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51 Cards in this Set
- Front
- Back
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heterotopia |
congenital; pancreatic tissue in pylorus
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pyloric stenosis |
congenital, familial, connection to 45 XO, trisomy 18; nonbilious vomiting in 2nd-3rd week |
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gastroparesis |
decr. stomach motility; early satiety, bloating; cause = autonomic neuropathy or prior vagotomy |
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upper GI bleed |
melena (dark, tarry stools) - prox. to DJ junction |
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erosion vs. ulcer |
limited to mucosa vs. into submucosa |
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gastropathy |
loss of mucin, reactive nuclei, tortuous glands |
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gastritis |
like gastropathy but inflammation is also present; acute/chronic |
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causes of acute ulcers |
stress (shock, sepsis, trauma), NSAIDs, NG tubes |
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acute ulcer |
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Gastric antral vascular ectasia (GAVE) |
upper GI bleed; idiopathic dilated vessels of submucosa + watermelon stomach |
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Portal hypertensive gastropathy |
upper GI bleed; snakeskin pattern |
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Dieulafoy lesion |
upper GI bleed; mucosal artery too large for the area -> large bleed |
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acute gastritis |
non-infectious (NSAID, EtOH, smoking, drugs, uremia), severe stress (physical, ischemia & shock, trauma) |
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things that protect mucosa |
mucus layer, bicarb secretion, rich blood supply |
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causes of decr. bicarb in stomach |
NSAID, uremia, H. pylori |
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chronic gastritis |
antral; high acid production; can spread (pangastritis); driven by H. pylori |
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chronic gastritis morphology |
chronic & acute inflammation; atrophy, metaplasia, G cell hyperplasia, dysplasia |
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hallmark of chronic gastritis histology |
lymphoid follicle present in the stomach |
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Helicobacter pylori |
causes 90% of chronic gastritis; organism has flagella, urease (ammonia buffers gastric acid), adhesins, blood group O binding; low-grade persistent infection |
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H. pylori genetic subtypes |
CagA (cytotoxin associated gene) + = more extensive infl. than CagA- => more likely to cause gastric malignancy, atrophic gastritis |
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sequelae of H. pylori infection |
chronic gastritis, PUD, gastric ca, gastric lymphoma, atrophic gastritis (antrum & pylorus) |
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gastric mucosa w/ high-grade dysplasia (precursor to adenoCA) |
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Peptic Ulcer Disease |
ulcer present w/ chronic gastritis; main cause = H. pylori; proximal duodenum (eating = relief), antrum (eating = worse) |
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ulcer - note no necrotic tissue |
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complications of peptic ulcer disease |
upper GI bleed, perforation (see free air under diaphragm) |
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Autoimmune gastritis |
<10% chronic gastritis cases; CD4+ T-cells injure H+, K+-ATPase and gastrin R or intrinsic factor w/ autoantibodies present; affects BODY and FUNDUS |
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Autoimmune gastritis - morphology & pathogenesis |
thin mucosa, lose rugal folds; lose acid production -> incr. gastrin -> G cell hyperplasia in antrum -> pernicious anemia, carcinoid tumor, achlorhydria |
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autoimmune gastritis - thin mucosa, atrophy, intestinal metaplasia |
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Menetrier's disease |
hypertrophic/plastic gastropathy w/ low chloride and low protein; lots of mucin, little acid produced; tortuous foveolar hyperplasia w/ glandular atrophy; cause = excessive TGF-alpha |
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Zollinger-ellison syndrome - definition & cause |
thickened body & fundus secondary to glandular hyperplasia; cause = excess gastrin (gastrinoma in small bowel or pancreas) |
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ZE syndrome - symptoms |
therapy resistant; lots of ulcers - esp. beyond proximal duodenum; diarrhea; family hx |
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Menetriers (expanded foveolar cells) |
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Zollinger-Ellison syndrome (expanded glands) |
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Polyps |
75% are inflammatory or hyperplasia (gastritis associated) |
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Fundic gland polyp - note cystic spaces; risk for dysplasia; incr. secondary to PPI use |
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Adenoma |
10% of polyps, a/w FAP, gastritis & intestinal metaplasia; risk of adenoCA if >2cm |
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adenoma |
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benign tumors of stomach |
leiomyoma, lipomas (rare) |
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Neuroendocrine tumors |
body/fundus of atrophic gastritis or ZE syndrome (indolent); sporadic may be aggressive |
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causes of adenocarcinoma in stomach |
H. pylori, environment/diet, geography, genetics |
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where does adenocarcinoma MC occur? |
pylorus/antrum (60%); lesser curvature |
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gastric adenocarcinoma - malignant ulcer (necrotic tissue in center, irregular edge) |
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linitis plastica (leather bottle)- diffuse adenocarcinoma; gross |
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linitis plastica (diffuse adenocarcinoma) - see signet ring cells; NOT related to H. pylori; Krukenberg tumor (mets to ovaries) |
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Acanthosis nigricans |
velvety, pigmented skin thickening a/w gastric malignancy |
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overall 5ys of gastric adenoCA |
<30% in US |
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Gastric lymphoma |
5% of stomach malignancies; B-cell lymphoma of mucosa associated lymphoid tissue (MALT); most a/w H. pylori |
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Gastri-intestinal stromal tumors (GIST) |
throughout GI tract, stomach MC; can be aggressive (malignant GIST); 80% have oncogenic mutation (tyrosine kinase C-KIT) |
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GIST - gross |
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spindle cell GIST (MC - also epithelioid type) |
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Gleevec |
Imatinib mesylate; competitive inhibitor of tyrosine kinases a/w KIT protein, ABL protein, and PLT-derived growth factor receptors - treat GISTs |
