L13: Gastric Disorders

Question 1

what is Gastritis?

Answer 1

Inflammation of the gastric mucosa

Question 2

Dx of Gastritis

Answer 2

Diagnosis mostly histological

Question 3

Nature of Acute Gastritis

Answer 3

Acute mucosal inflammatory process usually of a transient nature.

Question 4

Nature of infiltration in Acute Gastritis

Answer 4

Neutrophilic infiltration

Question 5

Causes of Acute Gastritis

Answer 5

Question 6

Pathogenesis of Acute Gastritis

Answer 6

Question 7

Morphology of gastric mucosa in Acute Gastritis

Answer 7

Question 8

Def of Chronic Gastritis

Answer 8

• Presence of chronic mucosal inflammatory changes leading eventually to mucosal atrophy and intestinal metaplasia, usually in the absence of erosions

Question 9

Causes of Chronic Gastritis

Answer 9

Question 10

Pathogenesis of Chronic atrophic gastritis

Answer 10

Question 11

Pathogenesis of Autoimmune atrophic gastritis

Answer 11

Question 12

Morphology of Chronic Gastritis

Answer 12

Question 13

Def of Gastric Polyps

Answer 13

luminal lesions projecting above the plane of the mucosal surface.

Question 14

Main goal in managment of Gastric Polyps

Answer 14

• to rule out the possibility of malignancy

Various subtypes of gastric polyps are recognized and generally divided into:
- Non- neoplastic
- Neoplastic.

Question 15

epidemeology of Gastric Polyps

Answer 15

Question 16

Incidence of Gastric Polyps

Answer 16

1-3% of all gastroscopies

Question 17

Age of Gastric Polyps

Answer 17

2/3 Above age of 60 years.

Question 18

Frequency and type of gastric polyps vary depending on the population and location.

• H Pylori common & PPI less common →
• H Pylori less common & PPI common →

Answer 18

• Hyperplastic / adenoma > Fundic
• Fundic > Hyperplastic / adenoma

Question 19

• Fundic glands polyp common in the West.

Answer 19

..

Question 20

• Specific genetic mutations are responsible for polyp formation.

Answer 20

..

Question 21

BSG Classification of Gastric Polyps

Answer 21

Question 22

Benign epithelial gastric polyps BEGP

Answer 22

Question 23

Non-mucosal intramural polyps

Answer 23

Question 24

Types of Fundic Gland Polyps

Answer 24

sporadic or associated with polyposis
syndrome.

Question 25

Characters of Fundic Gland Polyps

Answer 25

Typically small (0.1 -0.8 cm), hyperemic, sessile, flat, nodular lesions that have a smooth surface contour

Question 26

Site of **Fundic Gland Polyps**

Answer 26

Exclusively in the gastric corpus. Can sometimes be large.

Question 27

ME of **Fundic Gland Polyps**

Answer 27

Composed of normal gastric corpus-type epithelium, arranged in a disorderly and/or microcystic configuration.

Question 28

Incidence of **Sporadic Fundic Gland Polyps**

Answer 28

Sporadic FGP: F>M, middle age, 40% multiple.

Question 29

Long Term Use of PPI & Fundic Gland Polyps

Answer 29

Long term PPI associate with 4x risk of FGP

Question 30

H.Pylori & **Fundic Gland Polyps**

Answer 30

H Pylori infection appears to protect the development of FGP

Question 31

**Fundic Gland Polyps** in FAP

Answer 31

Question 32

**Fundic Gland Polyps** in FAP - Gene Mutation

Answer 32

Mutation of the APC gene

Question 33

Incidnce of **Hyperplastic Polyps**

Answer 33

75 % of gastric polyps in areas where H. pylori is common.

Question 34

Shape of **Hyperplastic Polyps**

Answer 34

Small, dome-shaped, or stalked polyps (average size 1.0 cm), single or multiple.

Question 34

Site of **Hyperplastic Polyps**

Answer 34

Primarily in the antrum, but may develop in the fundus or cardia.

Question 35

Incidence of **Adenomatous Polyps**

Answer 35

- 6 to 10 % of gastric polyps.

Question 35

ME of **Hyperplastic Polyps**

Answer 35

elongated, dilated or cystic, architecturally distorted, foveolar epithelium within chronically inflamed lamina propria.

Question 36

Site of **Adenomatous Polyps**

Answer 36

Found in the antrum, some occur in the corpus and cardia.

Question 37

Shape of ****Adenomatous Polyps****

Answer 37

flat or polypoid

Question 38

Size of **Adenomatous Polyps**

Answer 38

Range in size from a few mm to several cm.

Question 39

ME of **Adenomatous Polyps**

Answer 39

similar to typical colonic adenomas: tubular, tubulovillous, or villous, are sessile or stalked, occasionally large sizes

Question 40

Incidence of **Hamartomatous Polyps**

Answer 40

Rare

Question 41

Types of **Hamartomatous Polyps**

Answer 41

1. Juvenile polyps 2. PJS: (peutz jeghers syndrome) 3. Cowden disease

Question 42

Juvenile polyps

Answer 42

solitary, antral, inflammatory or hamartomatous, no malignant potential.

Question 43

PJS

Answer 43

AD, hamartomatous Gl polyps, mucocutan. Pigmentation, increase risk of cancer.

Question 44

Cowden disease

Answer 44

AD, orocutaneous hamartomatous, extra Gl abnormalities.

Question 45

Malignant transformation in **Hamartomatous polyps**

Answer 45

rare

Question 46

Tumors in **Inflammatory Fibroid Polyps**

Answer 46

Vanek tumors.

Question 47

Incidence of **Inflammatory Fibroid Polyps**

Answer 47

Rare, 1% of all gastric polyps.

Question 48

Origin of **Inflammatory Fibroid Polyps**

Answer 48

Originate from submucosa, usually in antrum or peripyloric area.

Question 49

Characters of **Inflammatory Fibroid Polyps**

Answer 49

Central depression/ ulceration.

Question 50

Symptoms of **Inflammatory Fibroid Polyps**

Answer 50

Asymptomatic, can be present with bleeding or gastric outlet obstruction.

Question 51

Malignant transformation of **Inflammatory Fibroid Polyps**

Answer 51

No malignant potential but as with chronic atrophic gastritis.

Question 52

ME of **Inflammatory Fibroid Polyps**

Answer 52

Submucosal proliferation of spindle cells/small vessels with an inflammatory infiltrate with many eosinophils.