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23 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Sites of occurrence of peptic ulcer
(in descending order of frequency) |
1. Duodenum
2. Stomach 3. Esophagus 4. Stoma of gastroenterostomy (jejunal side) 5. Others: e.g. Jejunum |
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Macroscopic appearance of acute VS chronic ulcer
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Acute:
Shallow Small Multiple Chronic: Round or oval Usually solitary Sharp margins Edematous surrounding mucosa Fibrotic base |
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Microscopic appearance of acute VS chronic ulcer
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Acute: only Necrotic debris and polymorph
Chronic: Uppermost: necrotic debris and polymorphs Middle: Granulation tissue Lowest: Fibrous scarring |
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Complications of peptic ulcer (5)
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1. Hemorrhage
2. Perforation 3. Penetration (e.g. to pancreas) 4. Fibrosis and stenosis 5. Carcinoma |
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Progression of perforation of peptic ulcer
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Chemical, then secondary bacterial peritonitis
Localized --> pelvic/subphrenic abscess |
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Etiology of peptic ulcer (4)
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1. H. pylori
2. Environmental (e.g. stress, diet) 3. Hormonal (male>female>pregnant women) 4. Hypercalcemia - stimulate gastrin production |
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Enzymes produced by HP (4)
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Urease, phospholipase, catalase, mucinase
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How does HP cause duodenal ulcer?
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High acidity --> gastric metaplasia
HP infection --> chronic antral gastritis --> infect metaplastic epithelium in duodenum --> active chronic duodenitis --> reduce mucosal resistance --> DU |
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Morphology of acute VS chronic gastritis
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Acute: acute inflammatory cells, predominantly neutrophils
Chronic: Mononuclear inflammatory cells (lymphocytes and plasma cells), density of neutrophil infiltration indicates activity |
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Etiology of gastritis
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1. HP infection
2. Idiopathic 3. Drug-associated, e.g. NSAID 4. Autoimmune (predominantly fundus) |
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Complications of autoimmune gastritis
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Severe mucosal atrophy
--> progressive reduction in secretion of acid, pepsinogen and intrinsic factor --> achlorhydira and pernicious anaemia Increased risk of gastric carcinoma |
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Most common malignant tumor in stomach
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Adenocarcinoma (95%)
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Etiology of gastric adenocarcinoma (3)
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1. HP infection
2. Diet (e.g. nitrosamine, low vege and fruit intake) 3. Premalignant conditions |
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Premalignant conditions for adenocarcinoma of the stomach (4)
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1. Gastric adenoma
2. Chronic type A autoimmune gastritis 3. Pernicious anaemia 4. Intestinal metaplasia and dysplasia in chronic atrophic gastritis |
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Clinical presentation gastric adenocarcinoma (4 early,
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Early:
1. Dyspepsia 2. Vomitting 3. Epigastric pain 4. Weight loss Late: 1. Obstructive symptoms 2. Frank hematemesis 3. Epigastric mass 4. Enlarged left supraclavicular lymph node (Virchow's node) |
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Relative frequency of site of occurence for gastric adenocarcinoma
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1. Polyrus and antrum (50-60%)
2. Body (25%) 3. Cardia (10%) 4. Others |
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Macroscopic classification of gastric adenocarcinoma (3)
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1. Ulcerative
2. Polypoid/fungating 3. Diffuse scirrhous |
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Lauren classification of gastric adenocarcinoma
(microscopic) |
1. Intestinal type: glandular structure
2. Diffuse type: Diffuse infiltrative pattern, signet ring cell |
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Direct spread of gastric caner
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Local spread to adjacent organs: duodenum, esophagus, lesser and greater omentum
(not common) Direct extension through the wall of stomach: liver, pancrease, transverse colon, diaphragm, common bile duct... |
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Hematogenous spread of gastric cancer
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Most common: liver
Others: Bone marrow, lung brain |
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Transcelomic spread
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Tumour seedling
Krukenberg tumour: bilateral ovarian solid tumours, signet ring cell |
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Definition of early gastric cancer
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A gastric carcinoma confined to the mucosa +/- submucosa, regardless of presence of lymph node metastasis
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Differentiation between benign peptic ulcer and ulcerative carcinoma of the stomach
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Peptic ulcer
Size: smaller Number: single/multiple Margin: oedematous, not raised Edge: Sharp Floor: clean Base: ulcer slough and granulation tissue with complete destruction of muscular layer Ulcerative carcinoma Size: Larger Number: SIngle Margin: Irregular, heaped up, raised Edge: Sharp/undrmined Floor: Dirty Base: Tumour cells intermixed with muscular layer |
Size
Number Margin Edge Floor Base (light microscopy |
