Gastritis and Gastric Cancer – Flashcards
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Most common cause of chronic gastritis? What sort of therapy is making this increasingly less common?
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H. Pylori Triple therapy for H. pylori
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Biopsy in H. Pylori?
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Gram negative slender curved rods Hyperemic mucosa Lymphocytes Plasma cells Warthrin Silver stain
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Simpler way to confirm H. pylori presence or eradication?
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Urease breath test Antigen in stool
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Three risks associated with H. Pylori chronic gastritis? Which one is common to Autoimmune gastritis?
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1. Ulceration 2. MALT lymphoma - Post germinal centre B cells in marginal zone 3. Intestinal metaplasia (common to autoimmune gastritis, risk for gastric adenocarcinoma).
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WHat is triple therapy?
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Clarithromycin Amoxycillin omeprazole to eradicate H pylori
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Autoimmune gastritis occurs in the what and what of the stomach?
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Fundus and body
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H. Pylori gastritis occurs in the what of the stomach?
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antrum.
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What is the most common cause of duodenal ulcer? Second most common cause?
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H. pylori Zollinger Ellinson-Syndrome / gastrinoma
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Why does pain caused by duodenal ulcers improve with meals?
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Because the duodenum begins to make protective substances in preparation for a meal that neutralize incoming stomach acid.
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What type of duodenal gland becomes hypertrophied in a duodenal ulcer? Why?
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Brunner's glands Because they usually produce mucous and alkalinizing substances.
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Complications of posterior duodenal ulcer rupture (2)?
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Acute pancreatitis Gastroduodenal artery rupture.
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Where are Foveolar cells located? WHat do they do?
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They are located on the surface layer of teh gastric mucosa. They produce neutralizing mucous.
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Causes of acute gastritis?
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Loss of prostaglandins due to NSAID use ISchemia (Burns, shock) Increased intracranial pressure Increased acid production
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How does increased ICP cause acute gastritis?
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Causes vagal stimulation, release of acetylcholine, which stimulates acid release from the parietal cell.
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What are the three substances that have receptors for inducing acid production from the parietal cell?
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Gastrin Histamine Acetylcholine
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What type of hypersensitivity is autoimmune gastritis, mediated by what type of cell?
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Type 4, by T cells
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What type of antibodies are created as a result of autoimmune destruction of parietal cells?
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Antibodies against IF Antibodies against Parietal cells.
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What are three consequences of fundal of body chronic gastritis?
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1. Chronic inflammation may lead to intestinal metaplasia, predisposing to gastric carcinoma 2. Achlorhydria causes antral G cell hyperplasia, increased gastrin 3. Loss of IF causes Pernicious anemia.
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Difference in pain features between duodenal ulcer and gastric ulcer?
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Duodenal ulcer - relieved by eating, gastric ulcer worsened by eating.
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Where are most gastric ulcers located? What structure is nearby here with what risk?
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Less curvature of the antrum. The left gastric artery.
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Causes of gastric ulcer (3).
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1. H pylori 2. NSAIDs 3. Gastric carcinoma.
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Risk factors for gastric adenocarcinoma. WHat cell type? aka? Where does it occur?
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1. Intestinal metaplasia 2. SMoked foods 3. Blood type A. Columnar epthelial cells. Intestinal type. Lesser curvature the stomach.
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Diffuse cell gastric cancer. Pathological features on gross section?
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Thickening of the stomach wall, rhinitis plastica, desmoplasia.
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Pathological features of X cancer on histology? Name of cell? Name of tissue change? What happens to the nuclei?
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Signet ring cells diffusely infiltrate gastric wall. Nucleus is pushed off to edge by mucin produced by tumor cells.
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Features of benign gastric ulcers?
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SMALL. Punched out. Margins not raised.
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Features of cancerous gastric ulcers?
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Large, irregular, heaped up margins, NOT punched out.
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Uh oh, mucous containing goblet cells in the stomach? Causes?
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Intestinal metaplasia H. pylori, autoimmune gastritis.
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Presenting signs of gastric carcinoma (4)? When does it present? Special features and why?
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Weight loss, early satiety, anemia, abdominal pain. Late. Acanthosis nigricans. Don't know. Lesser-Trelat sign. Many actinic keratoses seen on body.
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What is characteristic lymph node site for gastric cancer? Which side?
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Supraclavicular node. Left. Virchow's node.
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Classic site of met for intestinal type gastric cancer? NAme? Which type of gastric cancer does this again please?
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Sister Mary Joseph nodule. Periumbilical region. The intestinal type, aka adenocarcinoma.
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Classic site of met for diffuse type of cancer? Which side? NAme? So which type of cell would be in this type of tumor?
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Ovaries. bilateral. sneaky! Krukenberg tumor. Signet ring cell.
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Cellular features of gastric intestinal type adenocarcinoma? What factors determine survival rate (2).
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Well formed columnar or cuboidal cells in glands. 1) Degree of invasion through the vessel wall, 2) regional lymph node involvement.
