indicate an active H. pylori infection

Answer 6

stool antigen, urea breath test, biopsy.

(serology not active infection- just exposure),

Question 7

Key nugget of autoimmune gastritis

Answer 7

t-cell mediated destruction of parietal cells

Question 8

Describe some of the key findings of gastritis

Answer 8

decreased acid secretion
hyperplasia of G cells
vit B12 def.
reduced serum pepsinogen
inflammatory mucusoal damage atrophy of gastric mucosa
glossitis
CNS

Question 9

Normal things that cause chronic reactive gastropathy

Answer 9

NSAIDS, asprin, bile reflux, alcohol ingestion

Question 10

list complications of H. pylori infection.

Answer 10

peptic ulcer disease, chronic gastritis, gastric tumors, adenocarcinoma, lymphoma

Question 11

Two common causes of peptic ulcer disease

Answer 11

H. pylori or chronic use of NSAIDs

Question 12

List complications of PUD

Answer 12

bleeding
perforation
obstruction

Question 13

Keys of eosinophilic gastritis

Answer 13

eosinophils w/out known cause, probably an allergic rxn.

Question 14

What causes granulomatous?

Answer 14

Secondary to Crohn’s, sarcoidodis, mycobaterial and fungal infections, foreign body

Question 15

Describe what characterizes Lymphocytic gastritis

Answer 15

Intraepithelical lymphocytic inflammation (CD8+ T cells) 40% have celiac disase

Question 16

Excessive secretion of TGF-alpha is called this

Answer 16

Menetrier’s Ds (hypertrophic ds)

Question 17

Describe how one develops Zollinger-Ellison syndrome

Answer 17

Gastric secreting tumors of the pancreas or small bowel –> increased gastric acid production.

Question 18

Polyps that represent exaggerated mucosal response to tissue injury and inflammation

Answer 18

hyperplastic polyp

Question 19

What medication use can cause gastric polyps?

Answer 19

PPI’s cause cystic fundic gland polyp

Question 20

This neoplastic polyp is mostly seen in people >50.

Answer 20

Gastric adenoma usually seen with chronic gastritis and interstinal metaplasia

Question 21

These polyps occur in middle aged females and is thought to be a pseudotumor and involve mesenchymal proliferation

Answer 21

inflammatory fibroid polyp

Question 22

A pt. presents in the 2nd or 3rd week of life with regurgitation and projectile vomiting.

Answer 22

Congenital hypertrophic pyloric stenosis, cured with surgical myotomy

Question 23

What puts one at risk for Gastric adenocarcinoma?

Answer 23

chronic gastritis
dietary carcinogens
menetrier's ds
no antioxidatns
FAP

Question 24

Describe 2 morphological types of adenocarcinoma.

Answer 24

intestinal - invasive mass or ulcer

diffuse - diffuse involvement and thickening of gastric wall - see signet-ring cells - can be young people

Question 25

Keys of GIST tumor.

Answer 25

Most common to stomach
cells become interstitial cells of Cajal
85% have gain of function mutation for TK KIT
sporadic
Gleevec effective inhibitor TK.

Question 26

Most common risk factor for gastric MALT lymphoma.

Treatment?

Answer 26

chronic inflammation from H. pylori.

can treat with antibodies and remove transcription activation if no translocations..

Question 27

How do you diagnose carcinoid syndrome?

Answer 27

24 hour urinary 5-HIAA test (serotonin metabolite)

Question 28

What would you see in a patient with carcinoid syndrome?

Answer 28

intermittent flushing, sweating, bronchospasm, abdominal pain, diarrhea, right sided valvular fibrosis