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Pathology-8

STOMACH

QuestionAnswer
cardia is made up of what cells? mucous cells (cardia glands)
the fundus is made up of what cells? parietal, chief, oxyntic glands, scattered endocrine
body is made up of what cells? oxyntic: parietal/chief, scattered endocrine cells
the pylorus is made up of what cells? mucous secreting/endocrine
the antrum is made up of what cells? mucous secreting/endocrine, G cells
mucous cells are located? secreting? cardia/antral (secreting mucous and pepsinogens
where are parietal cells located in the oxyntic gland? in the upper part, toward the surface
what do parietal cells secrete? intrinsic factor, H+
what is the function of intrinsic factor? it binds vitamin B12 in teh duodenum and permits absorption in the ileum
where are chief cells located in the oxyntic gland? the lower part, toward the base
explain how pepsin is activated? parietal cells secrete H+ which lowers the pH, which activates pepsinogen 1 and 2 secreted by chief cells, which is converted to pepsin
where are the main endocrine cells located? G cells, in the antrum
what are the endocrine cells in the body of the stomach for? they release histamine, which activates parietal cells, decreasing pH, increasing acid production
B: explain how the cells interact during feeding? see food (celiac phase) activ Ach rec, which act parietal cells by influx of Ca2+, decreases pH. G cells were also stimulated so gastrin incr Ca2+ influx, and activ Histamine incr acid
what problems are associated with pyloric stenosis? trisomy 18, turner syndrome, esophageal atresia
who is most affected by pyloric stenosis? male infants
what is the typical presentation of congenital pyloric stenosis? projectile vomiting and regurgitation in the 2nd or 3rd week
severe congenital diaphragmatic hernias can be associated with what? all of GI out into thorax--> hypoplasia of lung (severe respiratory distress)
acquired pyloric stenosis arise from? tumors or fibrosis, often associated with gastric ulcers (scarring)
Helicobacter pylori, causing gastritis, most likely manifests where? antrum (90%)
what is the most impt cause of chronic gastritis? helicobacter pylori
What diseases is Hpyloir associated with? chronic gastritis, peptic ulcer ds, gastric carcinoma, Gastric MALT lymphoma (definitive)
GASTRIC MALT LYMPHOMA is always associated with what? Hpylori infx
what are the common etiologies for gastritis? autoimmunity, alco/cig, post-surgical, radiation, granulomatous inflamm (Chron's), GVHD
acute gastritis is usually caused by what? NSAIDS, alcohol
acute gastritis usually involves what part of the stomach? body, fundus, antrum
acute gastritis is characterized by what type of lesions? SUPERFICIAL
where does chronic gastritis usually locate? body/fundus, hardly ever the antrum
what is the most common cause of chronic gastritis? second most common? Hpylori (1) autoimmune (2)
autoimmune chronic gastritis is usually to ______ cells parietal
autoimmune chronic gastritis is usually associated with what? pernicous anemia, Hashimoto's thyroiditis, Addison's disease, DM type 1
You suspect gastritis in a pt. What tests can be done non-invasively? serology, fecal bacterial detection, urea breath test
You have exhausted all non-invasive tests on a patient for which you still suspect gastritis. Which invasive tests? rapid urease tests, PCR, biopsy (often done), culture
You obtain a biopsy on a pt with suspected gastritis. What will be done with this biopsy. Silver stain will look for superficial HP cells on the mucosal lining that look like seaguls
what typically defines a peptic ulcer? solitary lesion <4cm, but can see >4cm
What size of peptic ulcer is the worst? peptic ulcers are graded based on size; a small may be malignant where a large may be benign
where are peptic ulcers usually located? lesser curvature (antrum) or first part of duodenum
what is the trx for peptic ulcers? they normally heal spontanously, but can recur
what are complications for peptic ulcers? can cause massive hematemasis in addition to varicies, if perforates past muscularis mucosa or sometimes wall
You tell a pt you think their peptic ulcer has healed, bc you know they heal spontanously. She thanks you say much. What do you say? They can recur
what is the pathogenesis of a peptic ulcer? either increased aggressive forces or decreased body protection
what are the increased aggressive factors that can lead to peptic ulcer? HPylori infx, NSAID, aspirin, cigs/alc, impaired regulation of acid/pepsin secretion
what are the decreased body protections that can lead to peptic ulceration? ischemia, shock, delayed gastric emptying, duodenal reflux
what are the complications for peptic ulceration? bleeding (M/C), perforation, edema/scarring, pain
25% of peptic ulcer deaths are due to? bleeding
what is the most common complication in peptic ulcer? bleeding
what is the common morphology of acute gastric ulceration? multiple lesions (that may be superficial or deep) mainly in the stomach (less in duodenum)
what is the typical situation underlying acute gastric ulceration? extensive burns, shock, trauma, head injury
Menetrier's Disease? rare, hyperplasia of the superficial mucosal cells with glandular atrophy
hypertrophic hypersecretory gastropathy? rare, hyperplasia of chief and parietal cells
hyperplasia of the chief and parietal cells? hypertrophic hypersecretory gastropathy, rare
hyperplasia of the superficial mucosal cells with glandular atrophy? Menetrier's disease, rare
Zollinger Ellison Syndrome? rare, hypertrophic gastropathy, hyperplasia of gastric glands, secondary to gastrin production, multiple intractable ulcers, unbearably painful
what does a Zollinger Ellison syndrome slide look like (morphologically)? cerebriform hyperplasia of rugal fold, brain
what is the clinical significant of Zollinger-Ellison syndrome? it may mimick carcinoma of the stomach bc of changed rugal pattern
hyperplasia of gastric glands, causing excess gastrin production? Zollinger-Ellison syndrome, multiple intractable ulcers, unbearably painful
Most Benign Gastric Polyps are ______? Less commonly they are ---? hyperplastic (90%); adenomatous
You have a pt with a benign adematous polyp. Why are you clinically monitoring and being very thorough in your benign diagnosis? 40% of aden. polyps have a carcinoma focus on dx, and the risk of carcinoma in the adjacent mucosa is as high as 30%
gastric carcinoma is associated with? diet, smoking, Group A blood, chronic atrophic gastritis, HP infx, gastric adenoma, partial gastrectomy, Barret's esophagus
Barrett's esophagus may lead to what----? adenoCAR of esophagus and gastric carcinoma
what is the most common location for gastric carcinoma? pyloris and antrum, along the lesser curvature
How are gastric CAR's classified? intestinal (polypoidal or ulcerated) vs diffuse (Linitus plastica)
Diffuse gastric carcinoma? Linitus plastica
what defines gastric carcinoma as being advanced? Linitus plastica (diffuse) or excavated (extending into the muscularis propria)
what do you notice histologically for Linitus plastica? diffuse lesion, no distinct epi lesion, wall is thickened, signet ring cells
If you have a gastric carcinoma with no signet ring cells, how do you classify? poorly differentiated
what are the clinical features of gastric carcinoma? weight loss, abd pain, anorexia, vomiting, hemorrhage, anemia
what is the prx for gastric car? good prx if detected early
what is the most common site for extranodal lymphomas? stomach, weird..we're in the stomach section
GIST. what is the suspected cell of origin? interstitial cell of Cajal
GIST is associated with what? Carney's Triad: gastric GIST, paraganglioma, pulmonary chondroma
what is Carney's Triad? GIST, pulmonary chondroma, gastric GIST
You're in the NICU with 4 projectile vomiting male infants. You know 1 of them has cong. pyloric stenosis. What's a good way to tell by evaluating the vomit? good way to tell on gross finding? good way to tell genetically? Treatment? look for NON-BILOUS vomit bc it hasn't touched the stomach yet; grossly for esophageal atresia, visible peristalsis, or palpable mass; genetically trisomy 18, turner's syndr; tx is surgical splitting "knick"
You have a pt with antral gastritis and peptic ulcers. He's had this for 10years. Increases risk for? acquired pyloric stenosis
why are NSAIDS the main cause for acute gastritis? they inhibit prostaglandins which inhibit vasodilation of backflow vessels removing acid when it needs to be; prostaglanding also increases bicarb, which is now decreased
You see a gastric mucosa with hyperemic, punctate dark spots grossly. what do you suspect? what are common causes? acute gastritis--common causes aspirin/Rheumatoid arthritis
B: what accompanies chronic gastritis histologically, concerning the mucosa? mucosal inflammatory changes: mucosal atrophy and intestinal metaplasia, usually in the absence of erosions
How does Chron's disease involve the stomach? it can cause chronic gastritis
Helicobacter infx increases with ____. age
Most people (have/don't have) HPylori infx, which are mostly (symptomatic/asymptomatic)? most have; most asymptomatic
All bacteria don't survive in the stomach. Does Hpylori have something special? urease (produces ammonia to buffer acid) and flagella to move away from acid
Why is blood group A more prone to gastric carcinoma? Increased risk for infex, and association with Helicobacter pylori
B: what is the target for the autoanitbody in autoimmune gastritis leading to pernicious anemia? the H-K ATPase of parietal cells, gastrin receptor, and IF
autoimmune gastritis (a chronic gastritis) is at increased risk for _______? gastric carcinoma and endocrine carcinoid tumors
Why is there usually no damage to the antrum in autoimmune chronic gastritis? there are no parietal cells in the antrum
B: what do you typically see in terms of acid release in autoimmune chronic gastritis? increased gastrin and achlorochondria
There are many subtypes of hypertrophic gastropathies. How are they all similar They all produce cerebriform giant enlargement sof rugal folds of the gastric mucosa and they are all RARE
B: In hypertrophic gastrophy, specially Zollinger-Ellison syndrome, why does the gastric galnd undergo hyperplasia secondary to gastrin secrtion? in the settin gof a gastrinoma
B: Why are hypertrophic gastropathies clinically significant? On endoscopy they mimick gastric carcinoma or lymphoma, and (2) Zollinger Ellison or Hypertrophic-Hypersecretory gastropathy can predispose to peptic ulcers
B: Menetriers disease is a type of _________ that may be associated with ___secondary disease___? protein-losing gastroenteropathy
B: Gastric varicies? most often co-present with esophageal varicies, usually due to portal HTN, hard to see, most lie within 2 cm of GE jxn
B: Tumors of the stomach, just like in esophagus and intestines, predominantly arise from _____? mucosa, not mesenchyme or stroma
B: In the alimentary canal, the term polp is reserved for mass lesions in teh mucosa, but you may ocassionally get a submucosal ______ or _________ that may protrude, generating a "polypoid" lesion. lipoma or leiomyoma
gastric polyps common or uncommon? uncommon
peptic ulcers...common or uncommon? common
B: when you say that 90% of gastric polyps are hyperplastic, what do you mean? the foveolar epithelium is hyperplastic; benign (no dysplasia); also get cystically dilated glandular tissue, with a lamina propria with increased infl cells and smooth muscle
Most hyperplastic polyps are ________(morphology) and are located in the _____? sessile; antrum
Stomach adenomas comprise _____% of the polypoid lesions of the stomach? 5-10%
B: how do hyperplastic and adenoma polypoid lesions differ? adenomas are dysplastic, meaning they have malignant potential
Adenomatous polyps are much more common in ______ (location)? colon
Gastric adenomas may be ___________ (morphology) and are most commonly located in _____? sessile or pedunculated; antrum
B: How do adenomas of the stomach and colon differ? In the stomach they can cover a large area of flat gastric mucosa without forming a mass lesion; colon they cover small areas. In the stomach they arise with a background of inflammation and intestinal metaplasia, where in colon arise from normal mucosa
B: inflammatory fibroid polyp (eosinophilic granuloma)? typically at distal stomach, may cause acute gastric outlet obstruction
B: when are hyperplastic polyps most likely seen? in the setting of chronic gastritis
What is the most comon tumor of the stomach? gastric carcinoma
B: order of tumors from incr freq to decr regarding gastric tumors? gastric CAR>lymphomas>carcinoids> mesenchymal tumors> GI stromal tumors> leiomyosarcomas> schwannoma
what is the second most common tumor in the world? gastric carcinoma
Gastric CAR more likely to affect? men, other countries, lower socioeconomic status
What is the leading cause of cancer deaths worlwide? gastric carcinoma
B: what are the major differences between intestinal and diffuse gastric carcinomas? INTESTINAL (bulky, glandular, M>F, high risk areas, precurser lesions, 55yo) DIFFUSE (poorly diff, discohesive malig cells, constant areas, no precurser, 48yo, M=F)
B: incr incidence of gastric carcinoma (risk factors ass with intestinal type; diffuse not really known) ENVIROM (Hpyl, nitrites, smoked/salted foods, lack of fresh fruit, low socio, cigs); HOST (chronic gastritis, hypochl, gastric adenoma, barrets esophagus);GENETIC (blood groupA, hx, HNPCC, E-cadherin mut)
B: Why are partial gastrectomies a risk factor for gastric carcinoma? it disrupts mucosa leaving it in a state of shock and thus hypochlorochondria, which favors bacterial growth, bile reflux, and chronic gastritis.
B: Why does Menetrier's disease have an incr risk for gastric carcinoma? bc it causes hyperplasia of the mucosal cells and glandular atrophy which disrupts mucosa and turns acid production off (hypochlorochondria) favoring bacterial gastritis.
B: the favored location for gastric carcinoma is the _________ curvature in the _____ region? lesser; antropyloric region
B: what morphologic feature has the best cooreclation with clinical outcome in gastric car? depth of invasion
B: what separates an early vs advanced gastric carcinoma? early (mucosa+submucosa confined); advanced extends below the submucosa into the muscular wall
For unknown reasons, all gastric carcinomas eventually invade and become advanced (bc of serosa) and frequently metastasize to ______nodes? Virchow's nodes (supraclavicular sentinel), periumbilical region (foriming a subq nodule called a Sister Mary Joseph nodule)
Sister Mary Joseph Nodule? gastric carcinoma
Krunkenberg Tumor metastatic adenocarcinoma from gastric carcinoma spreading to ovary
interstitial cell of Cajal? GIST, cells that control GI peristalsis
GIST tumors are thought to be involved in a tumor syndrome? Carney's Syndrome (GIST, paraganglioma, pulomonary chondroma)
B: On a histologic slide you see a "lymphoepithelial lesion" from the stomach? Gastric MALT lymphoma
B: majority of GIST tumors are positive for? C-Kit
What is a gastric carcinoid tumor? a gastric neuroendocrine cell
B: breast and lung cancer metastasis can mimick _____ in the stomach? linitus plastica
Created by: HSF2