Usera: GI Tract 2

Question 1

What are the four anatomical regions of the stomach?

Answer 1

cardia (junction of esophagus & stomach)
fundus
body
pylorus (junction of stomach & small intestine)

Question 2

Describe the histology of the stomach - where are mucous cells found? Where are chief & parietal cells found? Where are enterochromaffin-like cells found? What do they secrete? Where are G cells, D cells, and enterochromaffin cells found? What does each of these secrete?

Answer 2

epithelial cells line the surface & pits of the entire stomach

chief & parietal cells are found in the body & fundus

enterochromaffin-like cells are found in the body & fundus & secrete histamine

G cells (secrete gastrin), D cells (secrete somatostatin), and enterochromaffin cells (secrete 5HT) - all found in the antrum of the stomach

Question 3

What are the three layers of the stomach?

Answer 3

mucosa
submucosa
muscularis propria

Question 4

The fundus/body of the stomach is comprised of (blank) that synthesize gastric juice. It is lined by (blank) and gastric pits. It contains (blank) & (blank) cells

Answer 4

straight tubular glands;
surface mucous cells;
parietal & chief cells

Question 5

Parietal cells are eosinophilic & secrete (blank)

Answer 5

intrinsic factor

Question 6

Chief cells are basophilic & secrete (blank)

Answer 6

pepsin

Question 7

Describe the histology of the antrum/cardia

Answer 7

contains glands that are branches & coiled & the gastric pits occupy half the thickness of the mucosa
glands are lined by mucus-secreting cells
small number of parietal cells are present

Question 8

The antrum/cardia contain (blank) that are branched & coiled and the (blank) occupy half the thickness of the mucosa. The glands are lined by (blank cells. Small number of (blank) are present.

Answer 8

glands;
gastric pits;
mucous-secreting cells;
parietal cells

Question 9

The gastric lumen has an acidic pH of (blank); therefore there is the potential for damage to the (blank)

Answer 9

1; mucosa

Question 10

What are some mechanisms for protection from the acidity of the stomach? What occurs when there is a breakdown of these mechanisms?

Answer 10

Mucin secreted from foveolar cells that prevents food from touching the epithelium
The mucus layer promotes the formation of a (neutral pH) layer of fluid over the epithelium
The rich vascular supply deliver O2, bicarbonate and nutrients and washes away acid that has back diffused into the lamina propria

**acute & chronic gastritis occur when there is a breakdown of these mechanisms

Question 11

What is acute gastritis? How does it present?

Answer 11

transient mucosal inflammatory process; 
usu asymptomatic
epigastric pain
nausea
vomiting
hematemesis
melena

Question 12

What things can cause acute gastritis?

Answer 12

NSAIDs (prevents prostaglandins - one of the major defense mechanisms)
H. pylori infection
aspirin
cigarettes (vasoconstriction)
alcohol (direct toxin)
gastric hyperacidity
duodenal-gastric reflux (bile reflux)

Question 13

(blank) is the preferred term for acute gastritis

Answer 13

active inflammation

Question 14

The presence of (blank) within the gastric mucosa denotes acute gastritis

Answer 14

neutrophils

**acute injury/inflammation

Question 15

How do you differentiate between erosion & ulceration?

Answer 15

erosion: loss of superficial epithelium - defect limited to the lamina propria - doesn’t get down to the muscularis
ulceration: loss of epithelium deeper than an erosion - includes a layer of necrosis, inflammation & granulation tissue - can get down past muscularis into superficial vessels

Question 16

What are the different types of gastric ulcers? What is each associated with?

Answer 16

stress ulcers - common in pts with SHOCK

curling ulcers - occur in the proximal duodenum, associated with SEVERE BURNS OR TRAUMA

cushing ulcers: gastric, duodenal or esophageal ulcers in patients with intracranial disease

Question 17

How does chronic gastritis present?

Answer 17

nausea
vomiting
upper abdominal discomfort

Question 18

What are some causes of chronic gastritis?

Answer 18

H. pylori
psychological stress
caffeine
alcohol
tobacco

Question 19

A spiral shaped or curved bacilli
Is present in almost all patients with duodenal ulcers and the majority of patients with gastric ulcers and chronic gastritis (90%)
Condition is the result of an imbalance between gastroduodenal mucosal defenses & damaging forces that overcome those defenses

Answer 19

H. pylori gastritis

Question 20

Which part of the stomach does H. pylori gastritis usually affect?

Answer 20

antrum

Question 21

What is the condition that occurs when H. pylori infects the fundus/body of the stomach? What are the symptoms?

Answer 21

multifocal atrophic gastritis;
reduced acid secretion
intestinal metaplasia
increased risk of gastric adenocarcinoma

Question 22

What will you see on histology with chronic gastritis?

Answer 22

plasma cells infiltrating

may see neutrophils if it is an “active” gastritis

Question 23

What part of the stomach is usually damaged by autoimmune gastritis? What are the symptoms?

Answer 23

body/fundus (this is where parietal cells are found);
antibodies to parietal cells & intrinsic factor
reduced pepsinogen concentration (some chief cell damage)
antral endocrine cell hyperplasia
Vit B12 deficiency (pernicious anemia)
achlorhydria

Question 24

What are some causes of reactive gastropathy?

Answer 24

chemical injury, NSAIDs, bile reflex, mucosal trauma

Question 25

Foveolar hyperplasia, mucosal edema and glandular regenerative changes

Answer 25

reactive gastropathy

Question 26

Dense infiltrates of eosinophils in the mucosa and muscularis

Answer 26

eosinophilic gastritis

Question 27

Causes of eosinophilic gastritis?

Answer 27

allergens, parasitic infection, H. pylori, collagen vascular disease

Question 28

What can cause granulomatous gastritis?

Answer 28

``` Chron's disease sarcoidosis mycobacteria fungi CMV H. pylori ```

Question 29

Peptic ulcer disease occurs in any portion of the GI tract exposed to (blank) Is most often associated with (blank) gastritis and (blank) gastritis

Answer 29

gastric acid; H. pylori; chronic

Question 30

Where do peptic ulcers usually occur? What causes peptic ulcer disease?

Answer 30

``` duodenum or antrum most commonly; anything that increases gastric acidity H. pylori infection parietal cell hyperplasia Zollinger-Ellison syndrome NSAIDs cigarette smoke high-dose steroids ```

Question 31

``` Nodules or masses that protrude above the level of the surrounding mucosa May result due to Epithelial or stromal hyperplasia Inflammation Ectopia Neoplasia ```

Answer 31

polyps

Question 32

75% of gastric polyps | Develop in association with CG (reactive hyperplasia)

Answer 32

inflammatory/hyperplastic polyps

Question 33

Seen in patients on long-term proton pump inhibitors | Occur sporadically and in those with familial adenomatous polyposis (FAP)

Answer 33

fundic gland polyps

Question 34

Occur in the background of chronic gastritis with atrophy and intestinal metaplasia Increased incidence in FAP (familial adenomatous polyposis) Low-grade dysplasia

Answer 34

adenoma

Question 35

Most common carcinoma of the stomach (90%)

Answer 35

adenocarcinoma

Question 36

Where does adenocarcinoma usu occur in the stomach?

Answer 36

antrum | lesser curvature

Question 37

2 major histological types of adenocarcinoma?

Answer 37

``` intestinal type (arise from adenoma) diffuse type (signet ring type - really lose, discohesive cells) ```

Question 38

What types of cells would you see in adenocarcinoma of the stomach - diffuse type?

Answer 38

signet ring cells

Question 39

What are lymphomas called in the gut? What usu caused em?

Answer 39

lymphomas derived from mucosa associated lymphoid tissue (MALToma) H. pylori!!!

Question 40

What is the most common lymphoma? What would you call it when it occurs in the gut mucosa?

Answer 40

extra nodal marginal zone B-cell lymphoma; MALToma

Question 41

Where do MALToma lymphomas usu arise in the stomach? How do you treat em?

Answer 41

at sites of chronic inflammation (due to H. pylori); treat the H. pylori infection w antibiotics!

Question 42

``` Another tumor of the stomach Formerly called carcinoids May be associated with Endocrine cell hyperplasia Chronic atrophic gastritis Zollinger-Ellison syndrome (gastrinoma) May produce a syndrome depending on which hormone is produces ```

Answer 42

neuroendocrine tumors

Question 43

Most common mesenchymal tumor of the abdomen Arise from the interstitial cells of Cajal in the GI tract Derived from mesenchyme Stain for CD117 (C-kit)

Answer 43

gastrointestinal stromal tumor CD117 - overactive tyrosine kinase

Question 44

What will you see in atrophic gastritis?

Answer 44

you'll see intestinal metaplasia **goblet cells of intestine w/i stomach

Question 45

Where does the signet ring carcinoma of the stomach metastasize to most commonly?

Answer 45

to the ovary - called a Krukenberg tumor