Stomach

Question 1

Gastritis is defined by inflammation of gastric epithelium True/False?

Answer 1

True

Question 2

Peptic ulcer is type of chronic inflammation True/False?

Answer 2

False .The correct is

Is a chronic ulcer

Question 3

In acute gastritis the inflammation accompanied by ….. and this …. Is an important cause of ….

Answer 3

Haemorrhage into gastric mucosa and erosion ,sever erosive process is , of gastrointestinal bleeding

Question 4

Numerate the causes of Acute gastritis !

Answer 4

1) Heavy use of NSANDs like aspirin
2) Excessive Alcohol consumption
3) Heavy smoking
4) Treatment with caner chemotherapeutic drug
5) Uraemia
6) Sever stress(surgery,trauma,burns)
7) Mechanical Trauma(nasogastric intubation)
8) Suicide attempts to acids and alkali

Question 5

Acute erosive gastritis ,how is it marked?

Answer 5

This is marked by:

1) mucosal oedema
2) inflammatory infiltrate of neutrophils
3) possibly by chronic inflammatory cell

Question 6

Chronic gastritis of characterised by hematemesis ,melena and fatal blood lose True/False?

Answer 6

False .The correct is

It is acute gastritis

Question 7

Define the chronic gastritis

Answer 7

Is defined by chronic mucosal inflammatory changes leading eventually to mucosal atrophy and epithelial metaplasia

Question 8

What are causes of Chronic gastritis ?

Answer 8

1) Helicobacter pylori

2) Autoimmune gastritis

Question 9

The inflammatory changes in chronic gastritis consist of ….. and ….. infiltrate in lamina propria ,occasionally accompanied by ….. of …..of gastric pit

Answer 9

Lymphocytic and Plasma cell ,

Neutrophilic inflammation, neck region

Question 10

Chronic gastritis ,in autoimmune variant loss of chief cell is dominant True/False?

Answer 10

False .The correct is

Parietal cells

Question 11

What is the cause on gastric lymphoma?

Answer 11

H.pylori induced proliferation of lymphoid tissue within gastric mucosa has been implicated as a precursor of gastric lymphoma

Question 12

Define the gastric ulceration !

Answer 12

Is defined as breach in mucosa of the alimentary-tract that extend through the muscular-is mucosa into the sub mucosa or deeper

Question 13

Gastric Ulcer include ….&….

Answer 13

Peptic ulcer (chronic ulcer) 
Stress ulcer (acute ulcer)

Question 14

Peptic ulcer occur in oesophagus True/False?

Answer 14

False .The correct is

Al least 98% of it occur either in first part of duodenum or in stomach

Question 15

Numerate the causes of Chronic ulcer

Answer 15

1) Mucosal exposure to aggressive action of acid-peptic juice
2) Very strong casual association with H.pylori infection

Question 16

Describe the host mechanism that preventing the gastric mucosa from being digested like a piece of meat

Answer 16

1) Secretion of mucous by surface epithelial cell
2) Secretion of bicarbonate into the surface mucous creating a buffered surface micro environment.
3) Secretion of acid-peptic juice from gastric pit as jet through surface mucous layer entering the lumen directly without contact surface epithelial cells
4) Rapid rate of epithelial regeneration
5) Mucosal elaboration of prostaglandin ,which help maintain mucosal blood flow

Question 17

Explain the possible mechanism by which H.pylori cause gastric ulcers ?

Answer 17

1)H.pylori doesn’t invade the tissue ,but induces an intense inflammatory response by induce production of pro inflammatory cytokines like interleukin which recruits and activates the neutrophils
2)Several bacterial products like ureas are causing epi. Cell injury and induction of inflammation.
Bacterial protease and phospholipase breakdown glycoproteins-lipid complexes in the gastric mucous ,thus weakening the first line of m. defence
3)H.pylori enhance gastric acid secretion and impairs duodenal bicarbonate production thus reducing normal luminal ph in the duodenum
4)Several H.pylori proteins are immunogenic ,and they evoke immune response in mucosa .Both activated T & B cells can be seen in chronic gastritis caused by H.pylori

Question 18

In patients who don’t have H.pylori infection NSAIDs are the major causes of peptic ulcer disease .Explain the mechanism !

Answer 18

1)Suppression of prostaglandin synthesis
2)Inhibition of prostaglandin synthesis increase secretion of HCL and reduce the HCO3-
and mucin production
3)Loss of mucin degrades the mucosal barrier that normally prevents acid from reaching the epithelium
4)By not clear mechanism ,some NSAIDs also impair angiogenesis,thus impeding the healing of ulcers

Question 19

Most peptic ulcer cause ….,….,….but significant minority first come to light with complications such as ….or….

Answer 19

Epigastric gnawing ,burning ,boring pain ,haemorrhage ,perforation

Question 20

The pain of peptic ulcer tends to be worse at evening and occurs usually 2-3 hours after meals True/False?

Answer 20

False .The correct is

At night ,1-3 hours after meals

Question 21

Classically how the pain of peptic ulcer is relived ?

Answer 21

By ingestion of alkalis and food

Question 22

Stomach and jejunum are the common site for stress ulcers True/False?

Answer 22

False .The correct is

Stomach and duodenum

Question 23

Numerate the causes of stress ulcer.

Answer 23

1)Severe trauma including major surgical procedures ,sepsis or grave disease of any type
2)Extensive burns(the ulcers is then referred to curling ulcers).
3)Traumatic or surgical injury of CNS or intracerebral
haemorrhage(the ulcer is then referred to cushing ulcer).
4)Chronic exposure to gastric irritant drugs ,particularly NSAIDs and corticosteroids

Question 24

Answer By True or False

1) The acute ulcer is appearing usually polypoid and medium lesions
2) Its base is frequently stained dark brown due to acid digestion of extruded blood

Answer 24

1)False .The correct is
Circular and small (less than 1 cm in diameter)
2)True

Question 25

Numerate the types of gastric polyps!

Answer 25

1)Hyper-plastic polyp (80%-85%)
2)Fundic polyp (about 10%)
3)Adenomatous polyp (about 5%)
All three types associated with chronic gastritis

Question 26

Carcinoma represent 80%-85% of gastric carcinoma True/False?

Answer 26

False .The correct is

90%-95%

Question 27

Gastric carcinoma include …..&…..&…..

Answer 27

1) Carcinoma which represents 90%-95%
2) Lymphomas and carcinoids (4%-3%)
3) Mesenchymal spindle cell tumours (2%)

Question 28

According the morphology of gastric carcinoma it classified into …..&…..&….

Answer 28

1) Exophytic
2) Flat or depressed
3) Excavated

Question 29

Which form of gastric carcinoma cause linitis plastica ?

Answer 29

Flat or depressed form

Question 30

Histologic appearance of gastric cancer include …..&…..

Answer 30

1) Intestinal variant

2) Diffuse variant

Question 31

Explain the early spread of gastric carcinoma !

Answer 31

The earliest lymph node metastasis may sometimes involve the supraclavicular lymph node (Virchow’s node)
Another somewhat of unusual intraperitoneal spread in women is to the both ovaries giving rise to so called Krukenberg tumour

Question 32

Advanced gastric carcinoma is symptomatic and involve sometimes abdominal discomfort or weight loss True/False ?

Answer 32

False .The correct is

Asymptomatic