Flashcards in Path slide set 2 Deck (356):
Do NOT express CD5 or CD10 but DO express CD43
pain on swalowing
PUD within gastric FUNDUS or BODY, is usually accompanied by what
lesser acid secretion as a result of mucosal atrophy
what bacteria has some serotypes that decrease risk of esophageal adenocarcinoma
Patients with GAVE may present with what
occult fecal blood or iron deficiency anemia
Eosinophilic gastritis can also occur in association with immune disorders such as what?
-H. pylori infection
Describe the pathogenesis of autoimmune gastritis
-loss of parietal cells responsible for gastric acid intrinsic factor
-no acid --> more gastrin release (hypergastrinemia and hyperplasia of antral G cells)
-no intrinsic factor ->no ileal vitamin absorption (B12 deficiency and megaloblastic anemia (pernicious))
-no serum pepsinogen I from chief cell destruction
The clinical presentation of autoimmune gastitis may be linked to symptoms of
In the US, H. pylori infection is associated with what
-African or Mexican Americans
-residence in rural areas
-birth outside the US
which type of gastric adenocarcinoma is early satiety a symptom of
erosion denotes loss of what
epithelium resulting in a superficial mucosal defect
What represent an induced form of MALT, that has potential to transform into lymphoma in H. pylori gastritis
lymphoid aggregates, some with germinal centers
what genetic diseases confer increased risk of congenital hypertrophic pyloric stenosis
Turner and trisomy 18
Autoimmune gastritis is characterized by what
diffuse mucosal damage of the oxyntic (acid producing) mucosa within the body and fundus
Submucosal glands are most abundant in proximal and distal esophagus, contibute to mucosal protection by secreting what?
mucin and bicarbonate
idipathic ledge-like protrusions of mucosa that may causes obstruction of esophagus
-nonprogressive dysphagia associated with incompletely chewed food
Esophageal mucosal Webs
Variceal hemorrhage is an emergency that can be treated medically how?
by inducing splanchnic vasoconstriction or endoscopically by sclerotherapy (injection of thrombotic agents), balloon tamponade, or variceal ligation
Pseudomembranes composed of densely matted fungal hypae
Stress related mucosal disease occurs in what patients?
-serious medical disease
GIST composed of elongated cells
Spindle cell type
characterized by intestinal metaplasia within the esophageal squamous mucosa
what type of ulcer?
-rounded and less than 1 cm
-base stained brown to black
-anywhere in stomach and often multiple
-Absent scarring and blood vessel thickenings
Acute stress ulcer
Race and gender for esophageal adenocarcinoma
-most frequent in caucasians
-strong gender bias. . .7X more males
blood to upper 1/3 of esophagus
inferior thyroid A.
The cardia and antrum are lines mainly with what?
mucin-secreting foveolar cells that form small glands
Barrett esophagus can only be identified through what?
endoscopy and biopsy
3 forms of esophageal dysmotility
-Diffuse esophageal spasm
Gastric carcinoid tumors may be associated with what?
-endocrine cell hyperplasia
-autoimmune chronic atrophic gastritis
-and Zollinger-Ellison syndrome
when does congenital hypertrophic pyloric stenosis present?
presents as what?
between third and sixth weeks
regurgitation, projectile, NONBILIOUS vomiting after feeding, and frequent demands for re-feeding
most common age for GERD
symptoms with esophageal adenocarcinoma
-pain or difficultly swallowing
-progressive weight loss
Time for pain in peptic ulcer
1 to 3 hours after meals during the day and worse at night (bt 11 pm and 2 am)
in the stomach, MALT is induced by what
chronic gastritis from H. pylori
most common cause of diffused atrophic gastritis
Benign tumors of the esophagus are generally what?
mesenchymal, smooth muscle . . leiomyomas most common
Ulcers occurring in proximal duodenum and associated with severe burns or trauma
exuberant reactive epithelial proliferation associated with entrapment of epithelial-lined cysts
Meckel diverticulum occurs where?
carcinoid tumors that produce gastrin may cause waht
Zollinger Ellison syndrome
Rash distribution for eosinophilic esophagitis in adults
What are some diagnostic tests for H. pylori in addition to histologic identification
-noninvasive serologic test for antibodies to H. pylori
-fecal bacterial detection
-urea breath test . . generation of ammonia by bacterial urease
Prognosis of a GIST correlates with what
What is the Virulent toxin produced by H. pylori that may be involved in disease progression
submucosal artery that does not branch properly within the wall of the stomach . . diameter 10 times the size of mucosal capillaries
type of gastric adenocarcinoma that tends to form bulky masses
What mutation of breast cancer patients causes increased risk for diffuse gastric cancer
Gender for hirschsprung
When females involved the segment is longer
Narrowing of the esophageal lumen generally caused by fibrous thickening of submucosa and associated with atrophy of the muscularis propria as well as secondary epithelial damage
benign esophageal stenosis
majority of individuals with eosinophilic esophagitis are ___
Blood to lower 1/3 of esophagus
left Gastric A.
uncommon diseases characterized by giant "cerebriform" enlargement of the rugal folds due to epithelial hyperplasia without inflammation
mucosal lining of meckel diverticulaum may resemble that of normal small intestine but what ectopic tissue may be present and what may it secrete
-gastric . . may secrete acid causing a peptic ulceration
length of esophagus
type of gastric adenocarcinoma that infiltrates the wall diffusely, thickens it, and is typically composed of SIGNET RING CELLS
neuropathic changes in autoimmune gastritis
Any gastritis that contains well-formed granulomas or aggregates of epitheloid macrophages
large Zenker diverticulum may produce what symptoms
regurgitation and halitosis
cutaneous flushing, sweating, bronchospasm, colicky abdominal pain, diarrhea, and right sided cardiac valvular fibrosis
Treatment for both primary and secondary achalasia
laparoscopic myotomy and pneumatic balloon dilatation
Botox injection to inhibit LES cholinergic neurons can also be effective
Cerebral manifestions of pernicious anemia and subacute combined degeneration of the cord
range from mild personality changes and memory loss to psychosis
characteristics of foregut carcinoid tumor
-generally cured by resection
GIST dominated by epithelial appearing cells
symptoms of GIST may be related to
high grade dysplasia in Barrett esophagus shows what?
more severe cytologic and architectural changes. with progression, epithelial cells may invade the lamina propria, a feature that defines intramucosal carcinoma
similar to Webs but are CIRCUMFERENTIAL, thicker, and include mucosa, submucosa, and occoasionally hypertrophic muscularis propria
esophageal RINGS or SCHATZKI rings
these polyps occur in individuals with familial adenomatous polyposis (FAP)
-Fundic gland polyps
most common site of acquired diverticula
The gastinomas of ZE syndrome are most commonly found where?
small intestine and pancreas
esophageal SCC most commonly presents with what?
dysphagia, odynophagia (pain on swallowing), or obstruction
-anemia or hemorrhage
Autoimmune gastritis is characterized by what?
-antibodies to parietal cells and intrinsic factor that can be detected in serum and gastric secretions
-reduced serum pepsinogen I concentration
-Endocrine cell hyperplasia
-Vitamin B12 deficiency
-defective gastric acid secretion (achlorhydria)
lymph node metastasis with esophageal SCC: upper 3rd
what is the COX-2 selective inhibitor that can result in gastropathy and gastritis
What is probably causing an increase in cancer of the gastric cardia?
related to Barrett esophagus and may reflect the increasing incidence of chronic GERD and obesity
structures for foregut carcinoid tumor
-duodenum proximal to ligament of Treitz
primary mode of treatment for Hirschsprung
surgical resection of the aganglionic segment followed by anastomosis of the normal proximal colon to the rectum
The presence of this . . . . a preinvasive change in Barrett esophagus is associated with prolonged symptoms, longer segment length, increased patient age, and caucasian race
Mutations which cause loss of SDF function confer increased risk for what 2 things? . . what is the syndrome?
GIST and paraganglioma
geographic highest rates for esophageal adenocarcinoma
immunohistochemical stains for synaptophysin and chromogranin A
Meckel diverticulum occurs as a result of what?
failed involution of the vitelline duct
impaired relaxation and spasm of what muscle after swallowing can result in increased pressure within distal pharynx
Age and gender for intestinal type gastric cancer
mean of 55 and males 2:1
mucosal inflammatory process of stomach . . neutrophils present
What is tylosis
risk factor for esophageal SCC . . RHBDF2 mutation . . Howel-Evans syndrome
Since chronic inflammation drives the development of inflammatory or hyperplastic polyps, the incidence depends partly on regional prevalence of what
majority or inflammatory or hyperplastic polyps are how big
smaller than 1 cm
Most common form of PUD occurs where and as a result of what?
within gastic antrum or duodenum
chronic, H. pylori induced antral gastritis which is associated with increased gastric acid secretion and decreased duodenal bicarbonate secretion
A less severe chemical injury to esophageal mucosa can occur when medicinal pills lodge and dissolve in the esophagus rather than passing into the stomach intact . .this is called
When present in esophagitis, ulceration is accompanied by what?
superficial necrosis with granulation tissue and eventual fibrosis
concurrent erosion and hemorrhage is termed
acute erosive hemorrhagic gastritis
highest geographic incidence for esophageal SCC
Local invasion to where is common in gastric cancer
over time . .esophageal SCC lesions may look like what/
polypoid, or exophytic and protrude into and obstruct the lumen
up to 75% of all gastric polyps are what
inflammatory or hyperplastic polyps
on a very basic level, Gastropathy and Acute Gastritis can occur when what happens?
-increase injurious agents leading to damage
Although they grow slowly, 60-90% of the gatrinomas in ZE are what
This form of gastritis is characterized by tissue damage associated with dense infiltrates of eosinophils in the mucosa and muscularis
what drugs exposure either orally or via mother's milk, in the first 2 weeks of life have been linked to increased incidence in congenital hypertrophic stenosis
erythromycin or azithromycin
2 types of esophageal cancer
-Squamous cell carcinoma
location for esophageal SCC
in contrast to H. pylori gastritis, autoimmune gastritis typically spares the ______ and is asoociated with _______
most common specific cause of granulomatous gastritis in Western populations
followed by sarcoidosis and infections (mycobacteria, fungi, CMV, and H. pylori)
Greatest concern of Barrett esophagus
increased risk of esophageal adenocarcinoma
Pernicious anemia and autoimmune gastritis are often associated with other autoimmune diseases such as?
-insulin-dependent (type 1) diabetes
-Primary ovarian failure
majority of adenomas are composed of what type of epithelium
intestinal type columnar that exhibits varying degrees of dysplasia
mechanism by which SDH mutations lead to GIST
accumulation of succinate leads to dysregulation of HIF-1a leading to increase in VEGF and IGF1R
genetic variants in what proinflammatory and immune response genes are associated with elevted risk of gastric cancer when accompanied by H. pylori
Rare hypertrophic gastropathy associated with excessive secretion of TGF-alpha
large cytoplasmic mucin vacuoles and peripherally displaces crescent shaped nuclei
signet ring cells of diffuse type gastric adenocarcinoma
congenital aganglionic megacolon is another name for ?
pill induced esophagitis occurs at what sites
strictures which impedes passage
Diagnosis of Barrett esophagus requires what?
endoscopic evidence of metaplastic columnar mucosa above the gastroesophageal junctions
H. Pylori virulence is linked to what factors
the most common translocation for MALT brings together what genes
API2 on 11
MLT on 18
API2-MLT fusion gene
Zollinger-Ellison syndrome (ZE) is caused by what?
gastrin secreting tumors (gastinomas)
Carcinoid syndrome is caused by what/
tumor secreting vasoactive substances into systemic circulation
origin of a GIST
interstitial cells of Cajal or pacemaker cells of the GI muscularis propria
Hemorrhage in gastritis may occur and cause what
dark punctae and hyperemic mucosa
What is ALWAYS affected in hirschsprung
Rash distribution for eosinophilic esophagitis in childhood
-flexural folds of extremities (antecubital, popliteal)
Gastric adenomas and malignant potential
they are pre-malignant neoplastic lesions
PDGFRA and KIT
histology in more significant cases of GERD
eosinophils recruited into squamous mucosa followed by neutrophils. Basal zone hyperplasia and elongation of lamina propria papillae
When viewed endoscopically, H. pylori infected antral mucosa is usually what?
erythematous and has a coarse or even nodular appearance
By the time symptoms appear with esophageal adenocarcinoma, the tumor has usually spread where?
submucosal lymphatic vessels
distinctive endoscopic appearance of lymphocytic gastritis
-thickened folds covered by small nodules with central aphthous ulceration
Lesions associated with intracranial injury are thought to be caused by direct stimulation of what? which causes hypersecretion of what?
In allogeneric hematopoietic stem cell and organ transplant recipients, the bowel is a frequent site for what?
caused by what?
EBV positive B cell lymphoproliferations
T cell deficits from cyclosporine
What host factor genetic polymorphisms are associated with pangastritis, atrophy, and gastric cancer in a patient with H. Pylori infection
-increase in TNF and IL-1B
-Decrease in in IL-10
What form of ACQUIRED megacolon is the only one associated with loss of ganglion cells?
pattern of H. pylori compared to autoimmune
multifocal rather than diffuse
GISTs without mutations in PDGFRA or KIT have mutations in what other genes that function in the pathway
or components of mitochondrial succinate dehydrogenase complex (SDHA, SDHB, SDHC, SDHD)
foregut carcinoid tumor that arises without predisposing factors
This type of gastric cancer predominates in high risk areas and developes from precursor lesions, including flat dysplasia and adenomas
rule of 2's for Meckel diverticulum
-2% of population
-within 2 feet of ileocecal valve
-approximately 2 inches long
-twice as common in males
-most often symptomatic by age 2
if GERD like symptoms but no acid reflux and high doses of proton pump inhibitors don't relieve
classic peptic ulcer description
round to oval SHARPLY PUNCHED_OUT DEFECT
if gastritic cystica is found in deeper layers of gastric wall
gastritis cystica profunda
size of GIST
as much as 30 cm
risk of dysplasia correlates with what?
length of esophagus affected
Extranodal lymphomas arise most commonly where
GI tract particularly the stomach
What type of esophageal dysmotility: repetitive simultaneous contractions of DISTAL esophageal smooth muscle
Diffuse Esophageal spasm
What are recognizable precursor lesions associated with gastric adenocarcinoma
Gastric dysplasia nad adenomas
Describe the change with Barrett esophagus
replacement of the squamous esophageal epithelium with goblet cells that have distinct mucous vacuoles that stain pale blue by hematoxylin and eosin and impart the shape of a wine goblet
firm, ovoid, 1 to 2 cm abdominal mass.
some cases abnormal left to right hyperperistalsis evident during feeding
Congenital hypertrophic pyloric stenosis
H. pylori infection most often presents as what?
predominantly antral gastritis with normal or increased acid production
age and gender for Barrett Esophagus
most common in white males between 40 and 60
Carcinoid syndrome is strongly associated with what?
metastatic disease to overcome first pass metabolism
Diagnosis of Hirschsprung requires what/
absence of ganglion cells within affected segment
Longitudinal mucosal tears near the gastroesophageal junction
Iatrogenic esophageal injury may be causes by what?
What is the most important prognostic factor for GI carcinoid tumors
location . . foregut, midgut, hindgut
diverticulum located immediately above upper esophageal sphincter
Iron deficiency may also be a risk factor for H. pyloi associated ________
INTRAepithelial neutrophils and SUBepithelial plasma cells are characteristic of what
H. pylori gastritis
GIST in children is related to what
Carney triad, a nonhereditary syndrome of unknown etiology seen in young females
GISTs with mutations in KIT or PDGFRA often respond to what
tyrosine kinase inhibitor imatinib
Those without these mutations are resistant
if ZE tumors are multiple or metastatic
MEN1 and may benefit from treatment with somatostatic analogues
behavior of a gastric GIST compared to those of small intestine
Agents that cause gastrophathy include
-stress induced injury
the spinal lesions in autoimmune gastritis result from demyelination of what?
this is called what clinical picture?
dorsal and lateral spinal tracts
subacute combined degeneration of the cord
Because of the association with chronic gastritis and partial gastrectomy, it is presumed that gastritis cystica is what?
nearly all peptic ulcers are associated with what?
-H. pylori infections
location for Dieulafoy lesion
along lesser curvature near the gastroesophageal junction
gender and age of esophageal webs
women older than age 40
clinical symptoms of GERD
-regurgitation of sour-tasting gastric contents
Ganglion cells can be identied by morphology in hematoxylin and eosin-stained sections and also by what?
IHC stains for acetylcholinesterase
Lymphocytic gastrits affects what part of stomach?
referred to as what?
mutations of KIT and PDGFRA are detectable in small GIST lesions but are not sufficient for tumorigenesis. what are other changes associated with progression to overt GIST
-loss or partial deletion of chromosomes 14 and 22
-deletion of 9p . .. loss of CDKN2A
The gastric injury that occurs in uremic patients and those infected with urease-secreting H. pylori may be due to what?
inhibition of gastric bicarbonate transporters by ammonium ions
Dieulafoy lesion causes gastric bleeding that is usually self limiting but can be copious and is often associated with what
NSAID use . . may be recurrent
another name for carcinoid tumor
well-differentiated neuroendocrine tumor
Do peptic ulcers undergo malignant transformation
Rarely . . basically No
is Barrett esophagus a precursor lesion to cancer
risk factors for esophageal SCC
-alcohol and tobacco
-caustic esophageal injury
-diets deficient in fruits or veggies
-frequent consumption of very hot beverages
pathogenesis of PUD
imbalances between mucosal defense mechanisms and damaging factors that cause chronic gastritis
chronic mucosal ulceration affecting the duodenum or stomach
Peptic ulcer disease (PUD)
histology of lymphocytic Gastritis
marked increase in number of intraepithelial T lymphocytes
GASTRIC peptic ulcers are predominantly located where
along lesser curvature near interface of body and antrum
transmission of H. Pylori
humans are carriers . . . fecal-oral route
Similar to other forms of gastric dysplasia, these almost always occur on a background of chronic gastritis with atrophy and intestinal metaplasia
Most common form of congenital intestinal atresia
Treatment of Menetrier disease
supportive with IV albumin and parenteral nutritional supplementation
in severe cases, gastrectomy may be needed
Viral esophagitis: shallower ulcer and nuclear and cytoplasmic inclusion within capillary endothelium and stromal cells
increased rates of esophageal adenocarcinoma may be partly due to what?
increased incidence of obesity-related gastroesophageal reflus and Barrett esophagus
symptoms of eosinophilic esophagitis
-dysphagia in adults
-feeding intolerance in children
What is the link between western Kenya and higher rates of esophageal SCC in patients younger than 30
consumption of a traditional fermented milk termed mursik which contains acetylaldehyde
genetics and esophageal SCC
-amplification of SOX2
-overexpression of cyclin D1
-loss of function of TP53, E-cadherin and NOTCH1
Genetics of Hirschsprung
-Loss of function in receptor tyrosine kinase RET
-endothelin and receptor
Modifying genes or environmental factors also important
-incomplete LES relaxation
-increased LES tone
-Aperistalsis of esophagus
all 3 translocations in MALT have what net effect
activation of NF-kB
mucosal inflammatory process of stomach in which inflammatory cells are rare or absent
current therapies for PUD
aimed at H. pylori eradication and neutralization of gastric acid primarily with proton pump inhibitors
The less common translocations in MALT increase expression of what intact proteins
MALT1 and BCL-10
Gastric, duodenal, and esophageal ulcers arising in person with intracranial disease
Cushing ulcers . . high indicence of perforation
initial differential diagnosis of someone with Boerhaave syndrome with include what?
MI . . . severe chest pain, tachypnea, and shock
decreased consumption of what things has also contributed to the decrease in gastric cancer prevalence
-dietary carcinogens such as N-nitroso compounds and benzo pyrene because of reduced use of salt and smoking for food preservation
what virus has been implicated in esophageal SCC in high risk areas
eso. Adenocarcinoma risk is reduced by what?
diets rich in fresh friuts and vegetables
most common location for gastric adenoma
loss of function of CDH1 which encodes E-cadherin
familial gastric DIFFUSE cancers
in UPPER esophagus, webs may be accompanied by what things?
part of what syndromes?
-iron deficiency anemia
Paterson-Brown-Kelly or Plummer-Vinson Syndrome
Rash distribution for eosinophilic esophagitis in infants
-extensor surfaces of extremities
Do most individuals with Barrett esophagus develop esophageal tumors
Wnt pathway proteins leading to Intestinal type gastric adenocarcinoma
-lof in APC
-gof in BETA-CATENIN
-lof in TGF-beta, BAX, and CDKN2A
In H. pylori chronic gastritis that involves the gastric body and fundus it is called multifocal atrophic gastritis and is associated with patchy mucosal atrophy, reduced parietal cell mass and acid secretion and intestinal metaplasi . . this causes increased risk for what?
location for esophageal adenocarcinoma
distal third . . from Barret esophagus . . . often involves gastric cardia
What length distinguishes long from short segment Barrett esophagus
peak age for GIST
penetrating peptic ulcers, pain is generally referred where?
-left upper quadrant
rule out a cardiac event
Viral esophagitis: nuclear viral inclusions within a rim of degenerating epithelial cells at hte margin of ulcer
Most esophageal adenocarcinomas arise from what
Secondary Acholasia may arise in what disease?
Chagas from typanosoma cruiz infections
destruction of the myenteric plexus, failure of peristalsis, and esophageal dilatation
if gastritis cystica is found within submucosa
gastritis cystica polyposa
dense lymphocytic infiltrate in the lamina propria. the neoplastic lymphocytes infiltrate the gastric glands focally to create diagnostic lymphoepithelial lesions
Treatment for Eosinophilic esophagitis
structurs for hindgut carcinoid tumor
appendix and colorectum
effective treatment for H. pylori infection include combinations of what?
antibiotics and proton pump inhibitors
Endoscopically longitudinal stripes of edematous erythematous mucosa that alternate with less severely injured paler mucosa
-Gastric Antral vascular ectasia (GAVE)
histologically, most characteristic feature of Menetrier disease
hyperplasia of FOVEOLAR mucous cells. the glands are elongated with a CORKSCREW like appearance and cystic dilation is common
Cardinal histologic feature of eosinophilic esophagitis
large numbers of intraepithelial eosinophils, particularly superficially
what countries is the incidence of gastric cancer 20 fold higher
Acquired pyloric stenosis occurs in adults as a consequence of what?
antral gastritis or peptic ulcers close to the pylorus
carcinomas of distal stomach and pancreas may also narrow the pyloric channel due to fibrosis or malignant infiltration
prognosis associated with lymph node metastases
normal migration of neural crest cells from cecum to rectum is arrested prematurely or ganglion cells undergo premature death
in situ lesion before esophageal SCC forms is called
geographic lowest rates for Esophageal adenocarcinoma
Risk of what is increased in adults with Menetrier disease
Most common malignancy of the stomach
gender for autoimmune gastritis
slightly more women
Esophageal adenocarcinoma tumors commonly produce what?
mucin and form glands often with intestinal type morphololgy
Primary achalasia is the result of what?
distal esophageal inhibitory neuronal ganglion cell degeneration
degeneration of extraesophageal vagus nerve or dorsal motor nucleus of vagus may also occur
twins and congenital hypertrophic pyloric stenosis
monzygotic have high rate of concordance
200 fold increased risk if one twin affected
Hirschsprung produces a distal intestinal segment that lacks what?
meissner submucosal and Auerbach myenteric plexus ("aganglionosis")
B-cell markers CD19 and CD20
intestinal metaplasia is strongly associated with increased risk of what?
adenocarcinoma . . . greatest in autoimmune gastritis
esophageal webs can be associated with what things?
-chronic graft-versus-host disease
-blistering skin diseases
positive Troisier's sign
. . metastasis of gastric cancer to supraclavicular node
Histologically, describe GAVE
antral mucosa shows reactive gastropathy with dilated capillaries containing fibrin thrombi
stomach lesion following disruption of gastric blood flow (portal HTN) or hemorrhage
blood to middle 1/3 of esophagus
branches of thoracic aorta
age for Zenker diverticulum
inflammatory infiltrate of H. pylori infected antral mucosa
variable number of Neutrophils within the lamina propria including some that cross basement membrane to assume intraepithalial location and accumulate in lumen of gastric pits to create pit abscesses
primary treatment for localized gastric GIST
complete surgical resections
Antral glands are similar to those in cardia and antrum but also contain what?
endocrine glands such as G cells
inflammatory infiltrate in autoimmune gastritis
typically lymphocytes, macrophages, and plasma cells, often in association with lymphoid aggregates and follicles
symptoms of Achalasia
-dysphagia for solids and liquids
-difficulty in belching
genetics of esophageal Adenocarcinoma
-Early: TP53 mutation and downregulation of CDKN2A (p16/INK4a) due to allelic loss and hypermethylation
Later: amplification of EGFR, ERBB2, MET, cyclin D1, and Cyclin E
Describe the progression of Menetrier disease in children
usually self limited and often follows respiratory infections
-desmoplastic reaction that stiffens the gastric wall
-diffuse rugal flattening and a rigid thickened wall may impart a LEATHER BOTTLE appearance termed LINITIS PLASTICA
Diffuse gastric cancer
Acquired megacolon may occur at any age as a result of what?
-obstruction by a neoplasm or inflammatory stricture
-toxic megacolon complicating ulcerative colitis
-in association with functional psychosomatic disorders
In the US, esophageal squamous cell carcinoma occurs in what people
-adults older than 45
-males 4x more
-african americans for than 8x more common
median age for autoimmune gastritis
60 . . slowly progressing over decades
pathogenesis of stress related gastric mucosal injury is most often related to what
-systemic hypotension or reduced blood flow caused by stress induced splanchnic vasoconstriction
in H. pylori chronic gastritis, when inflammation remains limited to the antrum, increased acid production results in what?
greater risk of duodenal peptic ulcer
foveolar hyperplasia with characteristic corkscrew profiles
approximately 75 to 80% of all GISTs have gain of function mutations in what
receptor for KIT
hypertrophic gastropathy is applied to a specific group of diseases exemplified by
Menetrier disease and Zollinger-Ellison Syndrome
white fleshy tumor with whorled apearance
most common mesenchymal tumor of the abdomen
GI stromal tumor (GIST)
Most frequent cause of esophagitis
reflux of gastric contents into lower esophagus (GERD)
Gastric adenoma frequency increases progressively with what
if an esophageal rings is in squamocolumnar junction of lower esophagus
what type of mucosa
Gastic cardia-type mucosa on their undersurface
Fundic gland polyps are increasing in prevalence due to what
increasing usef of proton pump inhibitor therapy which inhibit acid production and leads to increased gastrin secretions and increased oxyntic gland growth
Are neurologic changes in subacute combined degeneration of the cord reversed by vitamin B12 replacement therapy
patients with risk factors for hemorrhage, including large varices, elevated hepatic venous pressure gradient, pervious bleeding, and advanced liver disease may be treated prophylactically with what/
-beta blockers to reduce portal blood flow
G cells located where and secrete what which does what
-stimulates luminal acid secretion by parietal cells within fundus and body
Stain for H. Pylori
Warthin Starry silver stain
3 translocations with MALT
- 11:18 most common
Most gastric adenocarcinoma involve what location
Ileal carcinoid tumors may cause what
what is necessary to cure pyloric stenosis
surgical splitting of muscularis (myotomy)
peak age for carcinoid tumor
What is the most powerful prognostic indicator in gastric cancer
depth of invasion and extend of nodal and distant metastases at the time of diagnosis
Who are Gastric cancers more common in
-lower socioeconomic groups
-individuals with multifocal mucosal atrophy and intenstinal metaplasia
Menetrier Disease is characterized by what
diffuse hyperplasia of the foveolar epithelim of the body and fundus and HYPOPROTEINEMIA due to PROTEIN-LOSING ENTEROPATHY
Chemical injury to child's esophagous often is what
accidental ingestion of household cleaning products
Early lesions of esophageal SCC look like what
small, gray-white, plaque-like thinkenings
Mallory-Weiss tears are most often associated with what?
severe retching or vomiting secondary to acute alcohol intoxication
Lymphocytic Gastritis prefers what gender?
associated with what disease?
nonspecific abdominal symptoms
Perforation of a peptic ulcer into the peritoneal cavity is a surgical emergency that may be identified how?
detection of free air under the diaphragm on upright radiographs
lymph node metastasis with esophageal SCC: middle 3rd
mediastinal, paratracheal, and tracheobronchial
Viral esophagitis: Punched out ulcers
Most common sites of metastasis for gastric cancer
-supraclavicular sentinel lymph node (Virchow node)
-periumbilical nodes (sister mary joseph nodes)
-left axillary node (Irish node)
-ovary (Krukenberg tumor)
-the pouch of Douglas (Blumer shelf)
What are considered to be the principal agents of injury in autoimmune gastritis
CD4+ T cells directed against parietal cell components including the H+,K+ATPase
increased tone of LES as result of impaired smooth muscle relaxation
Previous radiated to mediastinum predisposes to esophages SCC which occurs how long after
5 to 10 years
What is the most useful diagnostic marker of a GIST
KIT . . in Cajal cells
characteristics for midgut carcinoid tumor
-multiple and aggressive
-Greater depth of local invasion, increased size, and presence of necrosis and mitosis are associated with worse outcome
within the stomach, the most remarkable feature of ZE syndrome is what?
a doubling of oxyntic mucosal thickness due to five fold increase in the number of parietal cells
Endocrine cell hyperplasia of autoimmune gastritis can be clearly demonstrated with immunostains for what?
What wall of duodenum do peptic ulcers most often affect
lymph node metastasis with esophageal SCC: lower 3rd
gastric and celiac
Most commn cause of chronic gastritis
age for inflammatory or hyperplastic polyps
b/t 50 and 60
What type of esophageal dysmotility: high amplitude contractions of DISTAL esophagus that are, in parte, due to loss of normal coordination of inner circular layer and outer longitudinal layer
Nutcracker (jackhammer) esophagus
Esophagus infection in debilitated or immunosuppressed
-fungi (candidiasis most common)
Barrett esophagus is a complication of what?
Treatment of ZE
blockade of acid hypersecretion by proton pump inhibitor allowing peptic ulcers to heal so we can focus on the gastinoma
Because the risk of dysplasia from inflammatory or hyperplastic polyps correlates with size, what size should be resected and examined histologically
1.5 cm or larger
pain for peptic ulcer is relieved by what?
alkali or food
One or several tongues or patches of red, velvety mucosa extending upward from the gastroesophageal junction. This metaplastic mucosa alternates with smooth pale squamous esophageal mucosa and interfaces with light brown columnar gastric mucosa distally
if an esophageal rings is in DISTAL esophagus above the gastroesophageal junction
covered by what
transmural tearing and rupture of the distal esophagus that produces severe mediastinitis and generally requires surgical intervention
Hirschsprung disease typically presents with what?
failure to pass meconium
-obstruction or constipation follows
-may progress to abdominal distention and BILIOUS vomiting
what has bee suggested as factors that explain the increased susceptibility of older adults to gastritis
reduced mucin and bicarb secretion
recurrence or metastasis is rare for what size GIST?
common for which ones?
smaller than 5 cm
mitotically active tumors larger than 10cm
polyps that occur in gastric body and fundus and are well circumscribed and composed of cystically dilated, irregular glands lined by flattened parietal and chief cells
Fundic Gland polyps
most frequent manifestation of peripheral neuropathy in autoimmune gastritis are
paresthesias and numbness
The well developed glands of the body and fundus also contain what?
chief cells that produce and secrete digestive enzymes such as pepsin
increased incidence of this GI tumor in those with neurofibromatosis type 1
The cause of overall reduction in gastric cancer is most closely linked to decreases in what
H. pylori prevalence
morphological hallmarks of dysplasia
-variations in epithelial size, shape, and orientation along with coarse chromatin texture, hyperchromasia and nuclear enlargement
MALTomas can transform into more aggressive tumors that are histologically identical to diffuse large B-cell lymphomas . . this is associated wit what genetic changes
p53 and p16 inactivation
what accounts for an increased incidence of gastritis at high altitudes
decreases oxygen delivery
increased release of what two things also contribute to ischemic gastric mucosal injury?
increase in what appears to be protective?
NO synthase and endothelin-1
the majority of peptic ulcers come to clinical attention because of what?
epigastric burning or aching pain
significant fraction present with complications such as iron deficiency anemia, hemorrhage, or perforation
nausea, vomiting, bloating, belching
Major threats to life in Hirschsprung
-fluid and electrolyte disturbances
gender for congenital hypertrophic pyloric stenosis
3-5 times more commn in males
what curvature of stomach is more often involved in Gastric adenocarcinoma
relationship between peptic ulcer size and depth
-less than .3 cm . . shallow
-greater than .6 cm . . deeper
characteristics of hind gut carcinoid tumor
-typically discover incidentally
-rarely bigger than 2 cm
-almost always benign
number for peptic ulcer
In granulomatous gastritis, in addition to presence of granulomas, what else may occur
narrowing and rigidity of the gastric antrum secondary to transmural granulomatous inflammation
age and gender for gastric adenoma
usually b/t 50 and 60
Males 3x more than females
in those sporadic gastric DIFFUSE cancers that do not have loss of function mutation in CDH1, what is found?
drastic decrease due to hypermethylation and silencing of CDH1
Stress ulcers are most common in individuals with what?
if esophagus gets infected in healthy individual, what most often causes it
Vitamin B12 deficiency in autoimmune gastritis may also cause what
-atrophic glossitis, in which the tongue becomes smooth and beefy red
-spinal cord lesions
structures for midgut carcinoid tumor
NSAIDS and gastritis/Gastropathy
-inhibit COX (1 more than 2)dependent prostaglandins E2 and I2
esophageal SCC may invade what structures causing what?
respiratory tree --> pneumonia
Aorta --> catastrophic exsanguination
mediastinum and pericardium
Long standing chronic gastritis that involves the body and fundus may ultimately lead to significant loss of parietal cells mass. This oxyntic atrophy may be associated with what?
intestinal metaplasia, recognized by the presence of goblet cells
Complications of GERD
Gastin of ZE syndrome induces what?
-hyperplasia of mucous neck cells
-proliferation of endocrine cells within oxyntic mucosa
in some cases these endocrine cells can form small dysplastic nodules or rarely CARCINOID tumors
symtoms of chronic gastritis as opposed to acute
-less severe but more persistent
-nausea and upper abdominal pain typical, sometimes with vomiting
second most common cause of varices
FAP patients who carry germline APC mutations have an increased risk for what
intestinal type gastric cancer
subacute combined degeneration of the cord is associated with what?
-mixture of loss of vibration and position sense
-sensory ataxia with positive Romberg sign
-extensor plantar responses
epidemiology of diffuse type gastric cancer
-uniform across countries
-no precursor lesion
-same gender frequency
Patients with ZE often present with what
duodenal ulcers or chronic diarrhea
describe H. pylori
-spiral shaped or curved bacilli
if ZE tumor is sporadic
solitary and surgically resectable
What is the most common gastric primary lymphomas
indolent extranodal marginal zone B cell lymphomas . . . MALT
PUD has been associated with cigarette use and cardiovascular disease, most likely due to
-reduced mucosal blood flow, oxygenation, and healing
most common allergic reactions that cause eosinophilic gastritis in children
cow's milk and soy protein
what shape is more characteristic of cancers
heaped up margins
What disease does not impart increased risk for gastric cancer but a partial gastrectomy for it does elevate the risk
microscopically, inflammatory or hyperplastic polyps have what
irregular, cystically dilated and elongated foveolar glands
secondary symptoms of Menetrier disease
location of eosinophilic gastritis
antral and pyloric regions
This type of gastric adenocarcinoma is composed of glandular structures
increase in Wnt pathway
INTESTINAL type gastric adenocarcinoma . .
describe the gastrin production increase in H. pylori infection
local production may be increased but hypergastinemia (increased serum gastrin) is UNCCOMMON
What treatment provide symptomatic relief for GERD
proton pump inhibitors