EXAM #1: PATHOLOGY OF THE STOMACH

Question 1

What is the definition of gastritis?

Answer 1

Acidic damage causing superficial inflammation of the gastric mucosa

Question 2

What is the underlying cause of acute gastritis?

Answer 2

Imbalance of mucosal defenses and acidic environment

Question 3

What are the three major mucosal defenses?

Answer 3

1) Mucin layer
2) Bicarbonate secretion
3) Normal blood supply

Normal blood supply delivers nutrients and removes acid*

Question 4

What wall layer does acute gastritis NOT penetrate through?

Answer 4

Muscularis mucosa

Question 5

What causes acute gastritis?

Answer 5

1) NSAIDs (esp Aspirin) b/c of decreased PGE2
2) Alcohol
3) Chemotherapy
4) Increased ICP–>vagal stimulation that increases acid production
5) Severe burns–>hypovolemia causing decreased blood flow
6) Shock–>decreased blood flow

Question 6

Describe the morphology of mild acute gastritis.

Answer 6

• Hyperemia and edema

- Neutrophils above BM

Question 7

Describe the morphology of severe acute gastritis.

Answer 7

Erosion of entire mucosal thickness and hemorrhage

Question 8

What are the clinical features of acute gastritis?

Answer 8

Hematemesis*
Melena

*Especially in alcoholics

Question 9

What is the definition of chronic gastritis? What does chronic gastritis lead to?

Answer 9

Chronic inflammatory changes of the gastric mucosa leading to:

• Mucosal atrophy
• Intestinal metaplasia

Question 10

What at patients with chronic gastritis at risk for?

Answer 10

Progression to gastric carcinoma

Question 11

What is the most common cause of Chronic Gastritis?

Answer 11

H. pylori

Question 12

What are the characteristics of H. pylori?

Answer 12

Gram negative
Bacillus
S-shaped

Question 13

Is H. pylori motile or non-motile?

Answer 13

Motile–contains a flagella

Question 14

What enzyme allows H. pylori to survive in the gastric mucosa?

Answer 14

Urease

Question 15

What allows H. pylori to bind to the epithelial surface of the stomach? What is the most common site of infection?

Answer 15

• Adhesins

- Antrum

Question 16

What factors associated with H. pylori induce the production of cytokines?

Answer 16

CagA
VacA

These are proinflammatory peptides associated with some strains of H. pylori

Question 17

There are divergent responses to H. pylori infection. When H. pylori causes disease, what is the most common outcome?

Answer 17

• Increased acid
• Increased gastrin

Leading to DUODENAL ULCER disease

Question 18

What is the less common scenario that occurs with H. pylori infection?

Answer 18

• Decreased acid
• Increased gastrin

Leading to a high risk of GASTRIC CARCINOMA

Question 19

What is autoimmune gastritis?

Answer 19

Gastritis that results from autoantibodies to parietal and IF cells

Question 20

What are the consequences of IF antibodies?

Answer 20

Pernicious anemia and megaloblastic anemia (B12 deficiency)

Question 21

What cancer are patients with autoimmune gastritis most at risk for?

Answer 21

Gastric carcinoma

Question 22

What does achlorhydia distinguish between?

Answer 22

Autoimmune gastritis can lead to achlorhydia, H. pylori does NOT

Question 23

Which primary cause of Chronic Gastritis can lead to Lymphoma and PUD?

Answer 23

H. pylori

Question 24

Which primary cause of Chronic Gastritis can lead to Endocrine tumors?

Answer 24

Autoimmune gastritis

Question 25

Structurally, what is the definition of an ulcer?

Answer 25

Involvement/ disruption of the muscularis mucosa

Question 26

What are is the classic presentation of a gastric ulcer?

Answer 26

Epigastric pain that is worse with eating

Question 27

How do you diagnose a gastric PUD?

Answer 27

1) Imaging 2) Endoscopy Note that you need endoscopy for gastric ulcer, but NOT duodenal--these are NEVER cancerous

Question 28

What is the most common cause of duodenal ulcers?

Answer 28

H. pylori (70%)

Question 29

What are the proinflammatory cytokines induced by H. pylori will activate and recruit neutrophils?

Answer 29

IL-8 ****Note that this is especially seen with CagA and VacA****

Question 30

How does H.pylori induced gastric acid secretion effect the duodenum?

Answer 30

Increased gastric acid secretion leads to decreases duodenal bicarbonate (protection)

Question 31

What is Zollinger-Ellison Syndrome?

Answer 31

Gastrinoma in the pancreas that drives HCl secretion in the stomach

Question 32

What is the worst complication of an ulcer?

Answer 32

Perforated ulcer leading to: 1) Peritonitis 2) Sepsis 3) Death

Question 33

Describe the morphology of a benign gastric ulcer. Where do these ulcers most commonly occur?

Answer 33

"Punched out" lesions along the Lesser Curvature (in the antrum)

Question 34

What are the characteristics of a malignant gastric ulcer?

Answer 34

Irregular with raised borders

Question 35

What is the major/ most common complication of PUD?

Answer 35

Bleeding

Question 36

What is a stress ulcer?

Answer 36

Multiple ulcers seen in the face of shock *Caused by decreased gastric blood flow

Question 37

What is the morphologic feature of stress ulcers?

Answer 37

Multiple small ulcers

Question 38

What is a Curling Ulcer?

Answer 38

Stress ulcer associated with extensive burns | Hypovolemia-->decreased blood flow

Question 39

What is a Cushing Ulcer?

Answer 39

Increased ICP leads to stress ulcer formation | ICP--> increased vagal stimulation-->increased ACh release-->increased acid secretion

Question 40

What is a Gastric Polyp?

Answer 40

Mass lesion in the stomach above the mucosa

Question 41

What are the two major types of Gastric Polyps?

Answer 41

1) Hyperplastic or inflammatory polyp | 2) Adenomatous polyps

Question 42

What is a gastric carcinoma? What stage is gastric carcinoma when it is typically found?

Answer 42

Malignant proliferation of gastric surface epithelial cells -->Late stage (poor prognosis)

Question 43

What are the two major types of Gastric Carcinoma?

Answer 43

1) Intestinal | 2) Diffuse

Question 44

Describe the morphology of an intestinal-type gastric carcinoma.

Answer 44

- Large - Irregular - Heaped-up margins

Question 45

Where are intestinal-type gastric carcinomas typically found?

Answer 45

Found in the antrum of the stomach along the lesser curvature

Question 46

What are the major risk factors for gastric carcinoma?

Answer 46

1) H. pylori 2) Autoimmune gastritis 3) Nitrosamines in smoked foods (Japan) 4) Blood type A

Question 47

Describe the morphology of a diffuse-type gastric carcinoma.

Answer 47

Signet ring cells that diffusely infiltrate the gastric wall

Question 48

What is linitis plastica?

Answer 48

Desmoplasia--fibrosis-- of the gastric wall in response to diffuse carcinoma that causes a THICKENING of the wall

Question 49

How does gastric carcinoma typically present?

Answer 49

Late with: - Weight loss - Abdominal pain - Anemia - Early satiety

Question 50

What is the prognosis for Gastric Carcinoma?

Answer 50

Poor--not found until late stage with less than 10% 5-year surivial

Question 51

What is a Virchow node?

Answer 51

Involvement of the sentinel supraclavicular node with cancer

Question 52

What is a Sister Mary Joseph nodule?

Answer 52

Gastric carcinoma to periumbilical area

Question 53

What is a Krukenburg Tumor?

Answer 53

Metastatic diffuse-type gastric carcinoma to the ovaries

Question 54

What is the Lymphoma associated with H. pylori infection?

Answer 54

MALToma

Question 55

How is MALToma treated?

Answer 55

Treat the underlying H. pylori infection

Question 56

What is a Gastrointestinal Stromal Tumor?

Answer 56

Neoplastic proliferation of mesenchymal cells i.e. "Cells of Cajal"

Question 57

What is a Carcinoid Tumor?

Answer 57

Neoplastic proliferation of gastric neuroendocrine cells

Question 58

What are GIST positive for?

Answer 58

c-KIT or CD117

Question 59

What drug can be used to treat GIST?

Answer 59

Imatinib i.e. tyrosine kinase inhibitors