Gastric pathology

Question 1

What are some of the causes of acute gastritis?

Answer 1

Chemical injury e.g. alcohol, medication
Shock
Trauma

Question 2

Why does shock or trauma cause acute gastritis?

Answer 2

Ischaemia

Question 3

What are some of the causes of chronic gastritis?

Answer 3

Autoimmune
Bacterial
Chemical

Question 4

In autoimmune gastritis, what are the host targets for antibodies?

Answer 4

Parietal cells

Intrinsic factor

Question 5

Why might autoimmune gastritis cause pernicious anaemia?

Answer 5

Attack on intrinsic factor which allows absorption of B12 - B12 deficiency is a form of anaemia

Question 6

What histological changes might occur in autoimmune chronic gastritis?

Answer 6

Loss of parietal cells
Fibrosis of lamina propria
Intestinal metaplasia in body of stomach

Question 7

Which is the most common type of chronic gastritis?

Answer 7

H. pylori associated chronic gastritis

Question 8

Describe H. pylori.

Answer 8

Gram negative curved rod

Question 9

What is the pathogenesis of H. pylori associated chronic gastritis?

Answer 9

H. pylori inhabit a niche between mucous barrier and epithelial surface
They excite an acute inflammatory response
If bacteria isn’t then cleared, a chronic active inflammation ensues

Question 10

Which inflammatory mediator is critical in the inflammatory response related to H. pylori associated chronic gastritis?

Answer 10

IL-8

Question 11

What further disease does H. pylori associated chronic gastritis predispose to?

Answer 11

Duodenal ulcer
Gastric ulcer
Gastric carcinoma
Gastric lymphoma

Question 12

What might cause chemical gastritis?

Answer 12

Alcohol
Bile reflux
NSAIDs

Question 13

What pathological changes might be seen in chemical gastritis?

Answer 13

Epithelial cell loss and marked epithelial regeneration
Hyperplasia
Congestion

Question 14

What is peptic ulceration?

Answer 14

A breach in the gastrointestinal mucosa as a result of acid and pepsin attack

Question 15

What are the major sites of peptic ulcer?

Answer 15

1st part of duodenum
Junction of antrum and body in stomach
Distal oesophagus

Question 16

Which part of the oesophagus are peptic ulcers most commonly found in?

Answer 16

The squamous-columnar junction

Question 17

What is the pathogenesis of peptic ulcer?

Answer 17

Increased acid secretion
H. pylori infection
Inflammation and epithelial damage
This leads to ulceration

Question 18

What is the microscopic appearance of a peptic ulcer?

Answer 18

Fibrous scar tissue, inflamed granulation tissue covered with necrotic tissue
The muscularis propria can be completely replaced with fibrous tissue

Question 19

What are some of the complications of peptic ulcer?

Answer 19

Perforation
Penetration
Haemorrhage
Stenosis
Pain

Question 20

What is the most common cancer of the stomach?

Answer 20

Adenocarcinoma

Question 21

Which two layers does tumour growth have to be confined to for it to be defined as “early” gastric cancer?

Answer 21

Mucosa

Submucosa

Question 22

Into which layer does a tumour have to grow to be defined as an “advanced” gastric cancer?

Answer 22

Into the muscularis propria

Then penetrates - subserosa, peritoneum, adjacent structures

Question 23

What has been identified as the most important environmental risk factor for gastric cancer?

Answer 23

H. pylori

Question 24

What is the pathogenesis from H. pylori infection to gastric cancer?

Answer 24

H. pylori infection
Chronic gastritis
Intestinal metaplasia/atrophy
Dysplasia
Carcinoma

Question 25

What are some of the other premalignant conditions in the pathogenesis of gastric adenocarcinoma?

Answer 25

Pernicious anaemia Partial gastrectomy Menetrier's disease

Question 26

What histological changes might you see in intestinal type gastric adenocarcinoma?

Answer 26

Gland formation | Tubular formations of cohesive cells

Question 27

What histological changes might you see in diffuse type gastric adenocarcinoma?

Answer 27

Scattered clusters of non-cohesive cells Signet ring cells Sclerosis

Question 28

Which gastic adenocarcinoma has the best prognosis: intestinal or diffuse type?

Answer 28

Intestinal type

Question 29

What is the name given to metastases of gastric carcinoma into the ovaries?

Answer 29

Kruckenberg tumours

Question 30

Where can gastric carcinomas spread?

Answer 30

Into other organs or peritoneal cavity and ovaries To lymph nodes To the liver

Question 31

Which lymph node, distant to the stomach, might be palpable in gastric cancer?

Answer 31

Virchow's node (left supraclavicular)

Question 32

Other than adenocarcinoma, which gastric malignancy is also related to H. pylori infection?

Answer 32

Lymphoma

Question 33

Where are gastric lymphoma derived from?

Answer 33

Mucosa associated lymphoid tissue (MALT)

Question 34

What is the pathogenesis of gastric lymphoma?

Answer 34

H. pylori infection (or other cause) provokes an influx of lymphocytes Continuous inflammation induces an evolution into a clonal B cell proliferation - low grade lymphoma If unchecked, develops into high grade B cell lymphoma

Question 35

What is the result of a low grade gastric lymphoma developing?

Answer 35

Lymphocytes attack the gastric epithelium

Question 36

What is gastroparesis?

Answer 36

Delayed/lack of gastric emptying with no physical obstruction Stomach paralysis

Question 37

What are some of the symptoms of gastroparesis?

Answer 37

``` Feeling of fullness Nausea Vomiting Weight loss Upper abdominal pain ```

Question 38

What are some of the causes of gastroparesis?

Answer 38

Idiopathic Diabetes mellitus Cannabis Medication e.g. opiates, anticholinergics Systemic diseases e.g. systemic sclerosis

Question 39

Which ulcers are more likely to perforate?

Answer 39

Duodenal ulcer