pathology of the stomach

Question 1

name 3 inflammatory disorders of the stomach

Answer 1

acute gastritis
chronic gastritis
rare: lymphocytic, granulomatous, osinophillic

Question 2

what can cause acute gastritis?

Answer 2

arritant chemical injury
severe burns
shock
severe trauma
head injury

Question 3

what can casue chronic gastritis?

Answer 3

autoimmune
bacterial
chemical

Question 4

what dos autoimmune chronic gastritis do?

Answer 4

due to immune system prodicing antibodies against own stomach lining (parietal cells) causing atrophy

Question 5

what can autoimmune chronic gastritis cause?

Answer 5

atrophy and intestinal metaplasia in body of stomach
pernicious anaemia, macrocytic due to B12 deficiency
increased risk of malignancy
SACD

Question 6

what are the symptoms of autoimmune chronic gastritis?

Answer 6

tiredness

staggering gate

Question 7

what is the most common type of chronic gastritis?

Answer 7

H. pylori associated

Question 8

what happens in H. pylori chronic gastritis?

Answer 8

bacteria inhibits a niche between epithelial cel surface and mucous barrier
Excites early acute inflammatory response
If not cleared then a chronic active inflammation
ensues
IL8 is involved

Question 9

what type of bacteria is H. pylori?

Answer 9

gram -ve curvilinear rod

Question 10

what can H. pylori associated chronic gastritis increase the risk of?

Answer 10

Lamina propria plasma cells produce anti H.pylori antibodies

Increases risk of Duodenal ulcer

Increases risk of Gastric Ulcer

Increases risk of Gastric carcinoma

Increases risk of Gastric lymphoma

Question 11

do the H. pylori invade the stomach?

Answer 11

no, just sit and irritate the epithelium

Question 12

what can cause chemical gastritis?

Answer 12

NSAIDs
alcohol
bile reflux
direct injury to mucous layer by fat solvents

Question 13

how does injury to mucous layer by fat solvents cause chemical gastritis?

Answer 13

Marked epithelial regeneration, hyperplasia, congestion and little inflammation
May produce erosions or ulcers

Question 14

what does chemical gastritis look like?

Answer 14

red with lots of lesions

Question 15

what is peptic ulceration?

Answer 15

a breach in the gastrointestinal mucosa as a result of acid and pepsin attack
a discontinuity in epithelial surface?
tend to be chronic an deep

Question 16

where are chronic peptic ulcers likely to appear?

Answer 16

duodenum
stomach
oesopho-gastric junction
stomal ulcers

Question 17

what is the pathogenesis of chronic duodenal ulcers?

Answer 17

50% have increased aci secretion or inappropriately sustained secretion of acid
excess acid in duodenum produces gastric metaplasia and leads to H. pylori infection, inflammation, epithelial damage and ulceration
Basically increased attack and failure of defence due to wrong type of epithelia (metaplasia)

Question 18

describe the morphology of peptic ulcers

Answer 18

2-10cm across

edges are clear cut and punched out

Question 19

what do peptic ulcers look like microscopically?

Answer 19

loayed appearance
floor of necrotic fibrinopurulent debris
Base of inflamed Granulation tissue
Deepest layer is fibrotic scar tissue

Question 20

list 6 possible complications of peptic ulcers

Answer 20

perforation
penetration
haemorrhage
stenosis
intractable pain

Question 21

what are benign gastric tumours? what do they do?

Answer 21

polyps
hyperplastic or cystic fundic gland polyps
Cause heaps of cells that sit on the lining but don’t cause problems

Question 22

what types of malignant tumours can arise in the stomach?

Answer 22

carcinomas
lymphomas
adenocarcinomas
Gastrointestinal stromal tumours (GISTs) = rare

Question 23

who gets gastric adenocarcinomas

Answer 23

japan, china, Columbia, finland

Question 24

what can cause gastric adenocarcinoma?

Answer 24

H. pylori can increase risk

Question 25

what is the pathogenesis of adenocarcinoma?

Answer 25

H. pylori infection > chronic gastritis > intestinal metaplasia/atrophy > dysplasia > carcinoma

Question 26

what other pre-malignant conditions can pre-dispose to gastric adenocarcinoma?

Answer 26

pernicious anaemia
partial gastrectomy
HNPCC/lynch syndrome (genetic)
menetrier’s syndrome

Question 27

what are the 2 subtypes of gastric adenocarcinoma?

Answer 27

Intestinal type…exophytic/polypoid mass

Diffuse type…expands/infiltrates stomach wall

Question 28

what does intestinal type adenocarcinoma look like histologically?

Answer 28

produces glands

Question 29

what does diffuse type adenocarcinoma look like physically?

Answer 29

thicker, rigid stomach wall

Question 30

what does diffuse type adenocarcinoma look like histologically?

Answer 30

forms signet rings

diffuse sheet of malignant cells

Question 31

which subtype of adenocarcinoma has the better prognosis?

Answer 31

intestinal

Question 32

where can gastric adenocarcinoma spread to?

Answer 32

locally = directly to other organs
Lymph nodes: omental
Haematogenous: to liver and beyond
Transcoelomic: into peritoneal cavity and ovaries (kruckenberg)

Question 33

where are gastric lymphomas (maltoma) derived from?

Answer 33

mucosa associated lymphoid tissue (MALT)

Question 34

what infection is gastric lymohoma associated with?

Answer 34

H. pylori

Question 35

what happens in gastric lymphoma?

Answer 35

Continuous inflammation induces an evolution into a clonal B-cell proliferation…low grade lymphoma
If unchecked evolves into a high grade B-cell lymphoma