Lecture 81 - Pathology of Gastric Disease Flashcards Preview

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Flashcards in Lecture 81 - Pathology of Gastric Disease Deck (30)
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1
Q

what are the different parts of the stomach?
what cells are located in each?
what are two kinds of epithelium?

where does H pylori like to live?

A

Cardia — distinct region that resembles the pylorus
Body and Fundus – Parietal cells, Chief Cells
Parietal cells – targetted by Auto-immune gastritis
Antrum – Mucus Cells; G Cells
H pylori likes to live here (+ antrum)
Pylorus –

The stomach has two types of mucosa: Antral and Fundal

2
Q

Gastritis vs Gastrophy

symptoms of gastropy?
common causes of gastrophy?

A

Gastritis – marked inflammation; often in an acute or severe phenomena

Gastrophy -- more common but less severe; 
	Catch all for mild inflammation 

Uncertain clinical significance; some asymptomatic
Common symptoms: pain and heart burn
Causes: NSAIDs, bile reflux, EtOH, Coffee, Cocaine,

3
Q

major causes of Gastritis?

A
H. Pylori -- main cause 
Autoimmune Gastritis -- second most common cause of gastritis 
Chemical Gastritis : Bile, Iron 
Crohn's Gastritis: 
Zollinger Ellison Syndrome -
Infectious
4
Q

H. Pylori Gastritis

what are you looking for on histology?

A

Histology – PMNs (active gastritis); THe organism itself (lives in the mucous glands of the cardia and the antrum)

5
Q

H. Pylori Gastritis - complications

A

PUD
Intestinal Metaplasia —-> Gastric Carcinoma
Similar to progression in Barrett’s

Lymphoma (MALToma)

6
Q

*Intestinal Metaplasia – A complication in the setting of H pylori:

the good?
the bad?

A

Short Term: good function –
H pylori can’t live in intestinal type epithelium,

Long term: Bad -- not wide spread enough to actually eradicate the infection; predisposes to carcinoma
7
Q

*Lymphoma (MALToma) - marginal zone lymphoma —complication of H. pylori gastritis

A

Stimulated by H. Pylori ongoing exposure

8
Q

Autoimmune Gastritis

– what is it –
where in the stomach?

whats seen on histology?

A

Auto-immune destruction of intrinsic factor and Parietal cells
Presents with Pernicious Anemia
A/w other auto immune phenomena

Histology – Antrum and the Fundus (parietal cell locations)
(Can get a form a metaplasia – Fundal – > Antral Mucosa)
Gradual destruction of the mucosa (“atrophic gastritis”)
Lots of Inflammation

9
Q

Autoimmune Gastritis -

Complications:

A

Anemia, PUD, Intestinal Metaplasia,

Neuro-endocrine cell Tumors

10
Q

Neuro-endocrine cell Tumors — complication of the auto-immune gastritis

whats happening?
prognosis?

what should you stain for?

A

Loss of acid secretion –> hypergastrinemia –> overgrowth of ECLs

Linear hyperplasia –> nodular hyperplasia –> Neuro-endocrine Tumors

	Typically indolent; low malignant potential 

	Positive for Synaptophysin
11
Q

Chemical Gastritis
- what can cause it?

histological changs?

A

bile and iron

Foveolar hyperplasia/elongation; may resemble villi of the small intestine
Complex glandular architecture (“corkscrew”)
Vascular congestion – looks red and inflammed

12
Q

Chemical Gastritis – Iron Pill –

histology?
treatment?>

A

Iron apparent in the lamina propria and crusted along surface
Tx – stop taking Iron pills

13
Q

Zollinger Ellison Syndrome leading to gastrin?

why/how?

A

hypergastrinemia, increased acid, duodenal ulcers

Overgrowth of the fundic mucosa in response to gastrin

14
Q

what is a heterotopias ?

what are the two types of the Stomach?

A

clinically insignificant; Right kind of tissue but in the wrong place;
Antral heterotopias

Pancreatic Heterotopias

15
Q

Antral heterotopias
Pancreatic Heterotopias

what are they?

A

Antral heterotopias –
Histologically unremarkable antral type mucosa in the body or the fundus
Clinically inconsequential

	Pancreatic Heterotopias -- Piece of normal pancreatic that during embryogenesis wound up in the stomach. Usually incidental and clinical
16
Q

what are the two types of Polyps seen in the stomach?

A

Hyperplastic Polyps –

Fundic gland polyp –

17
Q

Hyperplastic Polyps –
what is it?
histology?
risk factors?

A

Abnormal growths of the stomach which may harbor intestinal metaplasia, dysplasia or carcinoma

		Histology: Overgrowth of Foveolar epithelium;  cystically dilated glands 
			Antral type mucosa 

Risk factor: Gastritis (h pylori, auto immune)

18
Q

Fundic gland polyp –
two associations:

benign of malignant?

A

Associations;

    • long term PPI use — totally benign
    • FAP (familial adenomatous polyposis; mutation of APC)

polyp itself is benign, but condition itself dangerous ( Risk of colon cancer – 100%)

19
Q

Gastric Polyposis Syndrome

what is the mutation?
what is it?
clinical significance?

A

Characterized by multiple gastric polyps; usually fundic gland polyps
Associated with mutations in APC
Cancer Risk – need screening and colonoscopy

20
Q

Two premalignant conditions of gastric cancers?

what is the gross path distinction?

A

Gastric Dysplasia — appears as a flat lesion; often associated with metaplasia;

Adenoma – denotes glandular polyp with at least a low grade dysplasia
The bigger the polyp – the higher the grade/chance of malignancy

21
Q

histological features of adenoma?

types of gastric adenomas?

A

May be intestinal (goblet cell)
May be gastric type (foveolar cells)

Dark Epithelium  = increased replication; high N:C ratio 

Mucin Depletion = cells spending less time on normal function;

22
Q

two gastric malignancies to know

A

Adenocarcinoma –

Neuro-Endocrine Tumors:

23
Q

Gastric Adenocarcinoma –

– what are two types?

A

Intestinal vs Diffuse

  • E cadherin (classically associated with breast cancer), KRAS, p53, APC
24
Q
Intestinal type Gastric adeno-carcinoma 
- Risk factors? 
- histological features? 
Gross path: 
- prognosis? 

– mutations?

A

Risk factors: H pylori, Smoking
Diet – more so in Japan

histological: Cohesive glands;
gross path: typically discrete fungating masses or ulcers

prognosis: Much better prognosis; good outcomes if caught early enough
- E cadherin (classically associated with breast cancer), KRAS, p53, APC

25
Q

Diffuse type Gastric adeno-carcinoma

  • (not associated with…)
  • histological feature?
    gross path?
  • Genetics?

-prognosis?

A

Not associated with H Pylori

gross: Diffuse thickening of the stomach (linitis plastica = leather bottle stomach” )
histo: Very dis-cohesive; Signet Ring

			EPI: usually younger patients (30s); typically found at late stage 

Genetics: Usually sporadic

			Outcomes: very poor; rapid progression to death
26
Q

Neuro-Endocrine Tumors:

classifed by associatieon and morphology?
which has the worse prognosis?

A

Type 1 - - associated with auto immune gastritis; indolent (best prognosis)
Type 2 – associated with ZE (intermediate severity)
Type 3– sporadic; worst prognosis

27
Q

Neuro-Endocrine Tumors:

— stains for…?

A

Histo – dark nodulating groups of cells

Synpatophysin Stain

28
Q

Two vascular d/o of the stomach to know …

A

GAVE – Gastric Antral vascular Ectasia – “Watermelon Stomach”

CAP -(Caliber Persistent Artery)- Dieulafoy Lesions

29
Q

GAVE – Gastric Antral vascular Ectasia – aka ….?

who gets these?
what are they?
a/w?
outcomes?

A

Elderly women

Dilated Capillaries with fibrin thrombi; in the setting of gastropathy

Autoimmune assocation

	• Can Bleed- acute or chronic - -but usually just chronic discomfort
30
Q

CAP -(Caliber Persistent Artery)

aka?
what is it?
outcomes?
managment?

A

Dieulafoy Lesions

• Large-caliber artery going up to surface — if it erodes just starts spurting tons of blood;

Recurrent bleeding without other symptoms

can be fatal

	• Typically managed endoscopically