Comprehensive review (2) Flashcards by Meghan May

Chronic, most often solitary lesions that occur in any portion of the GI tract exposed to the aggressive actions of acid/peptic juices, often <4 cm

Peptic ulcers

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Histologic definition of peptic ulcer: a breach in the mucosa that penetrates the _______; may penetrate gastric wall

muscularis mucosa

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more common location of peptic ulcers

Duodenum, first part
Stomach, usually antrum
Within Barrett mucosa

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Most frequent complication of ulcers

Bleeding
• Most frequent complication
• Occurs in 15-20% of patients
• May be life-threatening
• Accounts for 25% of ulcer deaths
• May be first indication of an ulcer

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Is perforation common in ulcers?

rare but accounts for 70% of ulcer

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complication of ulcers located in pyloric channel

obstruction from edema or scarring

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When do we see acute gastric ulceration?

stress, shock, burns, trauma, NSAIDS

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Pathogenesis of acute gastric ulceration:

stimulation of vagal nuclei and secretion of acid, prostaglandin inhibition, decreased oxygenation,

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Can manifest as ulcers or erosions

• Discrete lesions with no surrounding gastritis, no chronic scarring

Acute gastric ulceration

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treatment for acute gastric ulceration

fix the cause

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concretions formed in the alimentary canal

bezoar

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• Acute gastritis
• Gastric varicies
• Mallory Weiss syndrome:
mucosal tear to due to severe retching
These can all lead to:

Gastric hemorrhage; can be asyptomtatic to life threatening

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 Massive hyperplasia of surface mucous cells

Menetrier disease (type of hypertrophic gastropathy)

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 Hyperplasia of parietal and chief cells

Hypertrophic-hypersecretory gastropathy

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Gastric gland hyperplasia due to excessive gastrin secretion

 Setting of gastrinoma: Zollinger-Ellison syndrome (type of hypertrophic gastropathy)

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Caused by gastrin-secreting

tumors, gastrinomas

ZE syndrome

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What is in the gastrinoma triange?

 duodenal wall
 peripancreatic soft tissue
 pancreas

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How do pts with ZE syndrome present?

Patients often present with duodenal ulcers, GERD, or chronic diarrhea
90% of ZE patients have peptic ulcers
Proximal dudodenum or unusual locations (distal duodenum, jejunum)

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effect of ZE syndrome on stomach

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 doubling of oxyntic mucosal thickness

 fivefold increase in the number of parietal cells

induces hyperplasia of mucous neck cells, mucin hyperproduction, and proliferation of endocrine
cells

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Gastrin

Tx of ZE syndrome

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• TX includes blockade of acid hypersecretion
 proton pump inhibitors
 high-dose H 2 histamine receptor antagonists
 Peptic ulcers to heal and prevents gastric perforation
 Allows treatment to focus on the gastrinoma, which becomes the main determinant of long-term survival

Gastrinoma: Grow slowly
• 60% to 90% are____
• 75% Gastrinoma is____ (40-50 yo)

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malignant

sporadic

solitary gastrinoma tumors can be:

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surgically resected
represent 75% of gastrinoma
seen in 40-50 yo

• 25% of gastrinomas are: Multiple endocrine neoplasia type I (MEN I) (20-30)
 Usually multiple tumors or metastatic disease and seen assoicated with what else?

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 “PPP” Pituitary Andenoma (<40y/o)

What may GAstrinomas respond to SST analogues

 Gastrinoma cells contain type 2 somatostatin receptors that bind somatostatin analogues (octreotide) with high affinity

• All patients with gastrinoma have an | elevated

gastrin level

Hypergastrinemia in the presence of | elevated acid production strongly suggests

gastrinoma

how must we rule out MEN1 if we suspect gastrinomas?

measure serum Ca and parathyroid hormone

Cells that stain with chromagranin are suggestive of:

hypergastrinemia( d/t increased gastrin secreation from chronic PPI use)

nodule or mass projecting above the mucosa and uncommon in stomach

Polyps

Majority of polyps are______(inflammatory or hyperplastic), most frequently associated with ______

non-neoplastic | chronic gastritis

proliferative gastric mucosa with acute and chronic inflammatory infiltrates in lamina propria, often multiple

Hyperplastic polyps

contains proliferative dysplastic epithelium, therefore potential for malignant transformation, usually single

Adenoma

What do we do to polpys?

remove them

majority of malignant gastric tumors are

Carcinomas(90-95%)... specifically adenocarcinomas

Leading world-wide cause of cancer death | • 2 nd most common tumor in the world

Gastric carcinoma | ***US has declined dramaticallY

Which type of gastric carcinoma? • Associated with defined risk factors • Develops from precursor lesions • 6 th decade, males>females

Intestinal

Which type of gastric carcinoma? • Relatively constant incidence with no known precursor lesion • 5 th decade, males=females

Diffuse

Risks: environmental for Gastric Carcinoma

• Diet  Nitrites (from nitrates in water, preserved food)  Smoked & salted food, pickled vegetables  Lack of fresh fruit & vegetables • Cigarette smoking • Low socioeconomic status • Infection by H. pylori

What cancer is H.pylori factor for?

intestinal type carcioma and MALToma

Shit about H.pylori

* H. pylori causes gastritis * Untreated gastritis is a risk factor for gastric cancer * Infection increases risk 5-6x * Prospective epidemiologic studies * Geographic and socioeconomic association

People with chronic gastritsi have what risk factors?

– Hypochlorhydria (favors H. pylori colonization) – Intestinal metaplasia: precursor lesion for CA – Setting for development of gastric adenomas

How are gastric adenomas correlated to risk for cancer in host?

• Gastric adenomas – 40% harbor carcinoma at time of diagnosis – 30% have adjacent carcinoma

How is Barretts a risk for gastric carcinioma?

• Barrett esophagus | – Increased incidence of cancer at GEJ

How do we determine prognosis of Gastric Carcinoma?

• Depth of invasion the most important factor, then lymph node involvement, metastasis; histology not as important

Prognosis of Gastric Carcinoma if found early and its confined

 If early (confined to mucosa, submucosa), 5-year survival 90-95%  good prognosis even with + local lymph nodes

Prognosos if carcinoma found later?

Advanced (into muscularis propria): <15% fiveyear survival

Comprehensive review (2) Flashcards

(47 cards)