Flashcards in *Oesophageal and Stomach disorders 3 (lectures 5 and 6) Deck (51)
What are the 3 main groups of inflammatory disorders of the stomach?
What are the causes of acute gastritis?
Irritant chemical injury
What are the causes of chronic gastritis?
Bacterial (H pylori)
Rare causes of gastritis? (3)
What antibodies are related to autoimmune chronic gastritis?
Anti-parietal and anti-intrinsic factor antibodies
What will be seen on biopsy of autoimmune chronic gastritis?
Atrophy and intestinal metaplasia in body of the stomach
What type of anaemia will patients with autoimmune chronic gastritis have?
Pernicious anaemia (due to B12 deficiency)
Do patients with autoimmune chronic gastritis have an increased risk of malignancy?
What conditions do patients with autoimmune gastritis also have?
Pernicious anaemia (B12 deficiency)
Often neurological symptoms
What is the most common type of chronic gastritis?
H. pylori associated chronic gastritis
How does H. pylori cause chronic gastritis?
It inhabits a niche between the epithelial cell surface and mucous barrier
If not cleared then a chronic active inflammation ensues
IL-8 is critical to this
What produces the anti-H pylori antibodies?
Lamina propria plasma cells
What causes chemical chronic gastritis?
These cause direct injury to mucus layer
What would be seen on biology of chemical chronic gastritis?
Marked epithelial regeneration, hyperplasia, contestation and little inflammation
(may produce congestion and little inflammation)
How does increased acid secretion lead to duodenal ulcers?
Excess acid in duodenum produces gastric metaplasia and leads to H. pylori infection, inflammation, epithelial damage and ulceration
Why are you more likely to get ulcers in the duodenum compared with the stomach?
The duodenum is built for absorption, not protection like the stomach
What 2 factors are important in the development of chronic peptic ulcers?
Increased acid production
Failure of mucosal defence
Edges of peptic ulcers?
Clear cut - punched out
Wha are the microscopic layers of a peptic ulcer?
Floor of necrotic fibrinopurulent debris
Base of inflamed granulation tissue
Deepest layer is fibrotic scar tissue
What type of cancers occur in the stomach?
Gastrointestinal stromal tumours
What are 4 other premalignant conditions of the stomach, other than H pylori?
HNPCC/ lynch syndrome
Menetrier's disease (large folds in stomach)
What are the 2 subtypes of gastric adenocarcinoma?
Intestinal type - exophytic/ polypoid mass (easier to treat)
Diffuse type - expands/ infiltrates stomach wall
15% are mixed
Are gastric ulcers potentially malignant?
What is a Kruckenberg tumour?
malignancy in the ovary that metastasized from a primary site, classically the gastrointestinal tract, although it can arise in other tissues such as the breast. Gastric adenocarcinoma, especially at the pylorus, is the most common source
What type of gastric lymphoma do patients get?
Mucosa associated lymphoid tissue (MALT)
What is MALT gastric lymphoma associated with?
H pylori - continuous inflammation induces an evolution into a clonal B-cell proliferation
What happens if you treat H pylori in patients with MALT?
It regresses 95% of the time
What are the most common causes of upper GI bleeding?
What is the most important initial treatment of a patient with an upper GI bleed?
Resuscitation (A, B, C) - O2, IV access, fluids