What Stomach Ailment Am I?

Front 1

angle along the lesser curve

marks the approximate point at which the stomach narrows prior to its junction with duodenum

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incisura angularis

Front 2

narrow conical portion of stomach immediately distal to gastroesophageal junction

Back 2

cardia

Front 3

dome shaped portion of the proximal stomach that extends superolateral to the gastroesophageal junction

Back 3

fundus

Front 4

stomach proximal to the incisura angularis

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body/corpora

Front 5

stomach distal to the angle

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antrum

Front 6

infoldings of mucosa and submucosa that extend longitudinally

most prominent in the proximal stomach

flatten out if the stomach

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rugae

Front 7

gastric pits leading to the mucosal glands

surface epithelial cells lining the entire mucosal surface

give's leaf like texture to mucosa

uniform throughout stomach

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gastric foveola

Front 8

cells located deep in gastric pits htat have a lower content of mucin granules

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mucous neck sales

Front 9

phase of acid secretion initiated by sight, taste, smell, chewing, and swallowing of palatable food

mediated by vagal activity

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cephalic phase

Front 10

phase of acid secretion that involves stimulation of stretch receptors

mediated by vagal impulse

involves gastrin release from the endocrine cells, G cells, in the antral glands

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gastric phase

Front 11

phase of acid secretion initiated when food containing digested protein enters the proximal small bowel

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the intestinal phase

Front 12

receptor stimulated by acetyl choline released from cephalic-vagal ro gastric-vagal afferents

results in increase in cytosolic Ca and activation of proton pump in the parietal cell

Back 12

muscarine 3 cholinergic receptor

Front 13

role of oxyntic gland ECL cell in acid secretion

Back 13

gastrin + vagal afferents cause histamine release which activates H2 receptors on the parietal cell

Front 14

superficial damage limited to the mucosa can heal in

Back 14

hours to days

Front 15

damage that extends to the submucosa can heal in

Back 15

weeks to months

Front 16

most common infection world wide

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chronic infection of the gastric mucosa by H. pylori

Front 17

nodules of essentially normal pancreatic tissue up to 1 cm in diameter is present in the gastric submucosa, muscle wall, or at subserosal location

small patches of ectopic gastric mucosa in the duodenum or in more distal sites may be present as perplexing sources of bleeding

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pancreatic heterotopia

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rupture of abdominal contents into thorax

may be asymptomatic or may engender potentially lethal respiratory problems

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diaphragmatic hernia

Front 19

mildest form involves moderate edema and slight vascular congestion of the lamina propria

presence of neutrophils above the basement membrane

erosion and hemorrhage may develop with increasing severity

robust acute inflammatory infiltrate adn extrusion of a fibrin-containing purulent exudate

punctate dark spots

asymptomatic or epgastric pain, nausea, vomiting, possible overt hemorrhage

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acute gastritis

Front 20

presence of chronic mucosal inflammatory changes leading to mucosal atrophy and intestinal metaplasia

absence of erosions

background for development of carcinoma

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chronic gastritis

Front 21

bacterial adhesin associated with H. Pylori

binds to the fucosylated Lewis B blood group antigen bearing cells

Back 21

BabA

Front 22

gastritis with high acid production and elevated risk for duodenal ulcer

low IL-1 beta

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antral gastritis

Front 23

gastritis followed by multifocal atrophy with lower gastric acid secretion and higher risk for adenocarcinoma

high IL-1 beta

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pangastritis

Front 24

presence of autoantibodies to components of gastric gland parietal cells, including antibodies against the acid producing enzyme H+,K+ ATPase

significant risk for developing carcinoma

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autoimmune gastritis

Front 25

diffuse mucosal damage of the body-fundic mucosa with less intense to absent antral damage

mucosa is usually reddened and has coarser texture than normal

muscosa thickened with rugal folds mimicking early infiltrative lesions

active inflammation is signified by the presence of neutrophils within the glandular nad surface epithelial layer

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autoimmune gastritis

Front 26

nausea, vomiting, adn upper abdominal discomfort

since parietal cells are never completely destroyed these patients do not develop achlorhydria or pernicious anemia

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autoimmune gastritis

Front 27

idiopathic condition that features a prominent eosinophilic infiltrate of the mucosa, muscle wall, or all layers of the stomach, usually in the antral or pyloric region

middle aged women

abdominal pain, swelling of the pylorus may produce gastric outlet obstruction

steroid therapy is usually effective

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eosinophilic gastritis

Front 28

disorder of children that may produce symptoms of diarrhea, vomiting, and growth failure

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allergic gastroenteropathy

Front 29

condition in which lymphocytes densely poulate the epithelial layer of the mucosal surface and gastric pits adn suffuse the lamina propria

mostly CD8+ cells

45-60% cases are associated with celiac disease

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lymphocytic gastritis

Front 30

presence of intramucosal epithelioid granulomas without Crohn disease, sarcoidosis, infection, a systemic vasculitis, or a reaction to foreign materials

clinically benign

narrowing and rigidity of the gastric antrum due to transmural granulomatous inflammation

Back 30

granulomatous gastrititis

Front 31

gastritis encountered in the setting of a bone marrow transplantation

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graft versus host disease

Front 32

longitudinal stripe of edematous erythematous mucosa alternating with less severely injured mucosa

water melon stomach

due to chemical injury from cyclooxygenase inhibition or bile reflux and mucosal trauma from prolapse

Back 32

reactive gastropathy

Front 33

breach in mucosa of the alimentary tract that extends through the muscularis mucosa

usually in the duodenum and stomach

Back 33

ulcers

Front 34

epithelial disruption within the mucosa but no breach of the muscularis mucosa

Back 34

erosions

Front 35

cytokines associated with H pylori

Back 35

IL-1, IL-6, TNF, IL-8

Front 36

enhances gastric acid secretion/duodenal bicarbonate production

T cell and B cell aggregation

thrombotic occlusion of surface capillaries promoted by bacterial platelet activating factor

damage to mucosa

Back 36

H. Pylori infection

Front 37

strains of H pylori associated with greater number of organisms in tissue adn severe epithelial damage

increased risk for gastric cancer

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CagA positive

Front 38

important gene regulated by CagA

causes cell injury by vacuole formation

behaves as a passive urea transporter, increasing permeability of epithelium to urea

Back 38

VacA

Front 39

pt with duodenal ulcer, the H. pylori infection is limited to the

Back 39

stomach

Front 40

chronic use of NSAIDs

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suppresses mucosal prostaglandins

Front 41

cigarette smoking and ulcers

Back 41

impairs mucosal blood flow and healing

Front 42

location of most duodenal ulcers

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w/in a few cm of the pyloric ring; anterior wall affected more than posterior wall

Front 43

round to oval, sharply punched-out defect with relatively straight walls

scarring may involve entire thickness of stomach; puckering of surrounding mucosa creates mucosal folds-> "spoke like"

surrounding mucosa is edematous and reddened

Back 43

classical peptic ulcer

Front 44

ulcers with four zones:
superficial necrotic fibrinoid debris, non-specific inflammatory infiltrate with neutrophils predominating, active granulationtissue infiltrated with mononuclear leukocytes, and solid fibrous or collagenous scar

Back 44

active ulcer

Front 45

epigastric gnawing, burning, aching pain

pain worse at night, usually occuring 1-3 hours after meals during the day

nausea, vomiting, bloating, belching, significant weight loss

occasionally pain referred to back, LUQ, or chest

Back 45

peptic ulcer

Front 46

time for medically untreated ulcer to heal

Back 46

15 years

Front 47

time for medically treated ulcer to heal

Back 47

few weeks; much less likely to require surgery

Front 48

ulcers/erosions encountered in pt with shock, extensive burns, sepsis, or severe trauma

intracranial injury that raises intracranial pressure

following intracranial surgery

Back 48

stress erosions/ulcers

Front 49

stress erosions/ulcers in pt with severe burns/trauma

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curling ulcers

Front 50

stress ulcers/erosions in pt with intracranial injury, operations, or tumors

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cushing ulcers

Front 51

ulcers less than 1 cm in diameter

circular and small; ulcer base frequently stained brown by digestion of extruded blood

abrupt lesions with essentiall unremarkable adjacent mucosa

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stress ulcers

Front 52

condition arising from outlet obstruction or functional atony of the stomach and intestines

may develop in pt wtih generalized peritonitis

gastric rupture may occur and is a calamatous event

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gastric dilation

Front 53

bezoar derived from plant material

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phytobezoar

Front 54

bezoars better known as hairballs

consist of ingested hair within mucoid coat containign decaying food stuff

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trichobezoars

Front 55

hyperplasia of mucosal epithelial cells without inflammation

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rugal enlargement

Front 56

profound hyperplasia of surface mucous cells with accompanying glandular atrophy

most often encountered in males in fourth to sixth decade

epigastric discomfort, diarrhea, weight loss, sometimes bleeding

Back 56

menetrier disease

Front 57

hyperplasia of parietal and chief cells within gastric glands

Back 57

hypertrophic-hypersecretory gastropathy

Front 58

portal hypertension

masslike nodular and tortuous winding elevations of the mucosa in the cardia or fundus

difficult to distinguish from rugae

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gastric varices

Front 59

any nodule or mass that projects above the level of surrounding mucosa

non neoplastic or neoplastic

Back 59

gastric polyp (uncommon)

Front 60

polyp like lesion that contains proliferative dysplastic epithelium and malignant potential

may be sessile (no stalk) or pedunculated (stalk)

most common location is antrum; usually single

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gastric adenoma

Front 61

polyp that is innocuous cystic dilation of glands in the oxyntic mucosa

occur with familial adenomatous polyposis

exhibit mutations in beta catenin

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fundic polyps

Front 62

striking lesion that is a bulky submucosal growth composed of inflamed vascularized fibromuscular tissue with prominent eosinophilic infiltrate and a tenuous mucosa stretched over the surface

most frequently found in distal stomach

may occlude pyloric channel

Back 62

inflammatory fibroid polyp/eosinophilic granuloma

Front 63

leading cause of cancer death worldwide

higher incidence in men (2:1)

associated strongly with chronic H. pylori infection which causes oxidative stress

lack of refrigeration; consumption of preserved, smoked, cured, and salted foods; water contamination with nitrates; lack of fresh fruits and vegetables in diet

Back 63

gastric carcinoma

Front 64

gastric carcinoma with formation of bulky tumors composed of glandular structures

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Lauren gastric carcinoma (intestinal)

Front 65

gastric carcinoma with diffuse infiltrative growth of poorly differentiated discohesive malignant cells

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Diffuse gastric carcinoma

Front 66

Higher risk in Native Americans and Hawaiians

favored location is lesser curvature of antropyloric region; although less common ulcerative lesion on greater curvature more likely to be malignant

may be confined to mucosa/submucosa (early) or extend beyond submucosa to muscular wall (advanced)

craters may be identified with heaped up beaded margins adn shaggy, necrotic bases; overt neoplastic tissue extending to surrounding mucosa wall

Back 66

gastric carcinoma

Front 67

gastric carcinoma with protrusion of a tumor mass into the lumen

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exophytic

Front 68

gastric carcinoma in which there is no obvious tumor mass within mucosa

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flat/depressed

Front 69

gastric carcinoma in which shallow or deeply erosive crater is present in wall of stomach

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excavated

Front 70

broad region of gastric wall or entire stomach is extensively infiltrated by malignancy

rigid, thickned, "leather bottle"

Back 70

linitis plastica in gastric carcinoma

Front 71

neoplastic intestinal glands resembling colonic adenocarcinoma

tend to grow along broad cohesive fronts in expanding growth pattern

mucin formation expands the malignant cells and pushes the nucleus to the periphery-> signet ring conformation

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diffuse variant gastric carcinoma

Front 72

node gastric carcinomas frequently metastasize to as first clinical manifestation

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supraclavicular

Front 73

gastric carcinoma that metastasizes to the periumbilical region to form subcutaneous nodule

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Sister Mary Joseph nodule

Front 74

metastatic adenocarcinoma to the ovaries

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Krukenberg tumor

Front 75

generally asymptomatic until late in course

weight loss, abdominal pain, anorexia, vomiting, altered bowel habits, dysphagia, anemia, hemorrhage

Back 75

gastric carcinoma

Front 76

tumor commonly occuring in the mucosa or superficial submucosa

monomorphic lymphocytic infiltrate of the lamina propria surrounds gastric glands massively infiltrated with atypical lymphocytes and undergoing destruction

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gastric lymphoma

Front 77

tumor thought to originate from interstitial cells of Cajal

cut surface is tan and usually lacks whirling smooth muscle patterns of leiomyomas or leiomyosarcomas

firm to soft; hemorrhagic changes common

spindle cells, plump "epithelioid cells or mixture"

c-KIT positive

Back 77

gastrointestinal stromal tumor (GIST)

Front 78

originate from ECL cells in oxyntic mucosa

can arise in setting of chronic atrophic gastritis, MEN1, or zollinger Ellison

hypergastrinemic state

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gastric neuroendocrine cell (carcinoid) tumor

Front 79

benign neoplasm of adipose tissue that usually present in submucosa

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lipomas

Front 80

although metastatic cancer of stomach is unusual the most common sources are

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systemic lymphomas