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Robbins Pathology GI (Chptr 16,17,18,19) > Chapter 17-Stomach > Flashcards

Chapter 17-Stomach Flashcards

1
Q

What is the terminology used when there are neutrophils present at the lesion in gastritis

A

Acute gastritis

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2
Q

What is the terminology used when there are no inflammatory cells present in the gastritis lesion

A

Gastropathy

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3
Q

What are the diseases that fall under the category of hypertrophic gastropathy

A
  • Menetrier disease

- Zollinger Ellison Syndrome

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4
Q

What is the mechanism that NSAIDs can cause gastritis or gastropathy

A
  • NSAIDs inhibit COX
  • COX stimulate prostaglandin synthesis
  • Prostaglandins stimulate production all of the products protecting the stomach lining from harsh conditions
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5
Q

What stomach condition are people at higher altitudes at risk of developing

A

Decreased oxygen leads to acute gastritis

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6
Q

Patients with NSAID induced gastritis will respond to which treatments

A

PPI

Antacids

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7
Q

What are the stree related mucosal diseases

A
  • Stress ulcers
  • Severe burns or Ulcers (Curling ulcers)
  • Intracranial disease (Cushing disease)
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8
Q

When are stress ulcers commonly seen in patients

A

Individuals with shock, sepsis or severe trauma

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9
Q

When are Curling ulcers commonly seen

A

Severe burns or trauma leading to ulcers in the proximal duodenum

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10
Q

When are Cushing ulcers commonly seen

A

Gastric, duodenal or esophageal ulcers in patients with increased intracranial disease

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11
Q

What are cushing ulcers commonly resulting in

A

Perforation

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12
Q

What is the common cause of stress related gastric mucosal injury

A

Local ischemia due to systemic hypotension of reduced bloody flow due to splanchnic vasoconstriction

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13
Q

Upregulation of what in the stomach that can cause ischemic gastric mucosal injury

A

iNOsynthase and release of endothelin 1 (causes vasoconstriction)

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14
Q

Upregulation of what in the stomach that can protect against ischemic gastric mucosal injury

A

COX2

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15
Q

How does increased intracranial pressure cause Cushing ulcers

A

Intracranial injury causes direct stimulation of vagal nuclei, causing hyposecretion of gastric acid

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16
Q

What is the location of acute stress ulcers and what are the number that they normally occur in

A

Anywhere in the stomach, and there are normally multiple lesions

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17
Q

What is the morphology of the stress ulcers

A

-Ulcer base is stained brown/black by digestion of extravasated blood

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18
Q

What is absent in acute stress ulcers that differentiate it from peptic ulcers

A

Scarring and blood vessel thickening

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19
Q

Most critically ill patients admitted to the ICU show signs of which condition

A

Histological evidence of gastric mucosal damage

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20
Q

What is the most important determination of clinical outcome of gastric mucosal damage

A

Correction of the underlying condition

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21
Q

What are the nonstress related caused of gastric bleeding

A

GAVE Disease

Dieulafoy lesion

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22
Q

What is the Dieulafoy lesion caused by

A

Submucosa artery does not branch within the wall of the stomach, leading to an enlarged mucosal artery

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23
Q

Where are Dieulafoy lesions commonly found

A

Along the lesser curvature, near the gastroesophageal junction

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24
Q

What is the result of the Dieulafoy lesion

A

Erosion of the overlying epithelium causes gastric bleeding

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25
Q

What exacerbates the bleeding from a Dieulafoy lesion

A

NSAID use

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26
Q

What is the characteristic endoscopic finding in GAVE disease

A

Longitudinal stripes of edematous erythematous mucosa alternating with less injured pale mucosa aka watermelon stomach

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27
Q

What are the longitudinal erythematous stripes in GAVE caused by

A

Ecstatic mucosal vessels

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28
Q

What are the histological findings of GAVE

A

Natural mucosa shows reactive gastropathy with dilated capillaries containing fibrin thrombi

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29
Q

What are the conditions associated with GAVE

A

Cirrhosis and systemic sclerosis

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30
Q

What is the most common cause of chronic gastritis

A

Infection with H. Pylori

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31
Q

What is the most common cause of diffuse atrophic gastritis, and the most common second to H. Pylori with chronic gastritis

A

Autoimmune gastric

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32
Q

If you were to take a gastric biopsy of the duodenal ulcer, what most likely will be present

A

H. Pylori

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33
Q

What percentage of patients with chronic gastritis are infected with H. Pylori

A

90%

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34
Q

What are the common cases where H.pylori is more prevalent

A
  • Poverty
  • Crowded housing
  • Black of Mexican
  • Rural housing
  • Birth outside US
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35
Q

What are the levels of gastrin in an infection with H. Pylori

A
  • Locally elevated

- Serum normal

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36
Q

What is the result when the inflammation from H.pylori is limited to the antrum of the stomach

A

Increased acid production causes increased risk of duodenal peptic ulcer

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37
Q

What is the result when the inflammation of the H. Pylori infection is in the fundus and body of the stomach

A

Multifocal atrophic gastritis

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38
Q

What is multifocal atrophic gastritis associated with

A
  • Patchy mucosa
  • Reduced parietal cell mass and acid secretion
  • intestinal metaplasia
  • increased risk of gastric adenocarcinoma
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39
Q

What is the relationship between duodenal ulcers and adenocarcinoma

A

They are inversely related, as the increased pattern causing adenocarcinoma will decrease the chance of duodenal ulcers

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40
Q

What are the four things that are associated with the virulence of the H. Pylori infections

A
  • Flagella
  • Urease
  • Adhesins
  • Toxins
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41
Q

What is the gene/toxin present in 90% of patients with elevated gastric cancer risk

A

CagA toxin from H pylori

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42
Q

Deficiency of which vitamin is associated with an increased risk of H.pylori associated gastric cancer

A

Iron

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43
Q

What is the locations commonly associated with H. Pylori

A

Gastric epithelium, not found in intestinal metaplasia or duodenal epithelium

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44
Q

What are characteristic of H. Pylori gastritis

A

Intraepithelial neutrophil and subepithelial plasma cells

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45
Q

When the inflammation due to H. Pylori is intense, which condition can it mimic

A

Thicken fugal folds that can mimic appearance of early cancers

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46
Q

How can H. Pylori gastritis be differentiated from autoimmune gastritis

A

H. Pylori causes mucosa to atrophy and result in loss of parietal and chief cells, taking on the appearance ECF antral mucosa. As opposed to autoimmune gastritis which takes on the form of patchiness, with intact oxytynic glands

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47
Q

The development of atrophy in the stomach is associated with which conditions

A

Intestinal metaplasia and gastric adenocarcinoma

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48
Q

What is the stain that is used to highlight H. Pylori in stains histologically

A

Warthin-Starry silver stain

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49
Q

What is autoimmune gastritis associated and defined by

A
  • Abs against parietal cells and intrinsic factor
  • reduced serum pepsinogen 1 levels
  • Endocrine cell hyperplasia
  • B12 deficiency
  • Defective gastric acid secretion
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50
Q

What is the cause of the increased gastrin release associated with autoimmune gastritis

A

Loss of parietal cells and acid secretion causes the increased levels of gastrin secretion

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51
Q

What is the principal cell of injury and the target in autoimmune gastritis

A

CD4 T cells targeting parietal cells

52
Q

What is morphologically characteristic of autoimmune gastritis

A

Diffuse mucosal damage to the oxyntic (acid production) mucosa within the body and fundus with atrophy and loss of rural folds

53
Q

Which stain can be used to see hyperplasia associated with autoimmune gastritis

A

Immunostaining for proteins such as chromogrannin A (parallels mucosal atrophy)

54
Q

What is the median age of diagnosis for autoimmune gastritis

A

60

55
Q

Which conditions are commonly associated with autoimmune gastritis

A

Other autoimmune diseases such as Hashimotos, DM, Addison’s, Graves, myasthenia gravis etc

56
Q

What is a potential response to the anemia caused by the lack of B12 in autoimmune gastritis

A

Atropic glossitis, which is a smooth and beefy red tongue, megaloblastosis, spinal cord lesions, and cerebral dysfunction. Usually presents with numbness and parenthesis

57
Q

What are the defining features of subacute combined degeneration of the cord

A
  • Loss of vibration and positional sense
  • Sensory ataxia with Romberg sign
  • limb weakness
  • extensor plantar response
58
Q

What is eosinophilia gastritis

A

Gastritis with tissue damage associated with dense infiltrates of eosinophils in the mucosa and muscularis part of the antral and pyloric region

59
Q

What is a common cause of allergens in children that lead to eosinophilia gastritis

A

Soy protein and cow’s milk

60
Q

Which conditions are commonly associated with eosinophilia gastritis

A

Immune disorders:

  • systemic sclerosis
  • polymyositis
  • Parastic infections
  • H.pyloir infections
61
Q

Which gender is more commonly to develop lymphocytic gastritis

A

Women

62
Q

Which condition is commonly presented with lymphocytic gastritis

A

Celiac disease

63
Q

What is the histological finding with lymphocytic gastritis

A

Intraepithelial T lymphocytes

64
Q

What are the morphological findings associated with lymphocytic gastritis

A

Thickened folds covered by small nodules with central aphthous ulcerations

65
Q

What is another name for lymphocytic gastritis

A

Varioliform gastritis

66
Q

What is the characteristic feature of granulomatous gastritis

A

Well formed granulomas or aggregates of macrophages

67
Q

What is the most common cause of granulomatous gastritis, and what are the second and third

A

First: crohns
Second: sarcoidosis
Third: Infections

68
Q

What is the location that is affected with peptic ulcer disease

A

Duodenum and stomach

69
Q

What three things are accounted for in almost all cases of peptic ulcer diseases

A
  • H. Pylori
  • NSAIDs
  • Cigarette smoke
70
Q

What is the most common peptic ulcer diseases associated with

A

H pylori leading to PUD affecting the gastric antrum and duodenum

71
Q

What is peptic ulcer disease of the antral portion of the stomach characterized by

A

Increased gastric acid secretion and decreased duodenal bicarbonate secretion

72
Q

What is peptic ulcer disease of the gastric body or fundus associated with

A

Less acid secretions as a result of mucosal atrophy, and although it is more than normal, not enough to overcome the protected membranes

73
Q

Why is peptic ulcer disease increasing in those over the age of 60

A

Use of baby aspirin (NSAID)

74
Q

What is the most common location for peptic ulcer disease

A

Proximal duodenum

75
Q

Which portion of the duodenum wall do peptic ulcers affect

A

Anterior wall

76
Q

Which portion of the stomac is affected in gastric peptic ulcers

A

Lesser curvature of the stomach

77
Q

What is the general morphology of a peptic ulcer

A

Solitary, with a round ulcer that sharply “punched out defect”

78
Q

How do you differentiate between peptic ulcers and cancer

A

Ulcers are punched out, while cancers will be raised

79
Q

How common is malignant transformation of the peptic ulcers

A

Very rarely

80
Q

Which complications are commonly reported with peptic ulcers

A

-Iron deficiency anemia, hemorrhage and perforation

81
Q

What does pain tend to occur with peptic ulcers

A
  • 1 to 3 hours after meals
  • worse at night
  • relieved by food or antacids
82
Q

Wheat is the first indication of an ulcer

A

Bleeding

83
Q

What is the percentage of patients that bleeding as a result of an ulcer may occur and what percentage of deaths

A

15-20% and accounts for 25% of deaths

84
Q

What accounts for the majority of deaths in patients with pueptic ulcers

A

Perforation

85
Q

What is the characteristic of the condition gastric cystica

A

Epithelial proliferation associated with entrapment of the epithelial lined cysts

86
Q

What are the characteristics of hypertropic gastropathies

A

-Uncommon diseases that have giant cerebriform enlargement of the rural folds (due to epithelial hyperplasia) without inflammation

87
Q

What are the two examples of hypergastric gastropathies

A
  • Menetrier Disease

- ZE

88
Q

What is the mechanism of disease of Menetrier disease

A

-excess TGF resulting in diffuse hyperplasia of the foveolar epithelium of the body and fundus and hyperproteinemia

89
Q

Patients with Menetrier disease are at an increase of which condition

A

Adenocarcinoma

90
Q

What are the morphological changes seen in Menetrier disease

A

-Rural fold enlargement in the bonds and fundus, but the antrum is spared

91
Q

What are the histological findings of Menetrier disease

A

-Hyperplasia of the fovealar cells, where the glands are elongated with a corkscrew like appearance and cystic dilation

92
Q

What are the treatments of Menetrier disease

A

Intravenous albumin, parenteral supplementation and anti TGF

93
Q

What are the characteristics of the Zollinger Ellison syndrome

A

Gastrin secreting tumors, presenting with duodenal or chronic diarrhea

94
Q

Where are gastromas commonly found

A

Small intestine and pancreas

95
Q

What are the features of Zollinger Ellison syndrome

A

-Doubling of the oxyntic mucosal thickening due to the increase in the number of parietal cels

96
Q

The increase in gastrin from Zollinger Ellison syndome result in hyperplasia of which areas

A
  • mucous neck cells
  • Mucin hyperproduction
  • proliferation of endocrine cells of oxyntic mucosa
97
Q

What is the main concern of treatment for Zollinger Ellison syndome

A

Treatment focused on the gastroma, because it is the main determinative of long term survival

98
Q

What percent of the Zollinger Ellison gastromas are milignant

A

60-90%

99
Q

Where condition/ neoplasias are associated with Zollinger Ellison

A

MEN1

100
Q

What is the treatment for patients with Zollinger Ellison and MEN1

A

Somatostatin analogues

101
Q

Fundic gland polyps occur in individuals with which condition

A

Familial adenomatous polyposis (FAP)

102
Q

What is the risk of fundic gland polyps that carry a large risk

A

Those that are familial with FAP, as sporadic carries no risk of cancer

103
Q

Which gender is more commonly affected by gastric adenomas

A

Males

104
Q

The risk of adenocarcinoma from gastric adenomas are correlated to what

A

Related to the size of the lesion

105
Q

What is the most common malignancy of the stomach and by which percentage

A

Adenocarcinoma and 90% of all cancers of the stomach

106
Q

What are the common sites involved in metastasis of gastric adenocarcinomas

A 
Virchow nodes (supraclavicular)
Sister Mary Joseph (Periumbicular)
Irish (left axillary node)
Krukenburg tumor (ovarian)
Blume shelf (punch of Douglas aka retouterine pouch)
107
Q

Which mutation is strongly associated with familial gastric adenocarcinomas

A

CDH1, which is for E cadherin

108
Q

Individuals with which mutation are at a higher risk of developing diffuse gastric cancer

A

BRCA2

109
Q

Which mutation is strongly assocaited with sporadic intestinal type gastric cancers

A

Wnt pathway (beta catenin and APC)

110
Q

Gastric tumors of diffuse infiltrate growth are commonly composed of which cells

A

Signet ring cells

111
Q

Which condition commonly demonstrates linitis plastica and what is that syndome

A

Gastric adenocarcinomas, with thickened gastric wall with thicker regal folds aka leather bottle appearance

112
Q

Which condition starts a desmoplastic reaction

A

Adenocarcinoma

113
Q

What is the most diagnostic feature of gastric cancer

A
  • Extent of nodal metastasis

- Depth of invasion

114
Q

What patient group and location is most common for EBV be cell lymphoproliferations

A

Allogenic hematopoietic stem cell and organ transplant patients, the bowel is the most common location

115
Q

Which translocation is most commonly associated with MALTomas and which is the gene product

A

(11;18)(q21;q21)

-apoptosis inhibitor protein 2 (API2)

116
Q

What is the histological characteristic feature of MALTomas

A

Lyzphoepithlelial lesion with neoplastic lymphocytes surrounding and infiltrating gastric glands

117
Q

Carcinoid syndrome is commonly assocaited with which metastatic disease

A

Liver metastatic disease

118
Q

What is the most common location of a GI carcinoid tumor

A

Midgut, aka jejunum and illeum

119
Q

What is the prognosis of forgut carcinoid tumor

A

Good, as they rarely metastasis and cured with resection

120
Q

What is the prognosis of midgut carcinoid tumors

A

Not great, since they tend to be aggressive

121
Q

What characteristics of the midgut carcinoid tumors are associated with worse outcomes

A

Greater depth
Increased size
Necrosis and mitosis

122
Q

What is the prognosis of hindgut carcinoid

A

Good, as most are benign

123
Q

What is the most common mesenchymal tumor of the abdomen, and which location is most common

A

GI stromal tumor (GIST) in the stomach

124
Q

What is the origin of the GI stromal tumors

A

Cells of Cajal

125
Q

Which condition is described as having a salt and pepper histological description

A

GI carcinoid tumor

126
Q

Which conditions of GIST

A
  • NF1

- Carney triad (GIST, paraganglioma, and pulmonary chondroma)

127
Q

Most GIST contain which mutation

A

Tyrosine kinase KIT

Robbins Pathology GI (Chptr 16,17,18,19) (32 decks)

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