EXAM #1: PATHOLOGY OF THE STOMACH Flashcards Preview

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Flashcards in EXAM #1: PATHOLOGY OF THE STOMACH Deck (59):
1

What is the definition of gastritis?

Acidic damage causing superficial inflammation of the gastric mucosa

2

What is the underlying cause of acute gastritis?

Imbalance of mucosal defenses and acidic environment

3

What are the three major mucosal defenses?

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

****Normal blood supply delivers nutrients and removes acid*****

4

What wall layer does acute gastritis NOT penetrate through?

Muscularis mucosa

5

What causes acute gastritis?

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

6

Describe the morphology of mild acute gastritis.

- Hyperemia and edema
- Neutrophils above BM

7

Describe the morphology of severe acute gastritis.

Erosion of entire mucosal thickness and hemorrhage

8

What are the clinical features of acute gastritis?

Hematemesis*
Melena

*Especially in alcoholics

9

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

Chronic inflammatory changes of the gastric mucosa leading to:
- Mucosal atrophy
- Intestinal metaplasia

10

What at patients with chronic gastritis at risk for?

Progression to gastric carcinoma

11

What is the most common cause of Chronic Gastritis?

H. pylori

12

What are the characteristics of H. pylori?

Gram negative
Bacillus
S-shaped

13

Is H. pylori motile or non-motile?

Motile--contains a flagella

14

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

Urease

15

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

- Adhesins
- Antrum

16

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

CagA
VacA

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

17

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

- Increased acid
- Increased gastrin

Leading to DUODENAL ULCER disease

18

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

- Decreased acid
- Increased gastrin

Leading to a high risk of GASTRIC CARCINOMA

19

What is autoimmune gastritis?

Gastritis that results from autoantibodies to parietal and IF cells

20

What are the consequences of IF antibodies?

Pernicious anemia and megaloblastic anemia (B12 deficiency)

21

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

Gastric carcinoma

22

What does achlorhydia distinguish between?

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

23

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

H. pylori

24

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

Autoimmune gastritis

25

Structurally, what is the definition of an ulcer?

Involvement/ disruption of the muscularis mucosa

26

What are is the classic presentation of a gastric ulcer?

Epigastric pain that is worse with eating

27

How do you diagnose a gastric PUD?

1) Imaging
2) Endoscopy

Note that you need endoscopy for gastric ulcer, but NOT duodenal--these are NEVER cancerous

28

What is the most common cause of duodenal ulcers?

H. pylori (70%)

29

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

IL-8

****Note that this is especially seen with CagA and VacA****

30

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

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

31

What is Zollinger-Ellison Syndrome?

Gastrinoma in the pancreas that drives HCl secretion in the stomach

32

What is the worst complication of an ulcer?

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

33

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

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

34

What are the characteristics of a malignant gastric ulcer?

Irregular with raised borders

35

What is the major/ most common complication of PUD?

Bleeding

36

What is a stress ulcer?

Multiple ulcers seen in the face of shock

*Caused by decreased gastric blood flow

37

What is the morphologic feature of stress ulcers?

Multiple small ulcers

38

What is a Curling Ulcer?

Stress ulcer associated with extensive burns

(Hypovolemia-->decreased blood flow)

39

What is a Cushing Ulcer?

Increased ICP leads to stress ulcer formation

(ICP--> increased vagal stimulation-->increased ACh release-->increased acid secretion)

40

What is a Gastric Polyp?

Mass lesion in the stomach above the mucosa

41

What are the two major types of Gastric Polyps?

1) Hyperplastic or inflammatory polyp
2) Adenomatous polyps

42

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

Malignant proliferation of gastric surface epithelial cells

-->Late stage (poor prognosis)

43

What are the two major types of Gastric Carcinoma?

1) Intestinal
2) Diffuse

44

Describe the morphology of an intestinal-type gastric carcinoma.

- Large
- Irregular
- Heaped-up margins

45

Where are intestinal-type gastric carcinomas typically found?

Found in the antrum of the stomach along the lesser curvature

46

What are the major risk factors for gastric carcinoma?

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

47

Describe the morphology of a diffuse-type gastric carcinoma.

Signet ring cells that diffusely infiltrate the gastric wall

48

What is linitis plastica?

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

49

How does gastric carcinoma typically present?

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

50

What is the prognosis for Gastric Carcinoma?

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

51

What is a Virchow node?

Involvement of the sentinel supraclavicular node with cancer

52

What is a Sister Mary Joseph nodule?

Gastric carcinoma to periumbilical area

53

What is a Krukenburg Tumor?

Metastatic diffuse-type gastric carcinoma to the ovaries

54

What is the Lymphoma associated with H. pylori infection?

MALToma

55

How is MALToma treated?

Treat the underlying H. pylori infection

56

What is a Gastrointestinal Stromal Tumor?

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

57

What is a Carcinoid Tumor?

Neoplastic proliferation of gastric neuroendocrine cells

58

What are GIST positive for?

c-KIT or CD117

59

What drug can be used to treat GIST?

Imatinib i.e. tyrosine kinase inhibitors