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Gastrointestinal > Pathology of the Stomach > Flashcards

Pathology of the Stomach Flashcards

1
Q

What are the cells that accumulate in an acute gastritis? Chronic?

A 
Acute = PMNs
Chronic = lymphocytes or plasma cells
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2
Q

Erosions of the stomach do not go past what layer of the GI tract? What happens it does?

A

Muscularis mucosa

Becomes an ulcer

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3
Q

What are the causes of acute gastritis?

A
  • Disruption of the mucus layer
  • Decrease bicarb secretion
  • Decreased mucosal blood flow
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4
Q

What are the two major chemicals that are absorbed through the stomach?

A

NSAIDs and EtOH

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5
Q

How can renal disease lead to gastritis?

A

Uremia

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6
Q

What is the morphology of acute gastritis?

A

Hyperemia and edema with PMNs above the BM

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7
Q

What is the morphology of more severe gastritis?

A

Entire mucosal thickness eroded and/or hemorrhage.

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8
Q

What is acute erosive hemorrhagic gastritis?

A

When the mucus layer of the stomach has eroded away, and is bleeding

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9
Q

What are the ssx of acute gastritis?

A

Hematemesis

Melena

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10
Q

What is chronic gastritis?

A

Chronic mucosal inflammatory changes eventually leading to mucosal atrophy and intestinal metaplasia

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11
Q

What CA can result from chronic gastritis?

A

Carcinoma

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12
Q

What is the autoimmune cause of gastric gastritis?

A

Pernicious anemia

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13
Q

What is the cause of granulomatous gastritis?

A

Crohn’s disease

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14
Q

What are the gram staining and morphological characteristics of chronic gastritis?

A

S shaped gram negative rod

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15
Q

Is H.Pylori invasive?

A

no

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16
Q

True or false: most H.pylori infections are asymptomatic

A

True

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17
Q

What are the risk factors of having an H.Pylori infection?

A

Increase peptic ulcer
carcinoma
Lymphoma

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18
Q

Where does H.pylori reside in the stomach?

A

In the mucus layer

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19
Q

What are the virulence factors that some strains of H.pylori produce? MOA?

A

CagA
VacA (forms vacuoles)

Both are inflammatory cytokines

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20
Q

True or false: H.pylori are flagellated

A

True

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21
Q

What are the protein that allow H.pylori to bind to the epithelial cells of the stomach?

A

Adhesins

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22
Q

What is a major cause of gastric epithelial degradation?

A

Pepsin is allowed in, degrading proteins

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23
Q

What is the major difference between acute an chronic gastritis secondary to H.pylori infection?

A

PMNs cause damage in chronic infections

Atrophy / dysplasia

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24
Q

What happens when H.pylori infections become symptomatic? (2 scenarios) where does this usually occur?

A

Increase acid and gastrin secretion. OR just increased gastrin.

usually occurs in the antrum.
Less commonly in the body

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25
Q

Autoimmune gastritis can have antibodies to what?

A

Parietal cells and IF

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26
Q

What are the microcytic anemias? (5)

A 
Fe deficiency
Chronic disease
Pb exposure
Sideroblastic 
Thalassemias
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27
Q

What is the MOA of CagA that H.pylori produces?

A

Activates IL-8, attracting PMNs

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28
Q

What are the histological characteristics of H.pylori dysplasia?

A

PMN infiltration

Dysplasia

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29
Q

What is the late morphology of Chronic gastritis?

A

Atrophy, dysplasia

carcinoma in situ

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30
Q

What is the early morphological characteristics of chronic gastritis?

A

Coarse, red mucosa; inflammatory infiltrate

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31
Q

What are the more severe morphological changes associated with chronic gastritis?

A

Variable atrophy
Thin, flattened mucosa
Regenerative changes

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32
Q

What happens to the rugal folds in chronic gastritis?

A

Flattening

33
Q

What are the symptoms of autoimmune chronic gastritis (besides pernicious anemia?

A

Achlorhydria and hypergastrinemia

34
Q

What is an ulcer?

A

Erosion below the muscularis mucosa

35
Q

Where do peptic ulcers form?

A

Antrum of the stomach
Pylorus
body of the stomach
Duodenum

36
Q

Who is affected with PUD more often: men or women

A

Men

37
Q

What is the relationship between hyperparathyroidism and PUD?

A

Hypercalcemia increases gastrin production

38
Q

What are the ssx of PUD?

A

Gnawing epigastric pain occurring 1-3 hours, worse at night

39
Q

How do you diagnose PUD?

A

Endoscopy and imaging

40
Q

Does eating improve or worsen the ssx of PUD?

A

Improve

41
Q

Which ulcers are usually cancerous: duodenal or stomach

A

Duodenal

42
Q

What is the main pathological cause of PUD?

A

Imbalance between mucosal defense and damaging forces

43
Q

H. Pylori is present in almost all (___) ulcers and most of the time in (___) ulcers?

A

Duodenal

Gastric

44
Q

What are some of the defensive forces against developing an ulcer?

A

Mucosal blood flow
Mucus
Bicarb secretion
Prostaglandins

45
Q

What are the pro-inflammatory cytokines that are secreted by H.pylori?

A

IL-1
IL-6
TNF
IL-8

46
Q

What is the role of IL-8 in H.pylori infection

A

Recruits PMNs

47
Q

What is the effect H.Pylori has on gastric acid secretion? Bicarb?

A

Increased gastric acid

Decreased bicarb

48
Q

What are the three enzymes that H.pylori secretes?

A

Urease
Protease
Phospholipase

49
Q

What is Zollinger-ellison syndrome?

A

Gastrinoma producing extra HCl

50
Q

What are the problems with the lower pyloric sphincter that can contribute to ulcer formation?

A

Delayed gastric emptying

Duodenal-gastric reflux

51
Q

What are the severe symptoms of gastric ulcers?

A

Hematemesis

Melena

52
Q

Where are the vast majority of ulcer located?

A

1st portion of the duodenum

53
Q

What is the best way to diagnose an ulcer?

A

Look at it (EGD)

54
Q

What are the characteristics of a benign gastric ulcer?

A

Small, punched out appearance without other signs of inflammation or dysplasia

55
Q

What do gastric carcinomas look like?

A

Raised edges around an ulcer

56
Q

What are the four demonstrable zones histologically of a peptic ulcer?

A
  1. Necrosis of ulcer base and margins
  2. Inflammatory infiltrate
  3. Granulation tissue
  4. Scarring (fibrosis)
57
Q

What are the 4 major complications with PUD?

A

Bleeding
Perforation
Obstruction
Intractable pain

58
Q

What causes the obstructive problems with PUD?

A

Edema or scarring

59
Q

What is the characteristic of stress ulcers? Where do these usually occur?

A

Multiple, small ulcers that Do not breach the muscularis mucosa

Stomach and the duodenum, esophagus

60
Q

True or false: stress ulcers are a precursor to chronic PUD

A

False

61
Q

What are Curling ulcers?

A

an acute peptic ulcer of the duodenum resulting as a complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa.

62
Q

What are Cushing ulcers?

A

Increased intracranial pressure may lead to overstimulation of the vagus nerve, causing increased gastric acid secretion, and ulcer formation

63
Q

What are polyps?

A

Mass lesions arising from and projecting above the mucosa

64
Q

What are hyperplastic or inflammatory polyps?

A

Usually nonneoplastic but hyperplastic epithelium overlying dilated glandular tissue

65
Q

What are adenomatous polyps?

A

True neoplasms–

66
Q

What type of polyps in the stomach are precancerous?

A

Adenomatous polyps

67
Q

What are the histological characteristics of hyperplastic gastric polyps?

A

Tons o’ glands in the epithelium

68
Q

What is the most common type of malignancy of the stomach?

A

Gastric carcinoma

69
Q

What are the two types of gastric carcinomas?

A

Intestinal types

Diffuse type

70
Q

Where, geographically, are most gastric carcinomas found?

A

Asia

71
Q

What is the most important factor for the development of the intestinal type of gastric carcinoma?

A

H.Pylori infection

72
Q

What are the major environmental influences on the intestinal type of gastric carcinoma?

A

nitrosamines

Benzopyrenes

73
Q

Where in the stomach does gastric carcinoma usually occur?

A

Lesser curvature of the stomach

74
Q

What is the most important prognostic factor for gastric carcinoma?

A

Depth of invasion

75
Q

What is the shape, generally, of a malignant ulcer?

A

Ragged edges with elevated edges

76
Q

What is the shape, generally, of a benign ulcer?

A

Smooth, round edges

77
Q

What is linitis plastic?

A

Diffuse gastric carcinoma that spreads out, causing diffuse thickening of the walls of the stomach

78
Q

Signet rings in gastric cells is indicative of what?

A

“Diffuse” typu adenocarcinoma

79
Q

What is the gene that is mutated that causes gastric carcinoma?

A

APC

Gastrointestinal (42 decks)

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