Gastric Cancer Types

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Questions and Answers

What percentage of duodenal ulcers are due to H. pylori?

80-90%

95% (correct)

60-70%

75%

What is the typical location of a gastric ulcer?

Fundus of the stomach

Pyloric antrum

Greater curvature of the antrum

Lesser curvature of the antrum (correct)

What is a common cause of gastric ulcers besides H. pylori infection?

NSAIDs

Bile reflux

Gastroesophageal reflux disease

All of the above (correct)

What is a characteristic feature of benign peptic ulcers?

Small, sharply demarcated, and surrounded by radiating folds of mucosa Signup and view all the answers

What is the main difference between duodenal and gastric ulcers?

Pain pattern Signup and view all the answers

What is the risk of bleeding from a ruptured gastric ulcer?

Bleeding from the left gastric artery Signup and view all the answers

What is the role of biopsy in peptic ulcer diagnosis?

To exclude gastric carcinoma Signup and view all the answers

What is the typical location of a duodenal ulcer?

Proximal duodenum Signup and view all the answers

What is a risk factor for the intestinal type of gastric carcinoma?

H pylori infection Signup and view all the answers

Which of the following is NOT associated with diffuse type of gastric carcinoma?

Signet ring cells Signup and view all the answers

What is a common site of distant metastasis in gastric carcinoma?

Liver Signup and view all the answers

What is a risk factor for acute gastritis?

Severe burn Signup and view all the answers

Which of the following is a rare presentation of gastric carcinoma?

Acanthosis nigricans Signup and view all the answers

What is the term for the thickening of the stomach wall seen in diffuse type of gastric carcinoma?

Linitis plastica Signup and view all the answers

What is a defense mechanism of the gastric mucosa?

Bicarbonate secretion by surface epithelium Signup and view all the answers

What is a clinical feature of chronic gastritis?

Chronic inflammation of the stomach mucosa Signup and view all the answers

Which of the following nodes can be involved in lymph node spread of gastric carcinoma?

Left supraclavicular node Signup and view all the answers

What is a consequence of acid damage to the gastric mucosa?

Superficial inflammation and ulceration Signup and view all the answers

What is a risk factor for gastric mucosal damage?

Long-term use of NSAIDs Signup and view all the answers

What is a complication of chronic gastritis?

All of the above Signup and view all the answers

What is a defense mechanism of the gastric mucosa against H. pylori infection?

Increased mucus production by foveolar cells Signup and view all the answers

What is a characteristic of chronic autoimmune gastritis?

Autoimmune response against parietal cells Signup and view all the answers

Study Notes

Gastric Carcinoma

Intestinal type: large, irregular ulcer with heaped up margins, commonly involves the lesser curvature of the antrum
Risk factors: intestinal metaplasia (e.g., due to H pylori and autoimmune gastritis), nitrosamines in smoked foods (Japan), and blood type A
Diffuse type: characterized by signet ring cells that diffusely infiltrate the gastric wall, resulting in thickening of the stomach wall (linitis plastica)
Not associated with H pylori, intestinal metaplasia, or nitrosamines
Presents late with weight loss, abdominal pain, anemia, and early satiety; rarely presents as acanthosis nigricans or Leser-Trelat sign
Spread to lymph nodes can involve the left supraclavicular node (Virchow node)
Distant metastasis most commonly involves the liver; other sites include the periumbilical region (Sister Mary Joseph nodule)

Peptic Ulcer Disease

Solitary mucosal ulcer involving the proximal duodenum (90%) or distal stomach (10%)
Duodenal ulcer: almost always due to H pylori (> 95%); rarely due to ZE syndrome
Presents with epigastric pain that improves with meals
Diagnostic endoscopic biopsy shows ulcer with hypertrophy of Brunner glands
Usually arises in the anterior duodenum; when present in the posterior duodenum, rupture may lead to bleeding from the gastroduodenal artery or acute pancreatitis
Gastric ulcer: usually due to H pylori (75%); other causes include NSAIDs and bile reflux
Presents with epigastric pain that worsens with meals
Ulcer is usually located on the lesser curvature of the antrum
Rupture carries risk of bleeding from the left gastric artery
Differential diagnosis of ulcers includes carcinoma
Benign peptic ulcers are usually small (< 3 cm), sharply demarcated ("punched-out"), and surrounded by radiating folds of mucosa
Malignant ulcers are large and irregular with heaped up margins
Biopsy is required for definitive diagnosis

Acute Gastritis

Acidic damage to the stomach mucosa
Due to imbalance between mucosal defenses and acidic environment
Defenses include mucin layer produced by foveolar cells, bicarbonate secretion by surface epithelium, and normal blood supply
Risk factors: severe burn (Curling ulcer), NSAIDs, heavy alcohol consumption, chemotherapy, increased intracranial pressure (Cushing ulcer), and shock
Acid damage results in superficial inflammation, erosion (loss of superficial epithelium), or ulcer (loss of mucosal layer)