Flashcards in CH10 - Gastrointestinal Pathology Deck (345)
How does H pylori lead to gastritis?
H pylori ureases and proteases along with inflammation weaken mucosal defenses; antrum is the most common site
How does H. Pylori gastritis present?
with epigastric abdominal pain; increased risk for ulceration (peptic ulcer disease), gastric adenocarcinoma (intestinal type), and MALT lymphoma
What is the treatment for H Pylori gastritis?
involves triple therapy.
What is triple therapy?
Proton pump inhibitors and antibiotics
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.
What is peptic ulcer disease?
Solitary mucosal ulcer involving proximal duodenum (90%) or distal stomach (10%)
What is the duodenal ulcer due to?
almost always due to H pylori (> 95%); rarely, may be due to Zollinger Ellison (ZE) syndrome
What does a duodenal ulcer present with?
epigastric pain that improves with meals
What does biopsy of a duodenal ulcer show?
Diagnostic endoscopic biopsy shows ulcer with hypertrophy of Brunner glands.
What might happen to a duodenal ulcer?
May rupture leading to bleeding from the gastroduodenal artery (anterior ulcer) or acute pancreatitis (posterior ulcer)
What is gastric ulcer usually due to?
H pylori (75%); other causes include NSAlDs and bile reflux.
What doses gastric ulcer present with?
epigastric pain that worsens with meals
Where is the gastric ulcer usually located?
on the lesser curvature of the antrum.
What does rupture of gastric ulcer result in?
carries a risk of bleeding from left gastric artery
What is the differential diagnosis of ulcers?
Might duodenal ulcers lead to carcinoma?
Duodenal ulcers are almost never malignant (duodenal carcinoma is extremely rare).
Is there a relationship between gastric ulcers and carcinoma?
Gastric ulcers can be caused by gastric carcinoma (intestinal subtype)
How do benign peptic ulcers usually appear?
small (< 3 cm), sharply demarcated (punched-out), and surrounded by radiating folds of mucosa
How do malignant ulcers appear?
they are large and irregular with heaped up margins
What is required for definitive diagnosis regarding gastric ulcers?
What is gastric carcinoma?
Malignant proliferation of surface epithelial cells (adenocarcinoma)
How is gastric carcinoma subclassified?
into intestinal and diffuse types
Which subclassification of gastric carcinoma is more common?
How does the intestinal type of gastric carcinoma present?
presents as a large, irregular ulcer with heaped up margins;
What does the intestinal type of gastric carcinoma most commonly?
involves the lesser curvature of the antrum
How is gastric carcinoma similar to gastric ulcer?
They both involve the lesser curvature of the antrum
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.
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)
What is the diffuse type of gastric carcinoma not associated with
its not associated with H pylori, intestinal metaplasia, or nitrosamines