Pathoma - Stomach

Question 1

Gastroschisis

Answer 1

congenital malformation of abdominal wall (exposes gastric contents to outside)

Question 2

Gastroschisis vs Omphacele

Answer 2

omphalocele contents inside “bubble” (peritoneum and amnion)

Question 3

Omphalocele

Answer 3

persistent herniation into umbilical cord

Question 4

Omphalocele - clinical presentation

Answer 4

contents covered by peritoneum and amnion of cord

Question 5

Pyloric stenosis

Answer 5

tightening of pyloric sphincter

Question 6

Pyloric stenosis - clinical presentation

Answer 6

presents 2 weeks after birth:
projectile vomit
olive-like mass in abdomen

Question 7

Pyloric stenosis - treatment

Answer 7

myotomy

Question 8

Acute gastritis

Answer 8

acidic damage to mucosa (imbalance between acidic environment and mucosal defense)

Question 9

Mucosal defenses

Answer 9

epithelial cells, mucous, bicarbonate, blood supply

Question 10

Acute gastritis - risk factors

Answer 10

Severe burns (hypovolemia-> dec BF to stomach)
NSAIDS
Alcohol (direct mucosal damage)
Chemotherapy (killing cells that are turning over)
Decreased ICP (Cushing ulcer)- increased vagal stimulation->ACh stimulation
Shock

Question 11

Prostaglandin effects on stomach

Answer 11

decrease acid production, increase mucous/bicarb production, increase BF to stomach

Question 12

which hormones/NT’s increase acid production?

Answer 12

Gastrin, ACh, histamine

Question 13

Outcomes of acidic damage

Answer 13

Superficial inflammation
Erosion (loss of epithelium)
Ulceration (loss of mucosal layer)

Question 14

Chronic gastritis - types

Answer 14

Chronic autoimmune gastritis

Question 15

Chronic autoimmune gastritis

Answer 15

autoimmune destruction of parietal cells (Type IV hypersensitivity)

Question 16

CAG - location

Answer 16

body and fundus of stomach

Question 17

CAG - labs

Answer 17

Ab’s against parietal cells or intrinsic factor
Achlorhydria
Increased gastrin levels
anemia (megaloblastic)

Question 18

CAG - clinical presentation

Answer 18

Atrophy of mucosa
Achlorhydria w/ increased gastrin levels (G cell hyperplasia in antrum
Megaloblastic anemia (IF Ab’s)

Question 19

CAG - complications

Answer 19

increased risk of gastric adenocarcinoma (inflammation->intestinal metaplasia)

Question 20

What histological finding suggests intestinal metaplasia

Answer 20

goblet cells

Question 21

Chronic H. pylori gastritis

Answer 21

90% of chronic gastritis, due to inflammation from H.pylori bacteria

Question 22

How does H. pylori weaken mucosal defenses?

Answer 22

ureases, proteases and inflammation

Question 23

H. pylori gastritis - location

Answer 23

antrum

Question 24

H. pylori gastritis - clinical presentation

Answer 24

epigastric abdominal pain

(+) urease breath test

Question 25

H. pylori gastritis - complications

Answer 25

inc risk of: ulceration, gastric adenocarcinoma, MALT lymphoma

Question 26

H. pylori gastritis - treatment

Answer 26

Triple therapy (PPI + amoxicillin + clarithromycin)

Question 27

Peptic ulcer disease

Answer 27

solitary mucosal ulcer

Question 28

PUD - location

Answer 28

proximal duodenum (90%) or distal stomach

Question 29

Duodenal ulcer - cause

Answer 29

almost always H. pylori | rarely Zollinger-Ellison Syndrome (gastrinoma)

Question 30

Duodenal ulcer - clinical presentation

Answer 30

epigastric pain that IMPROVES W/ MEALS

Question 31

Duodenal ulcer - diagnosis

Answer 31

ulcer w/ hypertrophy of Brunner glands on endoscopic biopsy

Question 32

Duodenal ulcer - complications

Answer 32

rupture of ulcer (anterior or posterior wall- anterior more common)

Question 33

Possible complications of POSTERIOR duodenal wall rupture from ulcer?

Answer 33

bleeding from gastroduodenal artery | acute pancreatitis

Question 34

Gastric ulcer - cause

Answer 34

60% H. pylori NSAIDS bile reflux

Question 35

Gastric ulcer - clinical presentation

Answer 35

epigastric pain that WORSENS W/ MEAL

Question 36

Gastric ulcer - location

Answer 36

lesser curvature of antrum

Question 37

possible complications from rupture of gastric ulcer

Answer 37

bleeding from left gastric artery

Question 38

DDX for ulcers

Answer 38

consider cancer very rarely malignant in duodenum gastric ulcer- can cause gastric carcinoma

Question 39

Gastric carcinoma

Answer 39

malignant proliferation of surface columnar epithelium (adenocarcinoma)

Question 40

GC: instestinal type

Answer 40

large, irregular ulcer w/ heaped-up margins

Question 41

GC: intestinal type - location

Answer 41

lesser curvature of antrum

Question 42

GC: intestinal type - risk factors

Answer 42

intestinal metaplasia, nitrosamines (smoked food), Type A blood

Question 43

GC: diffuse type

Answer 43

signet ring cells invade gastric wall (diffusely)

Question 44

GC: diffuse type - response to signet cell invasion

Answer 44

Desmoplasia (->thickening of stomach wall) (linitis plastica)

Question 45

GC: clinical presentation

Answer 45

weight loss, abdominal pain, anemia, early satiety | rare: acanthosis nigricans or Leser Trelat sign (seborrheic keratoses on skin)