Diseases Of Stomach

Front 1

Cells of the Stomach (4)

Back 1

Mucous cells - mucus and pspsinogen II (cardia and antrum), pepsinogen I and II (body and fundus)

Parietal cells - H+ ions, intrinsic factor

Chief cells - pesinogen I and II

Endocrine cells - gastrin and histamine

Front 2

Gastric mucosal protection

Back 2

mucus secretion

bicarbonate secretion

tight intercellular junctions

epithelial cell restitution

mucosal blood flow - prevents back diffusion of acid

prostaglandin - augments mucus production, bicarb production, increased mucosal bood flow

Front 3

congential abnormalities of the stomach

Back 3

heterotopic rests

diaphragmatic hernia

congenital hypertrophic pyloric stenosis

acquired pyloric stenosis

Front 4

congenital hypertrophic pyrloic stenosis

Back 4

projectile vomiting 2nd-4th week of life

mass in RUQ with visable peristalsis

associated with trisomy 18, 21 esophageal atresa

Front 5

Acute Gastritis

Back 5

epigastric pain, nausea, vomit

hematemesis, malena

associated with asprin use

morphology: intraepithelial neutrophils, vascular congestion, edema, erosions with bleeding, peticheal hemorrhage

Front 6

Chronic Gastritis

Back 6

lymphocytes and plasma cells in lamina propria

eventual atrophy and intestinal metaplasia

assocated with H. Pylori, autoimmune destruction of parietal cells, toxic (alcohol), + others

Front 7

Helicobacter Pylori

associations?
definitive cause of what?

Back 7

g- curveilinear rod colonizes antrum

strongly associated with: gastritis, peptic ulcer disease, gastric carcinoma.

definitive cause of gastric MALT lymphoma

Front 8

Autoimmune Gastritis

associations?
increased risk of what?

Back 8

Cd4+ T cells and autoantibodies against to H/K ATPase, Gastrin Receptor, Intrinsic Factor

gland destruction -> mucosal atrophy and decreased acid production

can cause loss of intrinsic factor -> pernicious anemia

association with other autoimmune disease - hashimotos thyroiditis, addisons, type 1 DM

increased risk of gastric carcinoma and endocrine tumors

Front 9

Lymphocytic Gastritis

Back 9

40% association with celiac disease

Front 10

Granulomatous Gastritis

Back 10

association wtih crohns disease, sarcoidosis, TB, CMV

Front 11

Reactive Gastropathy

Back 11

chemical injury (NSAIDS, Bile reflux)

Front 12

Eosinophilic Gastritis

Back 12

Allergic reactions, collagen vascular disease, systemic sclerosis

Front 13

Peptic Ulcer Disease (PUD)

pathology
location

Back 13

damage through the alimentary tract mucosa that extends through the mucularis mucosa and into the submucosa

due to imbalance of damaging factors to defensive factors

location in decreasing freq: duodenum (most common), stomach, GE junction

Front 14

Peptic Ulcer Disease (PUD)

Clinical
Complications

Back 14

burning epigastric pain worse at night and after meals, relieved by meals

bleeding
perforation (most cause death)
obstruction

Front 15

Peptic Ulcer Disease (PUD)

vs malignancy (gross)

Back 15

peptic ulcer has clean edges, punched out look with necrotic base

malignant tumor will have heaped up boarder

Front 16

Acute Gastric Ulceration

Back 16

also known as stress ulcers - patients with shock, severe trauma, intracranial injury, burns, sepsis

Curling ulcer - assocated with severe burns/trauma - proximal duodenum

Cushing ulcer - intercranial ulcer puts pressure on vagus nerve -> nerve stimulation -> increased acid secretion - gastric, duodenal, and esophageal ulcers - high incidence of perforation

Front 17

Menetrier Disease

Back 17

excessive TGFalpha causes hyperplasia of gastric surface mucous (hypertrophic gastropathy)

hypoproteinemia

increased risk of gastric adenocarcinoma

common in males

Front 18

Zollinger-Ellison Syndrome

Back 18

due to gastrinoma which secretes gastrin

PUD, chronic diarrhea, hyperplasia of parietal cells and endocrine cells

Front 19

Mucosal polyps

Back 19

benign

usually nonneoplastic - Fundic gland polyps

adenomatous polyps are premalignant

Front 20

gastric adenocarcinoma

Back 20

most common malignancy of the stomach (90%)

increased risk due to lack of refrigeration, smoked, cured and salted foods, smoking, H.Pylori

decreased risk with fresh vegetables

Front 21

Gasttric Carcinoma

location
growth pattern
linitis plastica

Back 21

location (dec freq): pyloris/antrum, cardia, body, fundus

lesser cuvature more than greater curvature

3 growth patterns
exophytic - protrudes into lumen
flat/depressed - no obvious mass
excavated/ulcerative - deep crater looks like PUD but has heaped up margins

Linitis Plastica - leather bottle look when a have extensive infiltration

Front 22

Gastric Carcinoma

histologic

Back 22

Intestinal type: neoplastic intestinal glands permeate gastric wall, grow in large groups

diffuse type - gastric mucous cells permeate the mucosa and wall as scattered cells or small cluster - form signet rings because mucus in cell pushes nucleus to edge

Front 23

Gastric Lymphoma

Back 23

almost all are B cell MALT lymphoma

assocated with chronic gastritis and H. Pylori infection

genetic
trisomy 3, t(11:18), t(1:11), t(14:18)

Front 24

Gastrointestinal Stromal Tumors (GIST)

Back 24

derived from interstitial cells of Cajal

95% positive for c-kit
70% positive for CD34

spindle and epithelial types

Front 25

Carney's Triad

Back 25

GIST

paraganglioma

pulmonary chondroma or NF1

Front 26

Gastric Neuroendocrine Tumors (Carcinoid Tumors)

Back 26

from endocrine cells in oxyntic mucosa

likely due to too much gastrin (Zollinger Ellison, chronic gastritis)

location is most important factor:

foregut - rare metastasis
midgut - multiple and agressive
hindgut - more agressive

Front 27

lipoma

Back 27

benign

in submucosa

composed of mature fibroadipose tissue

Front 28

metastatic cancer

Back 28

rare in the stomach

most common source
systemic lymphoma, malanoma, breast, lung