Pathology of the Stomach

Question 1

What causes acute gastritis?

Answer 1

Irritant chemical injury
systemic disease
severe burns

Question 2

What are the main groups of causes of chronic gastritis?

Answer 2

Autoimmune (rarest)
Bacterial (H. Pylori)
Chemical

Question 3

Give 3 rare inflammatory disorders of the stomach

Answer 3

Lymphocytic
Eosinophilic
Granulomatous

Question 4

Which antibodies cause autoimmune chronic gastritis?

Answer 4

Anti-parietal and anti-intrinsic factor antibodies

Question 5

What happens in autoimmune chronic gastritis?

Answer 5

There is an attack on the lining or products of stomach excretion by the immune system

Question 6

Where does H. pylori inhabit a niche?

Answer 6

between the epithelial cell surface and mucous barrier

Question 7

What happens if H. pylori is not cleared?

Answer 7

A chronic active inflammation ensues which damages epithelial cells and can lead to ulcers

Question 8

H. pylori gastritis increases the risk of what?

Answer 8

Duodenal ulcer
Gastric ulcer
Gastric lymphoma
Gastric carcinoma

Question 9

What causes chemical gastritis?

Answer 9

NSAIDs
alcohol
bile reflux

Question 10

What happens in chemical gastritis?

Answer 10

There is direct injury to mucus layer by fat solvents

Question 11

What is peptic ulceration?

Answer 11

a breach in the gastrointestinal mucosa as a result of acid and pepsin attack

Question 12

Sites of chronic peptic ulcers

Answer 12

1st part of the duodenum
Stomach (junction of body and antrum
Oesophago-gastric junction
Stomal ulcers

Question 13

What are the 2 parts of the pathogenesis of chronic peptic ulcers?

Answer 13

Increased acid production

Failure of mucosal defence

Question 14

What is the morphology of peptic ulcers?

Answer 14

2-10cm across
edges are clear cut, punched out 
flat along margin - benign 
raised rolled edge - malignant 
once established, inability to repair means they get larger and larger

Question 15

What is the deepest layer of a peptic ulcer?

Answer 15

Fibrotic scar tissue

Question 16

Complications of peptic ulcers

Answer 16

Perforation 
Penetrations 
haemorrhage 
stenosis 
intractable pain

Question 17

Primary malignant gastric tumours

Answer 17

carcinomas (adenocarciomas)
lymphomas
gastrointestinal stromal tumours (rarest)

Question 18

Premalignant conditions to gastric adenocarcioma

Answer 18

• Pernicious anaemia – automimmune gastritis
• Partial gastrectomy
• HNPCC / Lynch syndrome – familial
• Menetrier’s Disease

Question 19

Describe an intestinal type gastric adenocarcinoma

Answer 19

discrete localised mass

Question 20

Describe a diffuse type gastric adenocarcinoma

Answer 20

epands/infiltrates stomach wall
cannot be removed surgically
poor prognosis

Question 21

Which type of gastric adenocarcinoma (intestinal or difffuse) has a slightly better prognosis?

Answer 21

Intestinal type

Question 22

How do gastric adenocarcinomas spread?

Answer 22

Local
Lymph nodes
Haematogenous (to the liver)

Question 23

What are Maltomas (type of gastric lymphoma) derived from?

Answer 23

mucosa associated lymphoid tissue (MALT)

Question 24

What happens in a maltoma?

Answer 24

lymphocytes destroy the gastric epithelium by attacking crypts one by one

Question 25

What is a gastrointestinal stromal tumour (GIST)?

Answer 25

Neoplasma of connective tissue of stomach | Can arise in oesophagus and small bowel but rare

Question 26

What are the symptoms an signs of gastric cancer?

Answer 26

``` Dyspepsia upper GI haemorrhage weight loss abdominal mass jaundice (if compresses bile duct) Paraneoplastic syndromes (hyperthyroidism can occur) ```

Question 27

What investigations are used to diagnose gastric cancer?

Answer 27

Upper Gi endoscopy and biopsy #1 barium meal CT/MRI scan

Question 28

Why is surgery carried out in gastric cancer?

Answer 28

For palliation of symptoms | for improved survival

Question 29

Contraindications to gastric cancer surgery

Answer 29

widely metastatic disease malignant ascites brief life expectancy

Question 30

If the gastric cancer was in a distal lesion what kind of surgery would be carried out?

Answer 30

Partial gastrectomy

Question 31

If the gastric cancer was in a proximal lesion what kind of surgery would be carried out?

Answer 31

total gastrectomy

Question 32

What is the 5 year survival rate of gastric cancer? Does it increase if the pt has surgery?

Answer 32

15% | Yes, increases to 40-50%

Question 33

Gastric ulceration usually occurs with normal or low acid production. True or false.

Answer 33

True

Question 34

What is gastric adenocarcinoma associated with?

Answer 34

H. pylori infection achlorhydria pernicious anaemia