Gastritis and Peptic Ulcers

Question 1

what is gastritis?

Answer 1

inflammation of the gastric mucosa

Question 2

what is chronic gastritis?

Answer 2

the presence of chronic inflammatory changes leading eventually to mucosal atrophy and epithelial metaplasia

Question 3

3 types of chronic gastritis

Answer 3

• helicobacter associated
• autoimmune
• chemical

Question 4

causes of chronic gastritis

Answer 4

• chronic infection
• immunologic
• toxic: alcohol and tobacco use
• postsurgical: postantrectomy with bile reflux
• motor/mechanical: obstruction/atony
• others: radiation, Crohn’s disease, GVHD, uraemia, amyloidosis

Question 5

which are the modifying features of chronic gastritis?

Answer 5

• activity (intraepithelial neutrophils)
• regenerative change
• variable glandular atrophy
• intestinal metaplasia +/- dysplasia
• presence of H.pylori

Question 6

what happens in helicobacter-associated gastritis?

Answer 6

• colonisation of h.pylori
• epithelial damage and a mixed acute and chronic inflammatory infiltrate
• pyloric antrum most severely affected but also fundus and usually patchy

Question 7

what is autoimmune chronic gastritis associated with, as in conditions?

Answer 7

pernicious anaemia

Question 8

which antibodies are associated with autoimmune chronic gastritis?

Answer 8

• gastric parietal cells

- intrinsic factor

Question 9

what type of damage happens in autoimmune chronic gastritis?

Answer 9

• reduced gastric acid production

- failure to absorb vitamin B12

Question 10

what can trigger reactive gastropathy?

Answer 10

• bile reflux
• previous surgery to the pylorus
• NSAIDs/alcohol abuse

Question 11

which part of the stomach is damaged in reactive gastropathy?

Answer 11

toxic damage to mucus layer

Question 12

what can accompany acute gastritis?

Answer 12

• mucosal haemorrhage

- erosion

Question 13

what is associated with acute gastritis?

Answer 13

• heavy use of NSAIDs, mainly aspirin
• excessive alcohol consumption
• heavy smoking
• chemotherapy
• uraemia
• systemic infections
• severe physical stress

Question 14

what are ulcers?

Answer 14

a breach in the mucosa of the alimentary tract, which extends through the muscularis mucosa into the submucosa or deeper

Question 15

sites of peptic ulcer

Answer 15

• duodenum 1
• gastric antrum
• barrett’s mucosa
• margins of gastroenterostomy
• Zollinger-Elison syndrome: duodenum, stomach, jejunum
• within or next to a Meckel’s diverticulum

Question 16

clinical presentation of peptic ulcer

Answer 16

• epigastric burning or aching pain
• pain worse at night and 1-3hrs after a meal
• nausea, vomitng, bloating, belching, weight loss

Question 17

complications of peptic ulcer

Answer 17

• anaemia
• haemorrhage
• perforation
• obstruction
• malignant formation

Question 18

what imbalance is there to cause peptic ulcers?

Answer 18

gastro-duodenal mucosal defense mechanisms and damaging forces of gastric acid and pepsin, combined with superimposed injury from environmental or immunological agents

Question 19

what are the associated disease of peptic ulcers?

Answer 19

• cirrhosis
• chronic renal failure
• zollinger elison syndrome
• hyperparathyroidism
• chronic lung disease
• chronic pancreatitis

Question 20

morphology of peptic ulcers

Answer 20

• single, sharply out defect
• overhanging mucosal borders
• smooth and clear ulcer base

Question 21

four layers of peptic ulcers

Answer 21

• thin superficial layer of necrotic debris
• zone of inflammation
• layer of granulation tissue
• fibrous tissue or scarring

Question 22

complications of peptic ulcers

Answer 22

• anaemia
• haemorrhage
• penetration (into adjacent organs)
• perforation (leads to peritonitis)
• pyloric obstruction (oedema and scarring in pyloric channel)
• malignant transformation