Stomach pathology Flashcards by Stacey Hansen

This occurs when abdominal contents or adipose protrudes
Is due to periumbilical or linea alba weakness

Umbilical hernia

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Is an umbilical hernia covered by skin?

Yes
Skin and peritoneum

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Is an omphalocele covered by skin?

No
But covered by peritoneum

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Does an umbilical hernia require surgery?

Most close spontaneously by 4-5 years
Surgery if persistent or strangulation results

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This is a herniation of abdominal contents into base of umbilical cord

Omphalocele

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This is herniation of small/large intestine through abdominal wall opening

Gastroschisis

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Does a Gastroschsis occur on the left or right side of the umbilical insertion?

Right

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Are omphaloceles associated with syndromic / karyotypic abnormalities?

Yes; some

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Are gastroschisis associated with syndromic / karyotypic abnormalities?

Rarely
Thought to be ischemic insult

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Is Gastroschisis covered by skin?

No
No skin or peritoneal covering

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Neonatal gastric outlet obstruction caused by hypertrophic pyloric sphincter
More common in first born males
Begins at about 3 weeks

Pyloric stenosis

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A baby that eats, progresses to projectile vomiting, and then quickly hungry again may have this condition

Pyloric stenosis

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These three molecules are lost in Pyloric stenosis

H+, H2O, Cl-

Leading to hypochloremic metabolic alkalosis, dehydration, malnutrition

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A firm, movable, 2cm olive-shaped mass that is above/right on the umbilicus indicates this condition

Pyloric stenosis

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What is the treatment for Pyloric stenosis?

Pyloromyotomy

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Impaired mucosal integrity of gastric or duodenal mucosa resulting in exposure of underlying tissue
More common in men

Peptic ulcer disease

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This type of peptic ulcer disease is sometimes benign, sometimes malignant

Gastric

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Most gastric peptic ulcer disease occurs in this part of the stomach

Antrum / pylorus

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This type of peptic ulcer disease has pain that worsens with eating

Gastric

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This type of peptic ulcer disease is almost always benign

Duodenal

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Most duodenal peptic ulcer disease occurs in this part of the duodenum

Proximal

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This type of peptic ulcer disease has pain that improves with eating

Duodenal

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This type of peptic ulcer disease is associated with H+ hypersecretion
(like ZE syndrome)

Distal duodenum / jejunum

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With gastric peptic ulcer disease, is pain worse or better with eating?

Worse

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With duodenal peptic ulcer disease, is pain worse or better with eating?

Improves

Distal duodenum / jejunum peptic ulcer disease is associated with hypersecretion of this

H+

What effect do prostaglandins have on acid secretion?

Decrease (also increase blood flow, increase bicarb, increase mucus)

Chronic use of these two compounds can result in multiple shallow ulcers/erosions

NSAIDS and ethanol

Morphology of acute gastritis caused by chronic use of either of these two compounds will show reactive gastropathy

NSAIDS and ethanol

This type of ulcer is caused by stress, and etiologies like burns, shock, and critical illness (ICU patients)

Curling ulcers

Why are ICU patients usually placed on prophylactic PPI or H2 antagonists?

Because they can have stress ulcers (Curling ulcers)

This type of ulcer is caused by increased intracranial pressure, seen in head trauma/bleed

Cushing ulcer

In a Cushing ulcer, vagal stimulation releases this

Acetylcholine (which stimulates parietal cells to secrete acid)

Is Cushing ulcer more severe than ulcers from NSAID/EtOH?

Yes; often more severe

This condition is caused by a gastrin secreting tumor of the pancreas/duodenum

Zollinger-Ellison syndrome

Zollinger-Ellison syndrome is caused by a tumor of pancreas/duodenum that secretes this compound

Gastrin results in acid hypersecretion = multiple ulcers that tend to be refractory; often in distal locations

Multiple ulcers that tend to be refractory, often in distal locations like the jejunum, could be caused by this condition

Zollinger-Ellison syndrome

This is the most common cause of gastric and duodenal ulcers

Helicobacter pylori gastritis

Zollinger-Ellison syndrome typically presents with multiple ulcers in this location

Distal locations - like jejunum

Is H. pylori gram positive or negative?

Negative

Antral-predominant H. pylori infections are associated with this type of ulcer

Duodenal

Corpus-predominant H. pylori infections are associated with this type of ulcer

Gastric

Band of lymphoplasmacytic inflammation in superficial mucosa (chronic) and Intraepithelial neutrophils (active) are seen in this condition

Chronic superficial/active gastritis (caused by H. pylori)

H. pylori of this part of the stomach causes inflammation that results in D cells damage and loss of gastrin inhibition

Antrum

H. pylori of this part of the stomach causes hyperacidity that is passed to duodenum, leading to peptic duodenitis, duodenal ulcer, and foveolar metaplasia and inflammation

Antrum

H. pylori of this part of the stomach causes tissue damage and repair, resulting in gastric atrophy and hypochlorhydria

Corpus

What causes metaplasia (and subsequent dysplasia; carcinoma sequence) in H. pylori infection?

Free radicals, reactive oxygen species

How can iron deficiency result from H. pylori infection?

Peptic ulcer disease --> bleeding

This complication of H. pylori infection is protective against GERD

Chronic atrophic gastritis (but this can cause lymphoma and adenocarcinoma)

Is Autoimmune gastritis more common in males or females?

Females

Autoimmune gastritis is destruction of these cells

Parietal cells

This autoimmune condition that results in the destruction of parietal cells is associated with diabetes and hypothyroidism

Autoimmune gastritis

Parietal cells are present in this part of the stomach

Fundus / body

This condition is a loss of H+

Achlorhydria

Achlorhydria is a loss of this

H+

How does autoimmune gastritis cause macrocytic anemia?

Destruction of parietal cells, which leads to loss of intrinsic factor and low B12

How can Autoimmune gastritis cause carcinoid tumors?

Decreased H+ = hypochlorhydria --> enterochromaffin cell stimulation and hyperplasia --> neoplasia

Can Autoimmune gastritis cause adenocarcinoma?

Yes chronic inflammation --> intestine metaplasia

Are there goblet cells in the stomach?

Morphology of Autoimmune gastritis involves both of these parts of the stomach

Body and fundus

Lymphocytes and plasma cells in deep layers, that are centered on glands, and mucosal atrophy are seen in this condition Also intestinal metaplasia and ECL hyperplasia

Autoimmune gastritis

Subacute combined degeneration is a late manifestation of this autoimmune stomach condition

Autoimmune gastritis

This condition is hypertrophic gastropathy with hypermucinous change

Menetrier disease

This condition is also known as hypertrophic gastropathy

Menetrier disease

Rare idiopathic disorder resulting in prominent fundic/body folds Results in hypochlorhydria Protein loss due to hypersecretion Weight loss

Menetrier disease

What causes hypoproteinemia / albuminemia in Menetrier disease?

Excess mucus secretion

What causes hypochlorhydria in Menetrier disease?

Crowds out parietal cells

Morphology of this condition will show thick folds in fundus/body of the stomach, and thickened surface/neck mucus epithelium

Menetrier disease

This condition is hypergastrinemia driven hyperchlorhydria

Zollinger Ellison syndrome

This condition is ectopic autonomous gastrin secretion from neuroendocrine tumor

Zollinger Ellison syndrome

Zollinger Ellison syndrome causes increased secretion from these cells

Parietal cells

There is hyperplasia of these two cell types in Zollinger Ellison syndrome

Parietal cells Enterochromaffin cells

A patient with refractory, recurrent ulcers that is H. pylori negative may have this condition characterized by thick gastric folds, gastroesophageal reflux, and diarrhea from small bowel damage

Zollinger Ellison syndrome

A patient with a secretin test resulting in gastrin that remains high or increases has this condition

Zollinger Ellison syndrome

What is the result of the secretin test in Zollinger Ellison syndrome?

Increased serum gastrin with secretin administration

What is the normal result of the secretin test?

Secretin should decrease gastrin secretion

This is a gastric polyp with elevated carcinoma risk Dysplastic; risk of developing adenocarcinoma

Gastric adenoma

Gastric adenoma occurs in these two settings

Background of inflammation and atrophy Polyposis syndromes (APC gene in familial adenomatous polyposis, MUTYH mutations in MUTYH-associated polyposis)

These two genes are involved in two conditions that can cause Gastric adenoma

APC gene (in familial adenomatous polyposis) MUTYH mutations in MUTYH-associated polyposis

This is a malignant glandular tumor of gastric epithelium Associated with cultural/dietary factors High incidence in Japan, Eastern Europe, some South/Central America

Gastric adenocarcinoma

These two conditions are at risk for Gastric adenocarcinoma

Autoimmune gastritis Long-term atrophic gastritis

Is there a high incidence of Gastric adenocarcinoma in the Western world?

No (due to less salt, nitrate preservation, H. pylori eradication programs)

What are the two types of Gastric adenocarcinoma?

Intestinal Diffuse (aka signet ring cell)

This mutation pathway is at risk for the intestinal type Gastric adenocarcinoma

WNT mutation pathway (APC loss of function; Beta catenin gain of function)

Loss of function of this gene is seen in intestinal type Gastric adenocarcinoma

APC gene

Gain of function of this gene is seen in intestinal type Gastric adenocarcinoma

Beta catenin

APC loss and Beta catenin gain of function can cause this type of Gastric adenocarcinoma

Intestinal type

CDH mutations result in loss of this molecule, which can cause diffuse type Gastric adenocarcinoma

E-cadherin adhesion molecule

CDH mutations resulting in E-cadherin adhesion molecule loss can cause this type of Gastric adenocarcinoma

Diffuse type (aka signet ring cell)

Mutations in this gene result in loss of E-cadherin adhesion molecule, and can cause diffuse type Gastric adenocarcinoma

CDH mutations

This type of Gastric adenocarcinoma is also known as linitis plastica

Diffuse type

This type of Gastric adenocarcinoma involves signet ring cells

Diffuse type

This tumor is often stage IV at diagnosis, and spread to liver and peritoneum Can show Sister Mary Joseph nodule (periumbilical metastasis), Virchow node (supraclavicular node), and Krukenberg tumor (bilateral ovarian metastases)

Gastric adenocarcinoma

Gastric adenocarcinoma spreads to these two locations

Liver, peritoneum

This tumor is often large/deep before symptomatic Can have blood loss, early satiety, obstruction, perforation, and metastatic spread

Gastric adenocarcinoma

This is a periumbilical metastasis that can occur with Gastric adenocarcinoma

Sister Mary Joseph nodule

This is a supraclavicular node that can occur with Gastric adenocarcinoma

Virchow node

This is bilateral ovarian metastases that can occur with Gastric adenocarcinoma

Krukenberg tumor

Is Gastric adenocarcinoma intestinal type single or multiple polypoid, exophytic mass(es)?

Single

This type of Gastric adenocarcinoma tends to ulcerate, and should be part of the differential along with peptic ulcer disease

Intestinal

This type of Gastric adenocarcinoma has heaped up margins Is larger than benign ulcers Produces bleeding more often

Intestinal

Does intestinal or diffuse type of Gastric adenocarcinoma produce bleeding more?

Intestinal

This type of Gastric adenocarcinoma will have recognizable glands, nuclear atypia, lack of polarity, mucin depletion, nucleoli, and dirty necrosis

Intestinal

This type of Gastric adenocarcinoma involves infiltration of gastric wall, wall thickening and rigidity (desmoplasia), leading to early satiety

Diffuse

This type of Gastric adenocarcinoma will have invasive signet ring cells

Diffuse type

This is a neuroendocrine tumor of the stomach Low or intermediate grade neoplasms

Gastric carcinoid

Do patients with underlying predisposition or sporadic Gastric carcinoid have a better prognosis?

Good prognosis with underlying predisposition (sporadic has worse prognosis)

These types of Gastric carcinoid are due to feedback loops Majority of tumors Constant lack of inhibition of ECL cells Eventual autonomous growth

Type I and II

Type I and II Gastric carcinoid involve a constant lack of inhibition of these cells

ECL cells

These types of Gastric carcinoid are present in fundus and body

Type I and II

These types of Gastric carcinoid are present in pylorus

Type III

Type I and II Gastric carcinoid tumors are present in this part of the stomach

Fundus and body

Type III Gastric carcinoid tumors are present in this part of the stomach

Pylorus

10% of patients with this tumor have carcinoid syndrome from serotonin secretion (flushing, diarrhea, asthma, facial edema, headache)

Gastric carcinoid

Some patients with Gastric carcinoid have carcinoid syndrome from secretion of this

Serotonin

Gastric carcinoid involves this layer initially

Submucosal

This tumor is morphologically submucosal initially, has round nests of epithelioid cells, and salt and pepper chromatin

Gastric carcinoid

This stomach tumor is chromogranin positive and synaptophysin positive

Gastric carcinoid

Gastric carcinoid is positive for these two proteins

Chromogranin Synaptophysin

This is a mesenchymal tumor of interstitial cells of Cajal