GI Part 2: Stomach

Question 1

What are the 4 layers of the GI tract?

Answer 1

Mucosa
Submucosal
Muscularis propria/muscularis externa
Muscularis advanticia

Question 2

What are the 3 layers of the stomach?

Answer 2

Innercircular
Myenteric plexus (Arbach’s)
Outer longitudinal

Question 3

What cells is the GI tract made of?

Answer 3

Simple columnar epithelium except for the esophagus and anus which are made of stratified squamous non-keratinized epithelium

Question 4

Pathological condition where there is extereme concentric hypertrophy of circular layer of smooth muscle in muscularis propria of pylorus causes narrowing of the pyloric canal and then to obstruction of stomach outlet = projectile vomiting (presents in first 2 weeks of life), palpable pyloric mass, visible peristalsis. Tx is surgical excision of the herpertrophied muscle.

Answer 4

Congenital Hypertorphic Pyloric Stenosis

Question 5

Gastritis related to:
-Exogenous irritants (aspirin, NSAIDs, -ETOH, smoking,Ingestion of corrosives)
-Stress ulcers (trauma, surgery)
-Hyper excretion of gastric acid
-Surface irritation from spicy foods
Causing acute inflammation of mucosa, mucosal erosion (sloughing of epithelium, punch out ulcers, widespread petechial hemorrhages). Sx include epigastric pn, nausea, vomiting and may be complicated by massive hemorrhage or perforation leading to hemoperitoneum or peritonitis.

Answer 5

Acute erosive hemorrhagic gastritis

Question 6

What are the two possible causes of chronic gastritis?

Answer 6

Autoimmune gastritis

Infection with Helicobacter pylori

Question 7

What is the most common and important cause of gastritis in the USA?

Answer 7

Infection with Heliobacter pylori

Question 8

What would your see microscopically with chronic gastritis?

Answer 8

Chronic inflammatory cells: lymphocytes and plasma cells
And
MALT
Mucosa associated lymphoid tissue

Question 9

Type of gastritis in which there is a presence of antibodies to the parietal cells and intrinsic factor; involves fundus and body of stomach

Answer 9

Chronic autoimmune gastritis

Question 10

What does NSAIDs stand for?

Answer 10

Non-steroidal anti-inflammatory drugs

Question 11

Heliobactor pylori is what type of bacteria?

Answer 11

Gram negative bacillicus

Question 12

Plays an important role in peptic ulceration, increases the risk of cancer by 5 times, causes chronic inflammation, and is the most common and important cause of gastritis in the USA.

Answer 12

Helicobacter pylori

Question 13

Pathology which includes:

Loss of gastric glands

Metaplasia of epithelium into intestinal type with goblet cells

Dysplasia

Answer 13

Chronic atrophic gastritis

Question 14

Pathology which includes:

Infiltration of the mucosa by chronic inflammatory cels

Degeneration of the epithelium of gastric glands; marked reduction in their number (atrophic gastritis)

Intestinal metaplasia, gastric epithelium is replaced by intestinal type

Dysplasia: cytological alterations leading to increased incidence of gastric cancer

Answer 14

Chronic Gastritis

Question 15

Mucosal ulceration start extend through the epithelial layer into the submucosal or deeper in stomach and duodenum (more often in duodenum than stomach). Caused by an imbalance in HCL and pepsin (parietal cells vs. chief cells) secretion and the mucosal defense mechanism. Associated with parasympathetic stimulation and stress

Answer 15

Peptic ulcers

Question 16

What protects against peptic ulcers?

Answer 16

Mucus secretion

HCO3 secretion

Rich mucosal blood flow sustains the high regenerative activity

Mucosal release of prostaglandin and maintains mucosal blood supply and bicarbonates

Secretion of acid-pepsin in jets through mucous coat

Question 17

What are the two aggressive factors/primary underlying causes of peptic ulcer disease?

Answer 17

Helicobacter pylori and NSAID use

Question 18

Disease with gastrinomas in pancreas (1), lymphnodes around pancreas or duodenum leading to the secretion of gastrin(2), leading to increased acid, leading to peptic ulcers (3) and diarrhea. Tumors tend to metastasize to lymphnodes or liver. Can affect those 20-50 years. Associated with multiple endocrine neoplasia

Answer 18

Zollinger-Ellison Syndrome

Question 19

What would you see microscopically with Zollinger-Ellison syndrome?

Answer 19

Necrotic tissue on floor of ulcer

Inflammatory infiltrate

Gastrulation tissue for healing layer

Fibrous tissue at base of ulcer