Stomach and Peptic Ulcer Disease

Question 1

What are the mucosal defences of the stomach? (6)

Answer 1

1. mucous
2. phospholipids
3. bicarb
4. epithelial cells
5. blood flow
6. prostaglandin E2 and I2

Question 2

What is pyloric stenosis?

Answer 2

congenital concentric narrowing of the pyloric sphincter and narrowing of the pyloric canal

Question 3

What is the pathology of pyloric stenosis?

Answer 3

muscular hypertrophy of pyloric circular muscle coat

Question 4

What are the symptoms of pyloric stenosis?

Answer 4

projectile vomiting in the 2nd or 3rd week of life

Question 5

What are the causes of chronic gastritis? (3)

Answer 5

1. helicobacter pylori infection
2. autoimmune
3. chemical damage

Question 6

What is acute gastritis?

Answer 6

acute mucosal inflammation, without glandular loss or atrophy usually of a transient nature

Question 7

What are the associations of acute gastritis? (9)

Answer 7

1. NSAID use
2. alcohol
3. smoking
4. chemotherapy
5. uraemia
6. systemic infections
7. stress
8. ischaemia
9. neurotrauma

Question 8

What are the gross features of acute gastritis? (3)

Answer 8

1. shiny oedema
2. hyperaemia and intramucosal haemorrhage - red
3. multiple superficial erosions

Question 9

What are the histological characteristics of chronic gastritis? (5)

Answer 9

1. presence of chronic mucosal leucocytic infiltrate
2. lymphocytes
3. plama cells
4. +/- neutrophils
5. +/- epithelial changes

Question 10

What is chronic gastritis associated with? (3)

Answer 10

1. h pylori
2. autoimmunity
3. reflux

Question 11

What is the most common cause of chronic gastritis?

Answer 11

h pylori

Question 12

What virulence factors does h pylori use for colonisation?

Answer 12

1. Urease
2. flagella
3. adhesins

Question 13

What virulence factors does H pylori use for immune escape?

Answer 13

1. flagella
2. CagA
3. VacA

Question 14

What is the histology of chronic gastritis caused by h pylori? (4)

Answer 14

1. HLOs on surface epithelium
2. chronic inflammation
3. lymphoid follicle formation
4. MALT

Question 15

What are the host factors that influence H pylori gastritis? (3)

Answer 15

1. blood group A
2. cytokine
3. receptor gene polymorphisms

Question 16

What are the two patterns of h pylori associated gastritis?

Answer 16

1. antral gastritis

2. pangastritis

Question 17

What is the most common pattern of h pylori associated gastritis?

Answer 17

antral gastritis

Question 18

What are the risks of h pylori associated gastritis? (3)

Answer 18

1. peptic ulcer disease
2. gastric carcinoma risk
3. Maltoma

Question 19

What does the body generate antibodies against in autoimmune gastritis?

Answer 19

1. parietal cells

2. intrinsic factor

Question 20

When does chemical/reactive chronic gastritis occur?

Answer 20

1. post surgery cholecystectomy, by-pass
2. bile acids are an irritant
3. NSAIDS
4. alcohol

Question 21

What are the characteristics of chemical/reactive gastritis? (3)

Answer 21

1, oedema

2. vasodilation
3. scant leucocytes

Question 22

What is the definition of a gastric ulcer?

Answer 22

a breach in the mucosa of the alimentary tract that extends through the muscularis mucosa into the submucosa or deeper

Question 23

What is the definition of peptic ulceration?

Answer 23

a breach in the mucosal lining of the alimentary tract as a result of acid and pepsin attack

Question 24

What are the sites of peptid ulcer disease? (2)

Answer 24

1. first part of duodenum

2. stomach

Question 25

What is the cause of peptic ulcer disease? (6)

Answer 25

1. shift in balance from mucosal defence to mucosal damage 2. h pylori 3. hyperacidity 4. decreased prostaglandins 5. irritants 6. genetic factors

Question 26

What are the causes of acute peptic ulcers? (2)

Answer 26

1. stress | 2. extreme hyperacidity

Question 27

What is the gross appearance of chronic peptic ulcers? (6)

Answer 27

1. 80% solitary 2. 1-3cm 3. round to oval 4. sharply punched out 5. straight walls 6. overhang base

Question 28

Where do duodenal ulcers usually occur? (2)

Answer 28

1. 90% first part | 2. anterior wall

Question 29

Where do gastric ulcers usually occur?

Answer 29

1. predominantly on lesser curvature

Question 30

What are the complications of peptic ulcer disease? (5)

Answer 30

1. perforation - peritonitis 2. penetration - adjacent organ 3. haemorrhage 4. stenosis/stricture 5. malignant change

Question 31

What are the clinical features of peptic ulcer disease? (2)

Answer 31

1. dyspepsia | 2. epigastric pain

Question 32

What is a polyp?

Answer 32

protuberant mass of tissue

Question 33

What are the majority of mesenchymal tumours?

Answer 33

gastrointestinal stromal tumours

Question 34

What cells are affected by gastrointestinal stromal tumours?

Answer 34

interstitial pacemaker cells of cajal

Question 35

What are the mutations associated with gastrointestinal stromal tumours? (2)

Answer 35

1. C-Kit | 2. PDGFRA tyrosine kinase mutations

Question 36

What are adenomas?

Answer 36

benign glandular epithelial neoplasms

Question 37

What are the majority of malignant gastric tumours?

Answer 37

adenocarcinomas

Question 38

What are the different types of gastric adenocarcinomas?

Answer 38

1. intestinal type - glands | 2. diffuse - signet ring single cells

Question 39

What is intestinal gastric adenocarcinoma associated with?

Answer 39

1. h pylori 2. autoimmune gastritis 3. intestinal metaplasia 4. low acid 5. altered flora 6. carcinogens 7. preserved food 8. high prevalence areas

Question 40

What is diffuse gastric adenocarcinoma associated with?

Answer 40

1. low prevalence areas

Question 41

What do gastric lymphomas present with? (3)

Answer 41

1. weight loss 2. dyspepsia 3. abdominal pain

Question 42

What are the types of gastric lymphomas?

Answer 42

1. high grade diffuse large B cell lymphomas | 2. low grade B cell lymphomas - MALTOMAS