Flashcards in *Oesophageal and Stomach disorders 3 (lectures 5 and 6) Deck (51)
Loading flashcards...
1
What are the 3 main groups of inflammatory disorders of the stomach?
Acute gastritis
Chronic gastritis
Rare
2
What are the causes of acute gastritis?
Irritant chemical injury
Severe bruns
Shock
Severe trauma
Head injury
3
What are the causes of chronic gastritis?
Autoimmune
Bacterial (H pylori)
Chemical
4
Rare causes of gastritis? (3)
Lymphocytic
Eosinophilic
Granulomatous
5
What antibodies are related to autoimmune chronic gastritis?
Anti-parietal and anti-intrinsic factor antibodies
6
What will be seen on biopsy of autoimmune chronic gastritis?
Atrophy and intestinal metaplasia in body of the stomach
7
What type of anaemia will patients with autoimmune chronic gastritis have?
Pernicious anaemia (due to B12 deficiency)
8
Do patients with autoimmune chronic gastritis have an increased risk of malignancy?
Yes
9
What conditions do patients with autoimmune gastritis also have?
Pernicious anaemia (B12 deficiency)
Often neurological symptoms
10
What is the most common type of chronic gastritis?
H. pylori associated chronic gastritis
11
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
12
What produces the anti-H pylori antibodies?
Lamina propria plasma cells
13
What causes chemical chronic gastritis?
NSAIDs
Alcohol
Bile reflux
These cause direct injury to mucus layer
14
What would be seen on biology of chemical chronic gastritis?
Marked epithelial regeneration, hyperplasia, contestation and little inflammation
(may produce congestion and little inflammation)
15
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
16
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
17
What 2 factors are important in the development of chronic peptic ulcers?
Increased acid production
Failure of mucosal defence
18
Edges of peptic ulcers?
Clear cut - punched out
19
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
20
What type of cancers occur in the stomach?
Carcinomas (adencarcinoma)
Lymphomas
Gastrointestinal stromal tumours
21
What are 4 other premalignant conditions of the stomach, other than H pylori?
pernicious anaemia
Partial gastrectomy
HNPCC/ lynch syndrome
Menetrier's disease (large folds in stomach)
22
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
23
Are gastric ulcers potentially malignant?
Yes
24
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.[1] Gastric adenocarcinoma, especially at the pylorus, is the most common source
25
What type of gastric lymphoma do patients get?
Mucosa associated lymphoid tissue (MALT)
26
What is MALT gastric lymphoma associated with?
H pylori - continuous inflammation induces an evolution into a clonal B-cell proliferation
27
What happens if you treat H pylori in patients with MALT?
It regresses 95% of the time
28
What are the most common causes of upper GI bleeding?
Duodenal ucer
Gastric erosions
Gastric ulcer
Varices
Mallory-weiss tear
oesophagitis
erosive duodenitis
Neoplasm
Stomal ulcer
Oesophageal ulcer
29
What is the most important initial treatment of a patient with an upper GI bleed?
Resuscitation (A, B, C) - O2, IV access, fluids
Prompt endoscopy
30
