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GI pathology > Pathology of the stomach > Flashcards

Pathology of the stomach Flashcards

(32 cards)

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1
Q

What does the normal stomach look like

A
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2
Q

What are the inflammatory disorders of the Stomach

A
  1. Acute gastritis - irritant chamical injury, severe burns, shock, truama or head injury
  2. Chronic gastritis - autoimmune, Bacterial or chemical
  3. Rare: lymphocytic, Eosinophillic and granulomatous gastritis
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3
Q

What are the types of chronic gastritis

A
  • Chemical
  • Bacterial - H.pylori
  • Autoimmune
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4
Q

Describe chronic gastritis

A
  • Rarest
  • Leads to production of anti-parieral cells and anti-intrinsic factor antibodies
  • causes decreased acid secretion
  • Features: Atrophy, Intestinal metaplasia (mucosa looks like intestinal)
  • Perinicoius anaemia = decrease in RBC production due to lack of B12
  • Macrolytic anaemia = Big RBC due to B12 deficiency
  • SACDC - degeneration of posterior and lacteral spincal cord columns - B12 deficiency
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5
Q

What are the features of autoimmune chronic gastritis

A
  • causes decreased acid secretion
  • Atrophy, Intestinal metaplasia (mucosa looks like intestinal)
  • Perinicoius anaemia = decrease in RBC production due to lack of B12
  • Macrolytic anaemia = Big RBC due to B12 deficiency
  • SACDC - degeneration of posterior and lacteral spincal cord columns - B12 deficiency
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6
Q

Describe H.pylori Chronic gastritis

A
  • Most common type of chronic gastritis
  • Bactiria forms a niche between epthelial cell surface and mucous barrier
  • Gram negative curilinear rod
  • Exites early acute inflammatory responce - if not cleared then will be followed bt chronic active inflammation
  • Site effected: Antrum
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7
Q

What is the key inflammatory element that plays a role in h.pylori gastritis

A

IL-8 - chemotaxin allows infirtraltion of other immune cells to clear an infection (mice diffiecient cannot clear infection)

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8
Q

What are the histological features of H.pylori gastritis

A
  • Lamina propria = anti-hp antibodies
  • increased risk of doudenal and stomach ulcers
  • increased risk of gastric carcinoma and lymphoma
  • Infirtration of lymphocytes and plasma cells
  • Blue curved bacteria
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9
Q

What does infiltration of lymphocytes look like on histology

A
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10
Q

Descibe chemical gastritis

A
  • Chronic inflammation due to NSAIDS, alcohol, bile reflux
  • Direct injury to mucusal layer by fat solvents
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11
Q

What are the features of chemical gastritis

A
  • Epithelial regeneration, hyperplasia and congestion - as toxin injury causes degredation of cells - back diffusion of gastric acid
  • May produce ulcers
  • Gastric mucousa = hyperplastic with long foveoles
  • Lamina propria = edematous
  • Spindle shaped sm cells
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12
Q

Describe chornic doudenal ulcers

A
  • Increased attack by pepsin+acid and failure of defence
  • increased acid secretion
  • excess acid = gastric metaplasia, H.pylori infection, inflammation, epithelial damage and ulceration
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13
Q

Describe peptic ulcers

A
  • acid secretion and failure of defence
  • Morphology = 2-10cm across, clear,cut and punched out
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14
Q

What are the microscopic changes in peptic ulcers

A
  • muscle replaced by fibrous tissue
  • Hyperplasia of adjacent lymph nodes
  • Distal mucosa has a ladder like configurarion
  • Serosal fibrosis
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15
Q

What does a peptic ulcer look like

A
  • layered appearance
  • Floor is dicrotic fibronopurulent dibris
  • Base is inflamed grannulation tissue
  • Deepest layer is fibrotic scar tissue
  • Acute neutrophilic and chronic inflammation - B cells
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16
Q

What are complications of peptic ulcers

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A
  • Perforation
  • Penetration
  • Haemorrhage
  • Stenosis
  • Pain!
17
Q

What are the type of Binign gastric polyps

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A
  • Hyperplastic polyps
  • Cystic fundic gland polyps
18
Q

What are the types of malignant gastric tumours

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A
  • Carcinomas - Adenocarcinoma
  • Lymphoma
  • Gastrointestinal stromal tumours
19
Q

Describe Gastric adenocarcinoma

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A
  • Common in japana, china and promixal tumour of cardia are increasing whilst distal gastric tumours are decreasing
20
Q

What is the pathogenesis of gastric adenocarcionma

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A
  • H.pylori infection - stronge link to distal distal gastric cancers - Type 1 carcinogen
  • HP -> Chronic gastritis -> Intestinal metaplasia/atrophy -> Dysplasia -> carcinoma
21
Q

What are other causes of gastric adenocarcinoma

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A

Pre-malignant conditions

  • Perinicious anaemia
  • Partial gastrectomy
  • HNPCC/Lynch syndrome (hereditory nonpolyp colorectal cancer)
  • Menetrier’s disease
22
Q

What are the subtypes of Gastric adenocarcinoma

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A
  1. Intestinal type - exophytic/polyploid mass ​​
  2. Diffuse type- expands/infiltrates stomach wall
23
Q

What is the intestinal type - adenocarcinoma

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A
  • Well-formed glandular strutures
  • Polypoid or ulcerating lesions - heaped-up, rolled edges
  • Surrounding mucosa has intestinal metaplasia with H.pylori
  • Distal sotmach - patients with chronic gastritic
  • Strong environmental assoication
24
Q

What is the diffuse type - adenocarnoma

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A
  • poorly differentiated cells - infiltrate stomach wall
  • Can be any part of stomach - eps cardia
  • Worse prognosis compared to intestinal type
  • Loss expression of E-cadherin molecules - key event in carcinogesis
25
What are the features of diffuse-type adenocarcinoma
* **Gastric-type mucus cells -** do not form glands * **Infiltrate as individual cells or small clusters -** maybe transmural * Appear to arise from **middle layer of mucosa** * intestinal metaplasia - not present * **high signet ring cellls -** (mucin pushes nculeous to periphery- rings) * **submucosal fibrosis - viaraible mucosal ulceration** * **Hypertrophic muscularis propria**
26
What does the signet ring type look like
27
Diffuse type sclerotic appearance
28
Diffuse type Vs intestinal type
* intestinal type = better prognosis * 15% mixed * Causes/ genetic/ Epideomeology differences
29
Where does **Gastric adenocarcinoma spread**
* **Local :** directly into other organs * **lymphnodes : omental** * **Haematogenous: liver and beyond** * **Trasnceolomic :** into peritoneal cavity and ovaries - **Krunkberg**
30
Describe Gastric lymphomas - **maltoma**
* **Derived from Mucosal associate lymphatic tissues - MALT** * Associated with **h.pylori infection** * **Continous inflamamtion induces an evolution in a _Clonal B cell proliferation_ - Low grade lymphoma** * **if unchecked can turn into high grade**
31
What are the histological features of low grade MALTOMA
32
What is Gastrintestinal Stromal tumour
* Gastric Mesenchymal tumour

GI pathology (6 decks)

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