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61 Cards in this Set
- Front
- Back
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What are some things that protect the gastric mucosa?
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mucus secretion
bicarb mucosal blood flow tight juction epithelium regeneratig epithelium prostaglandin elaboration |
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What is a diaphragmatic hernia?
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congenital weakness or absence of entire diaphragm or part of it
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What happens due to the diaphragmatic hernia?
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stomah & other abdominal contents herniate into chest cavity and causes respiratory compromise
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What do you see with plyoric stenosis?
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regugitation & projectile vomitting ealry in infacy more often in boys with palpable mass and visible paeristatlsis
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What is gastritis?
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inflammation of gastric mucosa
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How do you diagnose gastritis?
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histologically
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What is acute gastritis due to?
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NSAIDs
excessive ethanol heavy smoking cancer chemo ischemia & shock stress uremia systemic infections suicide attempts mech trauma ie GI tubes |
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How do factors that cause acute gastritis interact?
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synergistically
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What can all of this cause?
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erode mucosa & cause bleeding
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Chronic gastritis is a background for?
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dysplaisa & neoplasia
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What is the pathogenesis of chronic gastritis?
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infection (h. pylori)
immuological (pernicious anemia) toxic (ethanol, tobacco) sugery |
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What is the morphology of chronic gastritis?
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neutrophils in epithelium
chronic inflammation regenerative change metaplasia atrophy dysplasia |
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What percent of chronic gastris is due to autoimmune?
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<10%
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Where in the stomach does autoimmune gastritis involve?
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body-fundic mucosa
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What antibodies are present?
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anti-parietal cells
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What does parietal cells do?
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secrete acid and intrinsic factor
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What else are there antibodies for?
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H,K,ATPase, and intrinsic factor
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What develops due to antibodies against intrinic factor?
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pernicious anemia due to lack of absorption of B12
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What other immune disorders is autoimmune gastritis assoicated with?
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Hashimotos thyroidits
addisons disease |
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What is helico bacter?
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gram - spiral bacteria in human stomachs
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What does h. bacter cause?
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chronic gastritis
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h. bacter is present in 90% of pts with?
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antral gastritis
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When do you get h. pylori?
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childhood & it persits for decades... most ppl remain asymptomatic
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H. pylori in the stomach...
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lives on the surface mucus layer and secretes urease, which converts urea to ammonia, creating a microenvironment to neutralize the surrounding gastric acid. H. pylori also secretes its own toxins, breaching the mucosal layer and subsequently allowing the gastric acid to directly attack the epithelial cells
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What happens to h. pylori once metaplasia is evident?
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no more h. pylori
"hit & run" there in infection gone with metaplasia |
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Where does h. pylori live in the stomach?
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sit on surface of epithelium & do not invade
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Disease association with h. pylori
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chronic gastritis: strong causal
peptic ulcer: strong causal gastric carcinoma: strong causal gastric lymphoma: etiolgical role |
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What is the histological definition of peptic ulcer disease?
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breach in the mucosa that penetrates muscularis mucosa, may penetrate the gastric wall
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Where can you get peptic ulcers?
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anywhere in the alimentary tract were acid & digestive juices can act
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How many lesions do you usually see?
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1
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How big is the peptic ulcer lesion usually?
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<4cm
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Where do you see peptic ulcers from most common to least?
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Duodenum, first part (closest to the stomach)
Stomach, usually antrum (this is also where H. pylori is often seen) Within Barrett mucosa Gastroenterostomy margin Duodenum, stomach, jejunum in Zollinger-Ellison (ZE) syndrome-ZE is a tumor that secretes gastrin, which stimulates parietal cells, creating an acidic environment that provokes multiple ulcers. Meckel diverticulum with ectopic gastric mucosa |
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Peptic ulcers are cause by damage due to...
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H. pylori, NSAIDs, Aspirin, tobacco, alcohol, gastric hyperacidity, duodenal-gastric reflux) or impaired defenses (i.e. ischemia, shock, delayed gastric emptying, host factors).
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What do you see with peptic ulcer disease?
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necrotic debris, inflammatory infiltrates, and eventually even fibrosis in the layers of the gastric wall.
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Bleeding caused by peptic ulcers...
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most frequent complication 15-20% of pts. can bleed to death accounts for 25% of ulcer deaths. Bleeding may be the first indication of an ulcer. The patient may have melena (dark blood in the stool).
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Perforation in peptic ulcers...
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5% of pts but accounts for 70% of ulcer deaths. Perforations are rarely the first indication of ulcers.
set up for peritintis |
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peptic ulcers also cause obstrucion from edema & scarring...
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2% of pts and is most often due to pyloric channel ulcers, which can obstruct the pyloris and cause emesis (vomiting). patient will present with crampy abdominal pain. Rarely do peptic ulcers lead to total obstruction with intractable vomiting.
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What is acute gastric ulceration?
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stress uclers mainly in stomach
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What is acute gastric ulceration associated with?
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shock, extensive burns, sepsis, severe trauma, increased intracranial pressure & NSAIDs
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What is the pathogenesis of acute gastric ulceration?
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stimulation of vagal nuclei & secretion of acid, prostaglandin inhibition & decreased oxygentation
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How can acute gastric ucleration maifest?
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ulcers or erosions
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What do you see with acute gastric ulceration?
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discrete lesions with no surrounding gastritis, with no chronic scarring
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What are curling ulcers?
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occur in proximal duodenum associated with severe burns or trauma
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What are cushing ulcers?
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associated with intracranial injury, operations or tumors, high incidence of perforation
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What are Bezoars?
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concretions formed in the alimentary canal by ingesting various substances
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What is gastric dilation?
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decreased peristalis
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What is gastric varices?
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dilated blood vessels usually a complication of cirrhosis...seen close to the gastroesophageal junction. can cause fatal bleeding.
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Gastric gland hyperplasia due to excessive gastrin secretion- also can develop into ulcers. Creates the setting for gastrinoma:
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Zollinger-Ellison syndrome
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What is a polyp?
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nodule or mass projecting above the mucosa
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How common is polyp of the stomach?
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rare
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Hyperplastic polyps of stomach?
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proliferative gastric mucosa with acute and chronic inflammatory infiltrates in the lamina propria. These arise in multiples
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Adenoma?
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contains dysplasic epithelium, therefore potential for malignant transformation, usually single
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What are some malignant gastric tumors?
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carcinoma (90-95%)
lymphoma 4% carcinoid 3% mesencymal 2% |
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What is the etiology of gastric carcinoma?
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Gastric carcinoma has a worldwide distribution with particularly high rates in Japan, Chile, China, Portugal and Russia. It is more common in lower socioeconomic groups. Gastric carcinoma is the leading worldwide cause of cancer death, as well as the 2nd most common tumor in the world. It is, however, not among the top most common cancers in the US. Incidence and mortality in the US have declined dramatically since 1930 (intestinal type).
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Intestinal gastric carcinoma characteristics?
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associated w risk factors
precursor lesions 6th decade M>F |
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Diffuse gastric carcinoma characterisitics?
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constant incidence (no risks)
no precursor lesion 5th decade (earlier) M=F |
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what in the diet can increase risk of gastric carcinoma?
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nitrates
smoked & salted foods lack of fruits & veggies |
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What else is a risk factor of gastric carcinoma?
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H. pylori
smoking (intestinal type) low SES chronic gastritis |
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What 2 diseases in a host can harbor/increase gastric carcinoma?
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gastric adenomas
barretts esophagus |
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How does gastric carcinoma grow & spread?
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spread through mucosa & eventual involvement of gastric wall (muscularis propria) and nodal involvement
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What are the most important prognosis factors in order?
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#1 depth of invation
LN mets |
