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87 Cards in this Set

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What is the usual age and demographic for barrett's?
white male, 40-60 y/o
What other kinds of origins (other than GERD) can you have for esophageal inflammation?
etoh, corrosive acids/alkalis, excessively hot fluids, smoking

cytotoxic anticancer therapy

infection following bacteremia or viermia, herpes or cmv

uremia in renal faliure

radiation and GVHD
What kinds of inflammation do you look for in different cases of esophagitis?
candidasis-grey white

hsv/cmv with both have characteristic inclusions

chemicals-localized sloughing

irradiation
intimal proliferation with luminal narrowing

GVHD-skin manifestations (apoptosis of basal epithelial cells, separation of epithelium and lamina propria, atrophy, and fibrosis of the lamina propia)
What kind of benign tumors can you have in the esophagus?
You can have fibroma, lipomas, hemangiomas, neurofibromas and lymphangiomas.
Squamous papillomas, condylomas. Inflammatory polyp.
Compare the world variation of esophageal cancer to the unitaed states?
in the us we are having more and more adenocarcinoma compared to the world where you have adenocarcinoma.

blacks are at 4 times high risk of squamous cell carcinoma.

in the us, it seems that the major carcinogen players are etoh and tobacco.... whereas in other parts you have nitrosomaines, funggus, malnutrition and hpv.
What is a key way esophageal tumors spread?
lymphatics, so you can have skip lesions.
which lymph nodes depend on where the thing is located.
What is the mortality?
75% survival in patients with superficial compared to 25% in patient's who undergo curative surgery. lymph nodes are a big player.
What is the lifetime risk from barrett's esophagus?
10%
What kind of genetic abnormalities occur in barrett's esophagus?
p53, tetraploidy, aneuploidy
what do chief cells secrete, how are they activated?
pepsinogen, 6.0
what do the endocrine cells secrete?
antrum-gastrin
body-histamine
also somatostatin and endothelin.
What are the three phases of acid secretion?
cephalic hase, gastric phase and intestinal phase.
What kinds of congenital abnormalities can you have in the stomach?
You can have pancreatic heterotopia, gastric heterotopia. You can have diaphgragmatic hernia as well as pulmonary tissue that gets infected and might be mistaken for a mass.
What are the two kinds of pylorid stenosis?
You can have congenital pyloric stenosis, affecting males 3-4 times more than females (Associated with turner sydnrome, trisomy 18,, esophageal atresia.

Acquired pyloric stenosis can occur secondary to chronic antral gastritis, peptic ulcers close to the pyloris.
What are some causes of acute gastritis?
Causes of acute gastritis include shock, trauma, renal failure, nasaids, NG tubes, etoh, smoking, chemo, invection, suicide, distal gastrectomy.

Think about stuff that would decrease mucosal flow, directly harm the mucosa.
What do you see morphologicall with acute gastritis?
You see vascular congestion, and neutrophils... the more superior the nutriphils, the worse..

You can also have erosive hemorrhagic gastritis.
Is gastritis sx all the time?

If i take nsaids how much more likely will i get it?
no, RA with nsaids, 25% of the time.
what happens with chronic gastritis?
You have chronic mucosal inflammatory changes, leading to a mucosal atrophy and intestinal metaplasia, in the absense of erosions. these can become dysplastic and get you into carcinoa..
What causes chronic gastritis?
h pylori, pernicious anemia, etoh, cigarrhetes, postsurgical, obstruction, antyhing mechanica, radiation, crohn's, amyloidosis, uremia, gvhd.
Are people with h pylori sx?
Usually no, although they usually do have chronic gatritis.

You can have two kinds of gastritis. Antral gastritiis which increases risk for ulcer and pangastritis with lower gastric acid secretion adn increased risk for adenocarcinoma.
What are the tests for h pylori?
breath, serum, antibodies, and of course histology.
What happens with autoimmune gastritis?
Effects less than 10% with gastritits... antibodies to gastrin receptors, h/k atpase, intrinsic factor on parietal cells. can get anemia. At sig for for endocrine/gastric carcinoma.
What makes chronic gastritis active?
Neutrophils in the glandular and surface epithelial layer.
What other things (do you look for in chronic gatsritis?)?
Regenerative change, metaplasia, atrophy, dysplasia.
What kinds of gastritis should you think when you see atrophy?
You want to think of autoimmune gastritis, pangastritis as caused by h pylori. Look for absense of parietal cells.
What kinds of changes do you get with dysplasia?
You get changes in size, shape, and orientation of epithelial cells, and nuclear enlargement and atypia.
Will you have h pylori in areas of intestinal metaplasia?
No.
Not in those areas.
Will you get hypochloridia, elevated gastrin levels with autoimmune gastritis?
Yes, but not just chronic where you would have parietal cell damage as well.

Small subset of people with autoimmune gastritis will get pernicious anemia.
What is the relative risk of cancer in someone with autoimmune gastritis?
2-4%
What is eosinophilic gastritis?
This is an inflammatory condition that features prominent eosinophilic infiltrate of the mucosa, muscle wall, or all layers of the stomach. Can be associated with eosinophlic eneteritis. Steroid therpay is effective.
What do you have to have to differentiate eosinophliic gsatritis from?
You want to diferentiate it from allergic gastroenteropathy.
What is lymphocytic gastritis?
You have a dense population of lymphocytes in the epithelial layer of the mucosal surface and gastric pits and suffuse the almina propia.
What kind of conditions do you want to r/o when you see granulomatous gastritis?
Crohn disease, sarcoid, infection (TB, histo), systemic vasculitis, or reaction to foreign material.
What does GVHD look in terms of gastritis?
You have apoptosis of the neck mucous glands, with lymphocytic infiltrate of the lamina propia.
What does reactive gatropathy look like?
Foveolar hyperplasia with loss of mucin and glandular regenerative changes, mucosal edema nda dilation of mucosal capillaries and smooth muscle fibers extending into the lamina propia between glands.
How far do you have to get down before you actualy have an ulcer?
Muscularis mucosa.
What is a peptic ulcer?
It is a chronic, mot often solitary lesoin that occurs in any porition of the GI tract exposed to aggressive action of acid/peptic juices.
Other than the duodenum and antrum, where else can you find PUD?
merckel, duodenum, stomach, jejunum in zollinger ellison syndrome, margins of gastroejejunostomy.
Is there a gender difference with ulcers?
No
What is the prevalence of H pylori in ulcers?
It is about 70% with those with gastric ulcers and all with duodenal ulcers.
What are the mechanisms by which h pylori damages the mucosa?
Causes an intense inflammatory and immune reponse, several bacterial gene products are involved in causing epithelial cell injury and induction of inflammation, enhances gastric acid secretion, proteins are immunogenic, thombotic occlusion of surface capillaries is promoted, other antigens recruit inflammatory cells to the mucosa. Damage to the is thought to permit leakage of tissue nutrients.
What gene are those affected with ulcers who have h pylori have?
They have Cag A which is a vacuolating toxin.
What is the incidence of peptic ulcer of those with h pylori?
10-20%
How does tobacco, cause ulcers?
It decreases the blood flow to the stomach mucosa.
Does etoh cause ulcers?
Not normally, but those with cirrhosis it does.
Who else is set up to get duodenal ulcers?
Rapid gastric emptying, chronic renal failure, hyperparathyroidism (hypercalcemia stimulates gastrin secretion) (like zollinger ellis syndrome).
Can stress and personality?
yes, although hard date is lacking.
Can you use size location to differntiate a benign from malignant ulcer?
no
What characteristic should you look for in cancer?
Elevated margins of the ulcer.
What are the four features of ulcers?
base and margins have a superficial thin layer of necrotic fibrinoid debris not visible to the naked eye

beneath this layer is a ne of non-specific inflammatory infiltrate, with neutrophils predominating

in the deeper layers, especially in the baes of the ulcer threris active granulation tissue infiltrated with mononuclear leukocytes

the granulatino tissue rests on the more solid scar
will you have chronic gastritis with someone who has peptic ulcer disease?
of course.
How long does it take to repar a peptic ulcer if no meds are used to treat it?
15 yrs to heal, few weeks otherwise...
When do you get stress ulcers, and what do they look like?
Focal black spots... commonly occured with shock, brain injury, NSAIDS, increased intracranial prssures.
Other than bleeding and perf, what can you get with ulcers?
You can actually get an obstruction from edema or scarring.
Microscopically how will it differ from a chronic?
The mucosa will be more abrupt, being normal and then will be ulcerated..
What is the most important determinant of clinical outcome of acute from chronic?
Ability to correct the underlying condition.
What condition is conducive for bezoares in the stomach?
Dysmotility, following partial gastrectomy.
What are the variations of hypertrophic gastropathy?
Three variants are recognized... you have menetrier's disease (profound hyperplasia of surface mucous cells with accompanying glandular atrophy), hypertrophic hypersecretory gastropathy, gastric gland hyperplasia secondary to excesive gastrin secretion.

Basically just think fo the cells that you have.

What can you loose in metrier's? It can be a protein losing gastroenteropathy.
How do you diagnose gastric varices?
You see esophageal varices, see lumps, and then leave it at that.. biopsy would not be a good idea..
What is a polp in the ailmentary tract?
It is applied to any nodule or mass that projects above the level of the surrounding mucosa.
What are the majority of polyps in the mucosa?
The majority are non neoplastic and appear to be hyperplastic nature.
What do they look like gastric mucosal polyps?
They tned to be composed of a variable mixture of hyperplastic surface epithelium and cystically dilated tissue
What else can a polyp be in the stomach/
Can be sessille or a pedunculated adenoma.
Are most gastric polyps neoplastic?
No, most gastric polyps are not neoplastic and are more of a hyperplastic nature with a lamina propia containing more inflammatory cells, and smooth muscle.
What constitutes the other 5-10% lesions in the stomach?
There is an adenoma of the stomach which contains dysplastic epithelaium and by definitiion is malignant.

These may be sesille or pedunculated.
What are uncommon polyps of the stomach/
Uncommon polyps of the stomach are peutz jeghers polyps, juvenile plyps, funcdic gland polyps, hamartomatous polyps. Ther is also an eosinophilic granuloma...
Can you tell an adenomatous polyp and a non neoplastic polyp grossly?
no, histological examination is required.
Is gastric carcinoma a killer?
Yes.. it is...It is the most common cancer killer in the world.
What are the two types of gastric cancer?
You appear to have an intestinal morphological type which has precursor lesions and then you tend to have a diffuse type that is poorly differentiated.
What environmental factors are associated with increased risk for gastric carcinoma?
h pylori, nityrites, smoked, chili pepper diet, no fresh fruit/veggies, low socioeconomic status, cig smoking.
What host factors are increasing the risk for gastric carcinoma?
chronic gastritis (hypochlorydia), intestinal metaplasia..
partial gatrectomy favors refux of bilious alkaline intestinal fluid.

gastric adenomas... 40% harbor cancer at time of diagnosis, 30% have adjacent cancer at the time of diagnosis.

Barrett's esophagus. increased risk of GE junction.
What genetic factors?
Blood group A is actually at increased risk. family hx of gastric cancer, Hereditary nonpolyposis colon cancer syndrome, famililal gastric carcinoma.
Is there evidence linking gastric adenocarcinoma to cigarrhette smoking and drinking?
No.
Which of the hypertrophic gastropathies is a risk factor for carcinoma?
Metrier's.
Is peptic ulcer disease a risk for gastric cancer?
no.
What is gastric carcinoma classified on the basis of?
It is classified on the basis of depth of invasion, macroscopic growth pattern and histologic subtype. Advanced gastric carcinoma is a neoplasm that has extended below the submucosa into the muscular wall.
What are the three type of growth patterns for gastric carcinoma?which is the hardest to see?
exophytic, flat and excavated. flat is the hardest to see.
What is linitis plastica?
It means leather bottle, and sometimes gastric malignancy can get this picture as well as metastatic carinoma of the breast and lung that may generate a similar picture.
What are the two types of gastric carcinoma?
The first type is intestinal variant that has glands and an expalnding like growth pattern? The second type has signet cells (if more than 50% its a signet ring carcinoma). The infiltrative tumor often evokes a strong desmoplastic reaction.
How does a gastric carcinoma likely first spread?
lymphatics..
What is a gist?
it is a gatrointestinal stromal tumor, thought to arise from the interstitial cells of cajal. 70% of these stain for CD 34
What is careny's triad?
You cn have Gist as part of a gastric gist, paraglangioma and pulmonary chorndroma. or NF type I. `
What does it look like?
It can protude on either side of the stomach. You can have necrosis and cystic changes. You can have spindle cells or plump epithelioid cells or a mixture oof both?
What is the tumor positive for?
ckit.
What drug can be effective this?
since tyrosine kinase is a big player in the oncogenesis, you can use gleevec aginst this.
What are gastric carcinoid tumors associated with?
zollinger ellis, men.
What other kinds of cancer can you have to the stomach.
lipoma, metastatic cancer.