Pathology of the stomach and duodenum Flashcards

1
Q

When does the pyloric channel end?

A

when the duodenum begins

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2
Q

Describe acute gastritis? Aeitology?

A
  • irratant chemical injury

Severe burns
Shock
Severe trauma
Head Injury

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3
Q

What is the aeitology of chronic gastritis?

A

Autoimmune
Bacterial (H.pylori)
Chemical

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4
Q

What are rare forms of inflammatory stomach disorders?

A

Lymphocytic
Eosinophillic
Granulomatous

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5
Q

Describe Autoimmune chronic gastritis?

A

Atrophy and intestinal metaplasia in body of stomach

  • due to the immune system producing antibodies against own stomach lining
  • Anti-parietal and anti-intrinsic factor antibodies
  • pernicious anaemia, macrocytic (insufficient oxygen), due to B12 deficiency
  • increased risk of malignancy
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6
Q

Describe Baterial chronic gastritis?

A

H.pylori
Bacteria inhabits a niche between the epithelial cell surface and mucous barrier
Excites early acute inflammatory response
Gram negative curvilinear rod
If not cleared then a chronic active inflammation ensues
IL8 is critical

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7
Q

What produces anti H.pylori antibodies?

A

lamina propria

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8
Q

What does H.pylori gastritis cause?

A

Increases risk of Duodenal ulcer

Increases risk of Gastric Ulcer

Increases risk of Gastric carcinoma

Increases risk of Gastric lymphoma

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9
Q

Describe chemical gastritis?

A

Due to: NSAIDs, alcohol, bile reflux

Direct injury to mucus layer by fat solvents - takes away the membrane of gastric epithelial cells

Marked epithelial regeneration, hyperplasia, congestion and little inflammation

May produce erosions or ulcers

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10
Q

What is peptic ulceration due to? what is it?

A

acid and pepsin attack

breach in the gastrointestinal mucosa

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11
Q

What sites are predisposed to developing peptic ulceration?

A

Duodenum (Ist. part) - first part hit by stomach acid

Stomach ( junction of body and antrum)

Oesophago-gastric Junction

Stomal ulcers

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12
Q

What are chronic duodenal ulcers due to?

A

Increased attack and failure of defence

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13
Q

What does excess acid in the duodenum do?

A
produces gastric metaplasia and leads to:
H.Pylori infection
inflammation
epithelial damage
ulceration
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14
Q

What are the complications of peptic ulcers?

A
Perforation
Penetration
Haemorrhage
Stenosis
Intractable pain
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15
Q

Name benign gastric tumours?

A

Hyperplastic polyps

Cystic fundic gland polyps

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16
Q

Name some malignant gastric tumours?

A

Carcinomas (adenocarcinomas)
Lymphomas
Gastrointestinal Stromal tumours (GISTs)

17
Q

What are gastric adenocarcinomas linked to?

A

smoked fish

18
Q

What is the gastric adenocarcinoma pathway?

A
H.pylori infection ->
Chronic gastritis ->
Intestinal metaplasia/atrophy ->
Dysplasia ->
Carcinoma
19
Q

What are the two types of gastric adenocarcinomas?

A

Intestinal type = well defined tumor in the stomach (better prognosis)
Diffuse type = spreads out

20
Q

What can also cause gastric adenocarcinoma?

A

Pernicious anaemia

Partial gastrectomy

HNPCC / Lynch syndrome

Menetrier’s Disease

21
Q

Where do gastric adenocarcinomas spread to?

A

Local: Into other organs and into peritoneal cavity and ovaries…Kruckenberg

Lymph nodes

Haematogenous: to the liver

22
Q

Describe gastric lymphoma (maltoma)?

A

Derived from mucosa associated lymphoid tissue (MALT)

Associated with H.Pylori infection

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

If unchecked evolves into a high grade B-cell lymphoma