GI Pathology I: Stomach Flashcards Preview

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Flashcards in GI Pathology I: Stomach Deck (43):
1

What cells are found in the fundus and the body of the stomach?

- Chief Cells
- Parietal Cells

2

Omphalocele

•Persistent herniation of bowel into umbilical cord
•Failure of abdominal wall to return to body cavity during development
•Covered by peritoneum and amnion of cord

3

Gastroschisis

•Malformation of abdominal wall causing exposure of abdominal contents

4

What is the main difference in the omphalocele and the gastroschisis?

Omphaloceles are partially protected so surgery can be delayed

5

Pyloric Stenosis

Congenital hypertrophy of smooth muscle of pylorus

6

What are the signs of pyloric stenosis?

• More common in males
• Causes projectile vomiting in first 2‐6 weeks of life
• Visible peristalsis
• Olive‐like mass in abdomen

7

What are some of the possible causes of gastritis?

- NSAID/Aspirin/Cigarettes/Alcohol can cause injury
- Ischemia/Shock/Delayed Emptying can impair defenses

8

What are the common causes of acute gastritis?

Impairment of protective system: NSAIDs, ingestion, direct injury

9

What is the common cause of chronic gastritis?

H. pylori infection

10

What is the gross finding of acute gastritis?

Hyperemic

11

What is the histologic finding of acute gastritis?

Infiltration of neutrophils and breakage of the mucosa

12

What are some of the risks of H. pylori infection?

– Poverty
– Household crowding
– Limited education
– African American or Mexican American ethnicity
– Poor sanitation
– Birth outside of US

13

Where is H. pylori infection of the stomach most often found in?

Antrum

14

What cancers does H. pylori increase the risk of?

- Gastric Adenocarcinoma
- MALT Lymphoma

15

What are the main treatment options for H. pylori?

Antibiotics with proton pump inhibitors
- Tripe and Quadruple Therapy
- Sequential Therapy

16

Autoimmune Chronic Gastritis

- Spare the antrum
- Ab are made against the parietal cells and intrinsic factor

17

What can autoimmune chronic gastritis lead to?

- Pernicious Anemia
- Gastric Adenocarcinoma
- Defective Acid Secretion

18

63‐year‐old male with occasional nausea and upper abdominal pain undergoes upper endoscopy. Biopsy shows chronic gastritis of the fundus with flattened mucosa and no ulceration. Which of the following is most likely to be associated with this finding?

A. Hyperchlorhydria
B. Infection with H. pylori
C. Diet high in nitrates
D. Elevated gastrin levels
E. Autoantibodies to parietal cells

E. Autoantibodies to parietal cells

19

What are stress ulcers associated with?

• Stress ulcers: shock, sepsis, severe trauma

20

What are Curling ulcers associated with?

• Curling ulcers: severe burns, trauma

21

What are Cushing ulcers associated with?

• Cushing ulcers: intracranial disease

22

What are the most common causes of chronic peptic ulcer disease?

- H. pylori
- NSAIDs

23

Where are chronic peptic ulcers most often found?

- Proximal Duodenum
- Antrum

24

How does food affect duodenal ulcers?

• Food Decreases pain with Duodenal ulcers

25

How does food affect gastric ulcers?

• Pain becomes Greater with Gastric ulcers

26

What are the mechanisms used to diagnose H. pylori?

• Biopsy
• Serologic testing for H pylori antibodies
• Fecal detection
• Urea breath test

27

What are some risk factors for chronic peptic ulcer disease?

– NSAIDs
– Cigarette smoking
– High‐dose corticosteroids
– Alcoholic cirrhosis
– COPD
– Chronic renal failure
– Hyperparathyroidism
– Psychologic stress

28

40‐year‐old female with obesity and diabetes mellitus presents to her doctor with 2 months of intermittent RUQ abdominal pain associated with food, most notably after eating fatty foods. What is the most likely diagnosis?

A. Biliary colic from gallstones
B. Acute gastritis
C. Gastroesophageal reflux disease (GERD)
D. Autoimmunegastritis

A. Biliary colic from gallstones

29

Gastric Polyp

Nodule or mass that projects above the level of the surrounding mucosa and forms due to hyperplasia, inflammation, ectopia or neoplasia.

30

Where do extra nodal lymphomas occur most commonly?

Extra nodal lymphomas occur most commonly in GI tract, especially stomach.

31

What is the origin of gastric carcinoid tumors?

Arise from neuroendocrine organs – G‐cells in stomach - with 40% found in the small intestine

32

Gastrointestinal stromal tumor

GIST are a mesenchymal neoplasm of interstitial cells of Cajal: pacemaker cells for gut peristalsis. Solitary, well‐circumscribed, fleshy, submucosal mass.

33

What population is GIST more prevalent in?

Males

34

What is the treatment for GIST?

• Surgical resection if possible
• Imatinib is a drug that inhibits tyrosine kinase activity of c‐KIT and PDGRFA

35

What are the types of Gastric Adenocarcinoma?

- Intestinal
- Diffuse

36

Intestinal Gastric Adenocarcinoma

Bulky, have glandular structures, exophytic mass or
ulcerated tumor

37

Diffuse Gastric Adenocarcinoma

Infiltrative growth, discohesive cells with large mucin vacuoles􏰀 with signet ring cells

38

What is the main mutation in diffuse adenocarcinoma?

E-cadherin mutations can lead to cell movement - diffuse

39

What is the main mutation in intestinal adenocarcinoma?

APC mutation which regulates cell growth - intestinal

40

What are some of the metastases of gastric adenocarcinoma?

• Left supraclavicular node: Virchow node
• Distant metastases often liver

41

What is the metastasis of diffuse adenocarcinoma?

Bilateral ovaries: Krukenberg tumor

42

What is the metastasis of intestinal adenocarcinoma?

Periumbilical region: Sister Mary Joseph nodule

43

56y female presents with abdominal fullness, nausea and weight loss worsening over 2 months. CT abdomen/pelvis shows thickening of her stomach and bilateral ovarian masses.
What would be expected on the ovarian biopsies?
A. Squamous cell cancer
B. Mucinous adenocarcinoma
C. Signet ring cells
D. Leiomyosarcoma

C. Signet ring cells

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