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20 Cards in this Set
- Front
- Back
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acute stress ulcers
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most often seen at autopsy, typically shallow and multiple in assoc with hypertension
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classification of chronic gastritis
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Nonatrophic-almost always due to infxn from H.pylori
Multifocal atrophic Autoimmune- rare. Lymphocytic Viral (systemic, CMV) Granulomatous Reactive |
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Helicobacter pylori
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Gram negative spiral rod
In 1984, Warren & Marshall associated Hp with disease Strong affinity for gastric surface epithelium Congregates near tight junctions & in mucus Produces urease, ammonia, acetaldehyde, phospholipases, toxins VacA & cagA, platelet activating factor In developing (especially tropical) countries, 90% prevalence in adults High prevalence in children indicates exposure occurs early In industrialized nations, exposure occurs later in life Prevalence of 30% by age 50 & is declining Associated with generalized improvement in sanitation |
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H pulori assoc disease
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Nonatrophic gastritis
Multifocal atrophic gastritis Peptic ulcers Gastric adenocarcinoma Gastric lymphoma Some studies have shown prevalence of nonulcer dyspepsia is similar with & without infection |
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Patholofy of nonatrophic gastritis
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Lymphoid follicles/nodules
Expansion of LP by plasma cells Neutrophils in LP & epithelium of surface & pits Erosions |
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normally no lymphoid aggregates in the
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stomach
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Multifocal Atrophic gastritis
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Multiple areas of chronic gastritis with marked glandular atrophy & intestinal metaplasia in fundus & antrum
H.pylori infection acquired early in life |
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Autoimmune Gastritis
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Corpus restricted atrophic gastritis with serum anti-parietal cell & anti-IF antibodies, & IF deficiency, with or without PA
Iron deficiency anemia also common Risk factor for adenomas, adenocarcinoma, endocrine tumors Idiopathic |
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Pathology of Autoimmune Gastritis
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Early: Diffuse or multifocal dense mononuclear infiltrates of entire fundic mucosa
Florid: Prominent atrophy of fundic glands, diffuse mononuclear infiltrates including invasion of glands, pit hyperplasia, possible reduced mucosal thickness, intestinal metaplasia End stage: Marked or complete loss of fundic glands, pit hyperplasia, microcystic change, thin mucosa, intestinal metaplasia |
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Peptic Ulcers
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Chronic, usually solitary, ulcer anywhere exposed to gastric secretions
Most common in duodenum (~75%), especially 1st segment & anterior wall M:F 3:1 ~100% H.pylori infection In stomach, most often distal & on lesser curvature M:F 1.5:1 ~70% H.pylori infection In US, 4 million people with 400,000 new cases per year Lifetime risk: 10% men, 5% women |
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peptic ulcer path
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round, sharply deliniated, striaght walls, clean base, usu fibrosis in underlying layers causin puckering making mucosa fold radiating from ulcer
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gastric Adenocarcinoma
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Overall incidence & mortality rates declined significantly worldwide
Marked decline in intestinal & distal cancers Increased incidence in cardiac cancers No change in diffuse type Highest incidence: China, Columbia, Chile, Costa Rico, Iceland |
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Risk Factors for Gastric Adenocarcinoma
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Helicobacter pylori gastritis
Atrophic gastritis Dietary nitrates Salted & smoked foods Partial gastrectomy (stump carcinomas) Adenomas |
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Intestinal Gastric Adenocarcinoma
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glandular, polupoid, assoc with h pylori, M>F, mean age 55
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Diffuse Gastric Adenocarcinoma
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singet ring cells, infiltrative, M=F, mean age is 45
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Early Gastric Carcinoma
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restricted to mucosa and or submucosa. mostly in japan. Demonstrates that depth of invasion and matastases affect prognoses
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Gastrointestinal Lymphomas
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GIT is most common site for extra-nodal NHLs
Predisposing factors: H. pylori infection, celiac disease, CIBD, immune deficiency states Stomach is primary site in 60-65% of GI NHLs Accounts for 5% gastric cancers SI is primary site 20-35% Accounts for 25% SI cancers |
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Types of Gastric Lymphomas
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DLBC
Marginal Zone (MALToma)-assoc with h pylori Burkitt's Mantle cell Follicular |
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gastric MALTomas
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Nearly all associated with H.pylori infection
Eradicate in up to 90% with antibiotics Composed of small-medium sized tumor cells with slightly irregular nuclei & clear cytoplasm Usually confined to mucosa & submucosa as diffuse infiltrate Lymphoepithelial lesions Colonized benign follicles Plasmacytoid features Most confined to stomach 90% 5 year survival Transformation possible |
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Gastrointestinal Stromal Tumors
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Most patients middle aged on older
M:F 1:1 65% in stomach; 30% in SI No known risk factors Interstitial cells of Cajal: pacemaker cells between autonomic nerves & smooth muscle Challenge of predicting behavior differs by location Gleevec (c-Kit; CKD 117) Composed of spinled or epithelioid tumor cells Predictors of malignant behavior: Size >5 cm MF count >5/50 hpf Invasion of LP Tumor cell necrosis Dense cellularity |
