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85 Cards in this Set

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What do mucuous cells in the stomach secrete?
Mucous

Pepsinogen II = converted to Pepsin by HCl
What kind of epithelium lines the stomach?
Cuboidal glandular
What do Parietal Cells of the stomach secrete?
HCl

Intrinsic Factor
What do Chief Cells of the stomach secrete?
Pepsinogen I and II
What do the Endocrine cells of the stomach secrete?
Peptide hormones
Fill in the blanks
-
What is the function of Gastrin?
Stimulates Parietal Cells to produce HCl
1. Surface epithelial cell
2. Mucous cell
3. Parietal cell between a mucous cell and Chief cell
4. Chief cell
5. Muscularis Mucosa
6. Submucosa
Label
1. Surface epithelial cell
2. Mucous cell
3. Solitary Lymph node
4. Endocrine cell
5. Muscularis mucosa
6. Submucosa
Labe these cells in the Antrum
What is the frequency of Pyloric Stenosis?

What is the gender dominance?
1:600 newborns

M:F = 4:1
What is the pathology in Pyloric Stenosis?
Hypertrophy of the pyloric sphincter muscle
What are the clinical findings in Pyloric Stenosis?
- Projectile vomiting of baby at 1-2 weeks of age***
- palpable abdominal "olive"

***TE fistula occurs earlier
What syndromes is Pyloric Stenosis associated with?
Turner (XO) and Edwards (trisomy 18)

**also with Polyhydramnios
What is the therapy for Pyloric Stenosis?
Surgical incision into the muscle
How does Acute Erosive Gastritis clinically present?
Epigastric burning, pain, nausea, and vomiting
What are the causes of Acute Erosive Gastritis?
1. Aspirin and NSAIDs
2. Alcohol
3. Cytostatic drugs
4. Shock
5. Sepsis
6. Stress
7. indwelling nasogastric tubes
Acute inflammation, erosion, and hemorrhage of the gastric mucosa due to a breakdown of the mucosal barrier and acid-induced injury
Acute Erosive Gastritis
Multiple mucosal erosions and ulcers that develop as a consequence of stress
Stress ulcers
What are possible causes of Stress Ulcers?
1. Trauma, sepsis, surgery
2. Burns (Curling ulcers)
3. Brain trauma (Cushing ulcers)
Chronic inflammation of the gastric mucosa eventually leading to atrophy or intestinal metaplasia
Chronic Gastritis
What percent of the elderly have Chronic Gastritis?
>50%
Which type of Chronic Gastritis occurs more often?
H. pylori >>> Autoimmune
Describe the pathology of Chronic Gastritis
Chronic inflammation of mucosa + Lymphoid follicles -> Atrophy of glands -> Intestinal metaplasia
What is Chronic Type A Gastritis caused by?
Autoimmunity = auto-ab's to Parietal Cells and/or Intrinsic Factor
What part of the Stomach does Chronic Type A Gastritis affect?
Body and Fundus
What part of the stomach does Type B Chronic Gastritis typically affect?
Antrum and Pylorus
What are the clinical findings (Lab) of Type A Chronic Gastritis?
1. Pernicious Anemia = megaloblastic anemia due to lack of intrinsic factor and B12 absorption
2. Achlorohydria = decreased acid secretion
3. Hypergastrinemia = due to loss of negative feedback
Which Chronic Gastritis' are diffuse and which are focal?
Diffuse = Type A

Focal = Type B
What is Type B Chronic Gastritis most commonly due to?
H. pylori
What are the major properties of H. pylori?
Gram -, curved rod
produces urease
T or F: H. pylori is invasive
False: it is NOT invasive, it affects ells indirectly by releasing Vacuolating toxin and releasing enzymes
What are the 3 histologic characteristics of Chronic Gastritis?
1. Atrophy of gastric glands
2. Intestinal Metaplasia = goblet cells and paneth cells from intestine in the stomach
3. Lymphocytic follicles in the atrophic mucosa
What 4 diseases are related to H. pylori?
1. Chronic Atrophic Gastritis
2. Duodonal and Gastric Peptic Ulcers
3. Gastric Adenocarcinoma
4. Gastric MALT lymphoma
Breach in the mucosa with extension into the submucosa or deeper
Ulcer
Breach in the epithelium of the mucosa
Erosion
Ulcers of the distal stomach and proximal duodenum caused by gastric secretions (HCl and Pepsin) and impaired mucosal defenses
Peptic ulcer
Which form of Chronic Gastritis is associated with a higher risk of cancer?
-Type A gastritis is associated with a higher risk of gastric adenocarcinoma

- However, Type B is much more prevalent so it is thought to cause many more cancers
What is the lifetime risk of Peptic Ulcers in the US?
10%
List the 4 layers in sequence noted histologic sections of Peptic Ulcers
1. Necrotic debris
2. Inflammation with predominance of neutrophils
3. Granulation tissue (repair tissue)
4. Fibrosis
What is the gross appearance of Peptic Ulcers?
- small, solitary ulcers
- round or oval shape
- sharply demarcated, "punched-out" ulcers
-overhanging margins
-radiating mucosal folds
What are the common complications of Peptic Ulcers?
1. Hemorrhage -> melena, iron deficiency anemia, hematemesis
2. Perforation -> peritonitis, paralytic ileus
3. Stenosis and obstruction
4. Penetration -> into pancreas -> dull pain, elevated serum amylase
Peptic Ulcers: What is Perforation associated with causing and what may be seen in an X-ray?
- Peritonitis and Paralytic Ileus

- Air under the diaphragm
Describe Penetration into the Pancreas caused by Peptic Ulcers
-Complication of posterior wall duodenal ulcers

- accompanied by dull pain and elevated serum Amylase
Where are Gastric Ulcers most often located?
Lesser curvature of the Antrum
Where are Duodenal Ulcers most commonly located?
Proximal area just beyond the Pylorus
What is Zollinger-Ellison Syndrome?
Malignant Pancreatic Isle cells tumors
- secrete excess Gastrin = Hyperacidity = multiple intractable peptic ulcers
- can cause Peptic Ulceration
What neoplasia is Zollinger-Ellison Syndrome associated with?
Multiple Endocrine Neoplasia I (MEN I)
What is the gross appearance of Menetrier Disease?
Enlarged (giant) rugal folds in the body and fundus
-sparing of the antrum
What happens microscopically in Menetrier Disease?
massive foveolar (mucus cells) hyperplasia with replacement of the Parietal and Chief Cells
What is there a decreased production of in Menetrier disease?
Acid
What enteropathy does Meneterier disease cause?
Protein-losing enteropathy = due to no pepsin from Chief cells

*also giant rugal folds
What is another name for Menetrier's Disease?
Hypertrophic Gastrophy
What are 3 benign Gastric Tumors?
1. Hyperplastic Polyp (most common)
2. Fundic gland polyp
3. Adenomatous polyp
List the 3 Malignant tumors of the stomach
1. Adenocarcinoma
2. Lymphoma
3. Carcinoid
What is the significance of Stomach Malignant Lymphomas?
they are the most common site for "extra-nodal" malignant lymphomas
In what countries is Gastric Carcinoma most common?
Japan
Iceland
Chile
What is the prognosis of Gastric Carcinoma?
20% 5 year survival = POOR
What is the cause of Gastric Carcinoma?
Diet
Smoked food
Nitrites
What is the most common benign tumor in the GI tract?
Gastric Leiomyoma
T or F: the incidence of Gastric Carcinoma has increased in the US over the past 70 years
False, has decreased
What correlates with the decreased incidence of Gastric Cancer in the US?
Refrigerators
What 3 diseases predispose to Gastric Cancer?
1. H. pylori infection
2. Chronic Atrophic Gastritis with Intestinal Metaplasia
3. Gastric Adenomatous Polyps
What are the 2 variants of Gastric Carcinoma?
Intestinal Adenocarcinoma

Diffuse Carcinoma = Linitus Plastica
T or F: Diffuse type Gastric Adenocarcinoma is associated with H. pylori
False
What type of cells are associated with Diffuse type gastric adenocarcinoma?
Signet ring cells
Describe Signet Ring Cells
nucleus is displaced to the periphery by intracellular mucin
What is the most common type of malignant stomach cancer?
Adenocarcinoma
What 3 organs commonly receive Gastric metastatic cancer cells
Liver

Lungs

Ovaries
Left supraclavicular lymph node where gastric cancer may metastasize to
Virchow node
Describe Krukenberg Tumors
metastatic Signet-ring cell to both ovaries
By what vessel does a metastatic stomach cancer cell reach Virchow's node?
Thoracic duct
What part of the stomach is most often involved in Gastric Carcinoma?
Pylorus and Pyloric antrum, mostly on the lesser curvature
What does GIST mean?
GI Stromal Tumor
What does GIST originate from?
stromal stem cells that are precursors of Smooth Muscle or GI fibroblasts
What is the most common clinical presentation with Gastric Carcinoma?
Weight loss and anorexia due to early satiety

*also
-Epigastric pain
-occult bleeding (too little to be noticed)
-Iron deficiency anemia
Petechial hemorrhages after shock = Acute Gastritis
This is the stomach...what are you seeing?
A 56 year old woman presents with vomiting coffee ground looking blood. She has epigastric pain. PMI is significant for Rheumatoid Arthritis, for which she has been taking Aspirin daily.
Acute Gastritis
-coffee ground blood vomit
-Aspirin
-Epigastric pain
Stress Ulcers = small (<1 cm) black mucosal defects
What is shown here?
Peptic Ulcer
What is this?
Duodenal ulcer
H. pylori
What is this showing?

What is the cause?
Hypertrophic gastritis
What is this?
Gastric Adenocarcinoma showing an irregular ulcer crater
What is shown here?
Diffuse Gastric Adenocarcinoma (Linitis Plastica) with Signet Ring tumor cells
What is shown here?
Gastric MALToma
What is this?
GI Stromal Tumor = GIST = have retained the phenotype of undifferentiated stromal cells
What is this?