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24 Cards in this Set

  • Front
  • Back
Two types of diaphragmatic
hernia:
Bochdalek hernia:
Involves an opening on the
left side of the diaphragm. The
stomach and intestines usually
move up into the chest cavity.
• Morgagni hernia (space of
Larrey):
Involves an opening on the
right side of the diaphragm.
The liver and intestines
usually move up into the chest
cavity.
Gastric gland hetero_____: gastric adenomyoma
Hamartoma of stomach composed of large ducts, Brunner’s glands, prominent
smooth muscle bundles
May produce peptic type ulcers in duodenum and bleeding
Gastric gland heterotopia: gastric adenomyoma
Hamartoma of stomach composed of large ducts, Brunner’s glands, prominent
smooth muscle bundles
May produce peptic type ulcers in duodenum and bleeding
Heterotopic pancreas/pancreatic acinar metaplasia
Nodules of normal pancreatic tissue up to 1 cm in gastric or intestinal wall
Prevalence 1-2%; incidental or presents as mass; in 4% of pediatric gastric
biopsies
Usually antrum or pylorus; when in pylorus, localized inflammation may
cause obstruction
Strongly associated with chronic gastritis and intestinal metaplasia, but not
H. pylori infection
At GE junction in children/young adults, but may also be congenital.
11
Heterotopic pancreas/pancreatic acinar metaplasia
Nodules of normal pancreatic tissue up to 1 cm in gastric or intestinal wall
Prevalence 1-2%; incidental or presents as mass; in 4% of pediatric gastric
biopsies
Usually antrum or pylorus; when in pylorus, localized inflammation may
cause obstruction
Strongly associated with chronic gastritis and intestinal metaplasia, but not
H. pylori infection
At GE junction in children/young adults, but may also be congenital.
11
Mucolipidosis type IV: autosomal recessive
_________ storage disease, causes severe
neurologic abnormalities
Mucolipidosis type IV: autosomal recessive
lysosomal storage disease, causes severe
neurologic abnormalities
H. Pylori is not assoc with:
Not associated with:
NSAID and NSAID-induced erosions and ulcers
Postgastrectomy status (unless they had it pre-op)
Pernicious anemia
H. pylori is Detectable in superficial mucus (noninvasive) by:
Endoscopic biopsy or brushing
Identify microscopically
CLO-test, incubate specimen, detects urease
Urea breath test -inhale radioactive carbon labelled urea test for
release of labeled carbon dioxide
Specific IgG tested in saliva by an ELISA assay
Most cases of chronic gastritis are caused by
_____________.
Most cases of chronic gastritis are caused by
heliobacter.
H.P: Bacterial factors
Epithelial injury is also caused by a ___________
toxin (VacA)
_________ associated gene A (CagA) is a powerful
stimulus for IL-_.
H.P. enhances gastric acid secretion and impairs
duodenal bicarbonate, reducing pH of duodenum.
This favors gastric metaplasia of duodenum
The antral gastric mucosa responds by __________
type metaplasia.
H.P: Bacterial factors
Epithelial injury is also caused by a vacuolating
toxin (VacA)
Cytotoxic associated gene A (CagA) is a powerful
stimulus for IL-8.
H.P. enhances gastric acid secretion and impairs
duodenal bicarbonate, reducing pH of duodenum.
This favors gastric metaplasia of duodenum
The antral gastric mucosa responds by intestinal
type metaplasia.
20
HP treatment
Tetracycline better than amoxicillin [Chiba]
2 types of Active gastritis, chronic
superficial

follicular
________ _______ or chemical gastritis is now the
2nd most common gastric bx diagnosis in USA.
Reflux gastritis or chemical gastritis is now the
2nd most common gastric bx diagnosis in USA.
Describe microcopic look of reactive gastropathy
Mucosa shows edema, congestion, foveolar
hyperplasia with mucin depletion often producing
a *corkscrew* appearance and paucity of inflx
cells.
Which is associated with HP?

a) increased muucosal lymphocytes in LP, surface, foveolar
epithelium.
b) Lymphoid follicle with
germinal centers of deep mucosa
b) Lymphoid follicle with
germinal centers of deep mucosa
Ulcer Perforation or penetration can be fatal:
Gastric -> referred pain to ____ _____ quadrant, thorax, or back
Duodenal ->____ or _____ upper quadrant
Ulcer Perforation or penetration can be fatal:
Gastric -> referred pain to left upper quadrant, thorax, or back
Duodenal ->back or right upper quadrant
Zollinger-Ellison syndrome
Multiple gastric and duodenal ulcers
Gastrin-secreting tumor of islet D-cells
Found in distal duodenum (even jejunum)
*No _______ loss or peripheral _____
Zollinger-Ellison syndrome
Multiple gastric and duodenal ulcers
Gastrin-secreting tumor of islet D-cells
Found in distal duodenum (even jejunum)
*No protein loss or peripheral edema
***********

Menetriers disease
profound hyperplasia of surface mucous cells with
accompanying glandular atrophy with antral sparing.
_______ loss and peripheral edema.
***********

Menetriers disease
profound hyperplasia of surface mucous cells with
accompanying glandular atrophy with antral sparing.
Protein loss and peripheral edema.
***************
Gastric polyps

90% are hyperplastic, regenerative and nonheoplastic but 20-25% of
hyperplastic polyps are associated with carcinomas when >_cm**********; usually multiple,
most <1 cm and sessile but can be 2 cm and pedunculated
***************
Gastric polyps

90% are hyperplastic, regenerative and nonheoplastic but 20-25% of
hyperplastic polyps are associated with carcinomas when >2cm**********; usually multiple,
most <1 cm and sessile but can be 2 cm and pedunculated
**************

Malignant tumors:
90-95% are adenocarcinoma; weak statistical link with incomplete __________ metaplasia (type III)
**************

Malignant tumors:
90-95% are adenocarcinoma; weak statistical link with incomplete intestinal metaplasia (type III)
Dukes stages
A, B, C, D
Risk factors for adenocarcinoma
prior gastrectomy >20 years old
Proximal
Gastroesophageal junction and cardia
- cardia type ***
b. Distal
-gastric body and antrum
Proximal
Gastroesophageal junction and cardia
- cardia type ***
b. Distal
-gastric body and antrum
Adverse prognostic factors

Duffuse gastric carcinoma
>70 years
proximal stomach
venous lymphatic invasion
CEA > 10 ng/ml
CA19-9 >37 g/ml

*********Most powerful determinant of prognosis is the TNM pathologic stage: refer to Dukes staging
***********

50% eliminated by __________ treatment for H
pylori
***********

50% eliminated by antibiotic treatment for H
pylori
95% of GIST stain with antibodies to c-KIT (CD___) and 70% CD34
95% of GIST stain with antibodies to c-KIT (CD117) and 70% CD34