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Flashcards in Gastro 2 Deck (17)
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1

Stomach: Acute gastritis

Caused by nonsteroidal anti-inflammatory drugs, heavy alcohol consumption, excessive acid secretion, infection and other systemic diseases that predispose to a breakdown of the protective mucous layer
Epithelial layer is intact, but scattered neutrophils above the basement membrane indicate acute gastritis
Pts present with pain, nausea, vomiting, hematemesis (vomiting blood)
can produce peptic ulcer

2

Stomach: Chronic gastritis

Ongoing inflammatory damage to epithelial cells, but stomach linine is intact
Pts present with pain, some vomiting, rare hematemesis
Most common cause is chronic bacterial infection by H. pylori

3

Chronic Gastritis: H. pylori

H. pylori initiates a chronic immunoreaction resulting in formation of lymphoid aggregates with germinal centers called mucosa-associated lymphoid tissue (MALT) in the gastric mucosa of the antrum
Increased risk for peptic ulcers (erosion or ulceration of stomach lining)

4

lesion on the skin or mucosal surface caused by superficial loss of tissue and usually accompanied by inflammation

Ulcer

5

arises from NSAID or H. pylori infection so that chronic gastritis is a risk factor

Peptic ulcer disease (PUD)

6

Peptic Ulcer

Caused by gastric hyperacidity
PUD most commonly occurs in the gastric antrum & first portion of the duodenum
Pts present with pain 1-3 hours after eating, worse at night, relieved by food or alkali
Nausea, vomiting, bloating & belching may occur
Males> females, middle-aged – older adults, 5000 deaths annually, 3 million pts treated annually
Typically managed by reducing acid secretion or antibiotics

7

Some patients with intractable peptic ulcers have ________, which results from the abnormal secretion of the hormone gastrin by tumors

Zollinger-Ellison syndrome

8

Stomach Polyps

Hyperplastic & inflammatory polyps account for 75% of stomach polyps
Fundic gland polyps correspond to dilation of fundic glands (benign & common in patients with familial polyposis (FAP))
Gastric adenomas (polyps) can be precursors of adenocarcinoma. (Usually located in the antrum)

9

Gastric Adenocarcinoma

Adenocarcinomas account for >90% gastric cancers
Early symptoms include dyspepsia, dysphagia, nausea
Pts at later stages present with weight loss, anorexia, altered bowel habits, anemia, hemorrhage
Gastric adenocarcinomas classified as intestinal & diffuse.

10

Stomach adenocarcinoma: Intestinal type

Intestinal gastric adenocarcinoma characterized by bulky tumors, composed of glandular elements resembling colon where glandular elements secrete intestinal type mucin
Intestinal type adenocarcinoma develops following intestinal mucosal metaplasia

11

Besides H. pylori infections, germline mutations in _______ associated with β-catenin alterations in FAP are at risk for intestinal type gastric cancer

APC gene

12

Stomach adenocarcinoma: Diffuse type

Diffuse gastric adenocarcinoma thickens the gastric wall without forming a discrete mass lesion
Infiltrative growth pattern composed of discohesive cells
Diffuse infiltration by tumor cells produces the "leather bottle" appearance of the stomach referred to as linitis plastica
Characterized by signet ring cells, which contain large mucin droplets & indent their nucleus

13

Mechanical obstructions of the intestine include

hernias, adhesions, volvulus, intussusceptions (infolding)

14

Intestinal Obstruction: Hirschsprung disease

Symptoms appear immediately after birth with failure to clear meconium & with subsequent constipation
Further consequences include enterocolitis, electrolyte imbalance & potential intestinal perforations
Hirschsprung's disease is a congenital abnormality of the intrinsic nervous system due to aganglionosis in the distal colon/rectum
Arises as a congenital colonic innervation defect

15

luminal outpouchings of the intestinal tract

Diverticula

16

Large Intestine: Diverticulosis

-congenital or acquired
-Acquired diverticulosis occurs in patients with chronic constipation because increased intraluminal pressure from straining to defecate causes focal luminal herniation
-Overgrowth of bacteria in diverticula and luminal blockage by fecal material can result in acute diverticulitis, which can progress to abscess formation and peritonitis
-Chronic diverticulitis results in fibrosis and stenosis of the large intestinal lumen

17

Small & Large intestine: Ischemic colitis

-Obstruction of intestinal arteries results in segmental intestinal ischemia or infarction
-Mucosal ischemia can result in GI hemorrhage with mucosal ulceration
-Ischemic colitis typified by "withering" of crypts & necrosis
-Prolonged or severe ischemia results in transmural necrosis, which usually is fatal
-Systemic hypotension can result in ischemia