CH10 - Gastrointestinal Pathology Flashcards Preview

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Flashcards in CH10 - Gastrointestinal Pathology Deck (345)
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121

How does H pylori lead to gastritis?

H pylori ureases and proteases along with inflammation weaken mucosal defenses; antrum is the most common site

122

How does H. Pylori gastritis present?

with epigastric abdominal pain; increased risk for ulceration (peptic ulcer disease), gastric adenocarcinoma (intestinal type), and MALT lymphoma

123

What is the treatment for H Pylori gastritis?

involves triple therapy.

124

What is triple therapy?

Proton pump inhibitors and antibiotics

125

What does triple therapy treatment for H pylori gastritis result in?

1) Resolves gastritis/ulcer and reverses intestinal metaplasia 2) Negative urea breath test and lack of stool antigen confirm eradication of H pylori.

126

What is peptic ulcer disease?

Solitary mucosal ulcer involving proximal duodenum (90%) or distal stomach (10%)

127

What is the duodenal ulcer due to?

almost always due to H pylori (> 95%); rarely, may be due to Zollinger Ellison (ZE) syndrome

128

What does a duodenal ulcer present with?

epigastric pain that improves with meals

129

What does biopsy of a duodenal ulcer show?

Diagnostic endoscopic biopsy shows ulcer with hypertrophy of Brunner glands.

130

What might happen to a duodenal ulcer?

May rupture leading to bleeding from the gastroduodenal artery (anterior ulcer) or acute pancreatitis (posterior ulcer)

131

What is gastric ulcer usually due to?

H pylori (75%); other causes include NSAlDs and bile reflux.

132

What doses gastric ulcer present with?

epigastric pain that worsens with meals

133

Where is the gastric ulcer usually located?

on the lesser curvature of the antrum.

134

What does rupture of gastric ulcer result in?

carries a risk of bleeding from left gastric artery

135

What is the differential diagnosis of ulcers?

includes carcinoma.

136

Might duodenal ulcers lead to carcinoma?

Duodenal ulcers are almost never malignant (duodenal carcinoma is extremely rare).

137

Is there a relationship between gastric ulcers and carcinoma?

Gastric ulcers can be caused by gastric carcinoma (intestinal subtype)

138

How do benign peptic ulcers usually appear?

small (< 3 cm), sharply demarcated (punched-out), and surrounded by radiating folds of mucosa

139

How do malignant ulcers appear?

they are large and irregular with heaped up margins

140

What is required for definitive diagnosis regarding gastric ulcers?

biopsy

141

What is gastric carcinoma?

Malignant proliferation of surface epithelial cells (adenocarcinoma)

142

How is gastric carcinoma subclassified?

into intestinal and diffuse types

143

Which subclassification of gastric carcinoma is more common?

Intestinal type

144

How does the intestinal type of gastric carcinoma present?

presents as a large, irregular ulcer with heaped up margins;

145

What does the intestinal type of gastric carcinoma most commonly?

involves the lesser curvature of the antrum

146

How is gastric carcinoma similar to gastric ulcer?

They both involve the lesser curvature of the antrum

147

What are risk factor for the intestinal type of gastric carcinoma?

they include intestinal metaplasia (e.g., due to H pylori and autoimmune gastritis), nitrosamines in smoked foods (Japan), and blood type A.

148

How is the diffuse type of gastric carcinoma characterized?

by signet ring cells that diffusely infiltrate the gastric wall, desmoplasia resulting in thickening of stomach wall (linitis plasties)

149

What is the diffuse type of gastric carcinoma not associated with

its not associated with H pylori, intestinal metaplasia, or nitrosamines

150

What does gastric carcinoma present with?

It presents late with weight loss, abdominal pain, anemia, and early satiety; rarely presents as acanthosis nigricans or Leser-Trelat sign