Pathology of the stomach Flashcards Preview

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Flashcards in Pathology of the stomach Deck (32):

What does the normal stomach look like


What are the inflammatory disorders of the Stomach

  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 


What are the types of chronic gastritis 

  • Chemical
  • Bacterial - H.pylori 
  • Autoimmune 


Describe chronic gastritis 

  • 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 


What are the features of autoimmune chronic gastritis 

  • 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 


Describe H.pylori Chronic gastritis 

  • 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 


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

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


What are the histological features of H.pylori gastritis 

  • 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 


What does infiltration of lymphocytes look like on histology 


Descibe chemical gastritis 

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


What are the features of chemical gastritis 

  • 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 


Describe chornic doudenal ulcers

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


Describe peptic ulcers 

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


What are the microscopic changes in peptic ulcers 

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


What does a peptic ulcer look like 

  • 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 


What are complications of peptic ulcers 

  • Perforation 
  • Penetration 
  • Haemorrhage 
  • Stenosis 
  • Pain! 


What are the type of Binign gastric polyps

  • Hyperplastic polyps 
  • Cystic fundic gland polyps 


What are the types of malignant gastric tumours 

  • Carcinomas - Adenocarcinoma
  • Lymphoma 
  • Gastrointestinal stromal tumours 


Describe Gastric adenocarcinoma 

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


What is the pathogenesis of gastric adenocarcionma 

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


What are other causes of gastric adenocarcinoma 

Pre-malignant conditions

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


What are the subtypes of Gastric adenocarcinoma 

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


What is the intestinal type - adenocarcinoma 

  • 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 


What is the diffuse type - adenocarnoma 

  • 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 


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 


What does the signet ring type look like 


Diffuse type sclerotic appearance 


Diffuse type Vs intestinal type 

  • intestinal type = better prognosis 
  • 15% mixed
  • Causes/ genetic/ Epideomeology differences 


Where does Gastric adenocarcinoma spread 

  • Local : directly into other organs
  • lymphnodes : omental 
  • Haematogenous: liver and beyond
  • Trasnceolomic : into peritoneal cavity and ovaries - Krunkberg 


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


What are the histological features of low grade MALTOMA 


What is Gastrintestinal Stromal tumour 

  • Gastric Mesenchymal tumour