Stomach Pathology Overview
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Questions and Answers

What is a significant characteristic of a malignant gastric ulcer?

  • Heaped-up margins with a necrotic floor (correct)
  • Ulcer with a sloping edge
  • Ulcer characterized by fibrotic tissue at the base
  • Typically occurs in individuals aged 30-40
  • In which age group is peptic ulcer disease more commonly found?

  • 30-40 years (correct)
  • Over 70 years
  • 50-70 years
  • Below 20 years
  • Which type of gastric carcinoma shows the highest survival rate when detected early?

  • Advanced gastric carcinoma
  • Signet-ring cell carcinoma
  • Well differentiated adenocarcinoma
  • Resected gastric cancer (correct)
  • What is a common clinical feature of ulcerative gastric carcinoma?

    <p>Epigastric pain or fullness (C)</p> Signup and view all the answers

    Which of the following tumors accounts for the least percentage of gastric tumors?

    <p>Leiomyosarcoma (D)</p> Signup and view all the answers

    Which type of cell is primarily involved in signet-ring cell carcinoma?

    <p>Mucin-producing malignant cells (B)</p> Signup and view all the answers

    What distinguishes the microscopic appearance of gastric carcinoma from that of peptic ulcers?

    <p>Malignant cells forming glands and invading the muscular wall (A)</p> Signup and view all the answers

    What is the typical pattern of gastric acidity associated with malignant ulcers?

    <p>Absent or normal acidity (B)</p> Signup and view all the answers

    Which feature is indicative of a poorly differentiated gastric carcinoma?

    <p>Mucinous pools within the tumor (A)</p> Signup and view all the answers

    What factor significantly affects the prognosis of gastric carcinoma?

    <p>Extent of tumor resection at diagnosis (C)</p> Signup and view all the answers

    What is the primary cause of congenital pyloric stenosis in infants?

    <p>Abnormal muscle development in the pylorus (A)</p> Signup and view all the answers

    Which symptom is most closely associated with acute gastritis?

    <p>Epi-gastric pain (A)</p> Signup and view all the answers

    Which type of gastritis is typically linked to Helicobacter pylori infection?

    <p>Antral type gastritis (D)</p> Signup and view all the answers

    What is a key histological feature of chronic atrophic gastritis?

    <p>Loss of parietal cells (A)</p> Signup and view all the answers

    Which of the following is NOT a common cause of acute gastritis?

    <p>Dietary fiber deficiency (A)</p> Signup and view all the answers

    What clinical manifestation is associated with congenital pyloric stenosis?

    <p>Palpable abdominal mass (A)</p> Signup and view all the answers

    What is a significant risk associated with chronic atrophic gastritis?

    <p>Gastric carcinoma (C)</p> Signup and view all the answers

    What anatomical feature is notably affected in patients with fundic type gastritis?

    <p>Rugal folds (A)</p> Signup and view all the answers

    Which of the following is commonly observed in the microscopic examination of acute gastritis?

    <p>Neutrophil infiltration (C)</p> Signup and view all the answers

    What hematological disorder may result from autoimmune atrophic gastritis?

    <p>Pernicious anemia (B)</p> Signup and view all the answers

    What is a key characteristic of Ménétrier disease?

    <p>Hyperplasia of mucous cells with fundic gland atrophy (C)</p> Signup and view all the answers

    Which of the following is a primary cause of gastric gland hyperplasia in Zollinger-Ellison syndrome?

    <p>Excessive secretion of gastrin (A)</p> Signup and view all the answers

    Which of the following ulcers is most commonly associated with peptic ulcers?

    <p>Duodenal ulcers (D)</p> Signup and view all the answers

    What is the most significant complication of a peptic ulcer?

    <p>Hemorrhage (C)</p> Signup and view all the answers

    What best describes the gross appearance of peptic ulcers?

    <p>Round or oval with sharply demarcated edges (C)</p> Signup and view all the answers

    What is one of the damaging forces contributing to the formation of peptic ulcers?

    <p>H.pylori infection (B)</p> Signup and view all the answers

    What symptom is commonly associated with Zollinger-Ellison syndrome?

    <p>Persistent abdominal pain (A)</p> Signup and view all the answers

    Which element is NOT considered part of mucosal defense mechanisms against ulcers?

    <p>Excess gastric acid (A)</p> Signup and view all the answers

    Which condition is characterized by giant gastric folds and peripheral edema?

    <p>Ménétrier disease (B)</p> Signup and view all the answers

    What type of tissue is typically found at the active margins of a peptic ulcer?

    <p>Necrotic debris (B)</p> Signup and view all the answers

    What is the most common site for duodenal peptic ulcers?

    <p>Anterior wall of the first portion of duodenum (B)</p> Signup and view all the answers

    Which of the following is NOT typically associated with duodenal peptic ulcers?

    <p>Malignant change to carcinoma (A)</p> Signup and view all the answers

    What is the primary type of gastric polyp found in chronic gastritis?

    <p>Hyperplastic or inflammatory polyps (B)</p> Signup and view all the answers

    What feature distinguishes the ulcerative type of gastric carcinoma?

    <p>It shows heaped-up margins and a necrotic floor. (C)</p> Signup and view all the answers

    Which of the following is considered a benign gastric tumor?

    <p>Gastric adenoma (D)</p> Signup and view all the answers

    Which dietary factor is a known risk for gastric carcinoma?

    <p>Use of preservatives like nitrates (A)</p> Signup and view all the answers

    What is a clinical feature common to gastric peptic ulcers?

    <p>Burning epigastric pain that worsens with eating (B)</p> Signup and view all the answers

    What type of gastric polyp has the potential for malignant change?

    <p>Adenomatous polyp (B)</p> Signup and view all the answers

    In Zollinger-Ellison syndrome, what is primarily increased?

    <p>Gastric acid secretion (D)</p> Signup and view all the answers

    Which characteristic is typically associated with hyperplastic or inflammatory gastric polyps?

    <p>Multiple with smooth surface (B)</p> Signup and view all the answers

    Flashcards

    Congenital Pyloric Stenosis

    A condition where the pyloric sphincter between the stomach and small intestine is narrowed, preventing food from passing through.

    Gastritis

    Inflammation of the stomach lining that can be acute or chronic.

    Acute Gastritis

    A short-term inflammation of the stomach lining, often caused by irritants like NSAIDs, alcohol, or smoking.

    Chronic Gastritis

    A long-term inflammation of the stomach lining, often leading to atrophy. It can be caused by autoimmune disorders or Helicobacter pylori infection.

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    Fundic Gastritis

    A type of chronic gastritis that is caused by an autoimmune reaction attacking the stomach lining.

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    Antral Gastritis

    A type of chronic gastritis caused by infection with Helicobacter pylori.

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    Autoimmune Atrophic Gastritis

    A condition where the body develops antibodies against the parietal cells in the stomach, leading to reduced acid secretion.

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    Pernicious Anemia

    A condition caused by the lack of intrinsic factor, which is needed for the absorption of vitamin B12, leading to megaloblastic anemia.

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    Loss of Rugal Folds

    The loss of the normal folds in the lining of the stomach, often seen in chronic gastritis.

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    Dysplasia

    An abnormal growth of cells in the stomach lining, which can be a precursor to cancer.

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    Helicobacter pylori

    A bacterial infection that can cause inflammation and ulcers in the stomach and duodenum.

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    Hypertrophic Gastropathy

    An enlargement of the stomach's lining folds, often resulting in symptoms like pain, vomiting, and swelling.

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    Ménétrier disease

    A rare condition characterized by excessive mucus secretion, decreased acid production, and giant stomach folds.

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    Gastric Gland Hyperplasia (Zollinger-Ellison syndrome)

    A condition caused by excessive gastrin production, leading to stomach gland overgrowth and excess acid.

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    Peptic Ulcers

    Open sores that develop in the inner lining of the stomach or duodenum.

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    Gastro-duodenal Mucosal Defense Mechanisms

    The ability of the stomach lining to resist damage from acids and other factors.

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    Damaging forces that contribute to peptic ulcer formation

    Excess gastric acid and pepsin, H. pylori infection, aspirin, smoking, and alcohol.

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    Gross appearance of Peptic Ulcers

    A wound with sharply defined edges and a clean base, often radiating from the center.

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    Hemorrhage

    Bleeding from the ulcer, often resulting in vomiting blood or dark stools.

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    Perforation

    A life-threatening complication where the ulcer breaks through the stomach or duodenum.

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    Duodenal peptic ulcer

    A common type of peptic ulcer, usually found in the first part of the duodenum, often associated with H. pylori infection and increased gastric acid secretion.

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    Gastric peptic ulcer

    An ulcer occurring in the stomach lining, often associated with H. pylori infection, characterized by burning pain after eating.

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    Gastric polyp

    Non-cancerous growth in the stomach lining, often multiple, smooth surfaced, and can be either flat or stalk-like.

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    Benign gastric tumors

    Non-cancerous tumors in the stomach, commonly adenomas (non-cancerous growths), along with other types like leiomyoma, lipoma, and hemangioma.

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    Gastric carcinoma

    A type of stomach tumor, usually characterized by its growth pattern, which can be projecting inward (exophytic), ulcer-like, or spreading flat (infiltrating).

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    Exophytic gastric carcinoma

    A type of gastric carcinoma where the tumor grows outward, creating a mass that protrudes into the stomach.

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    Excavated gastric carcinoma

    A type of gastric carcinoma where the tumor forms an ulcer-like sore with raised edges and a necrotic base.

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    Infiltrating gastric carcinoma

    A type of gastric carcinoma where the tumor spreads flat and invades the stomach wall, causing it to shrink and become stiff.

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    Linitis plastica

    The condition where the stomach wall becomes thickened and stiff due to infiltrating gastric carcinoma, making the stomach small and contracted.

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    Gastric Carcinoma (Microscopic)

    A type of gastric cancer where malignant cells form glands and invade the muscular wall of the stomach, often appearing on the left side of the stomach.

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    Signet-ring cells

    Malignant cells that produce a large amount of mucin, giving them a signet ring-like appearance under a microscope.

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    Adenocarcinoma

    A common type of gastric cancer characterized by poorly differentiated cells that invade the surrounding tissue. Can be well differentiated, mucinous, or signet-ring cell carcinoma.

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    MALToma

    A type of lymphoma affecting the stomach's mucosa-associated lymphoid tissue (MALT).

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    Leiomyosarcoma

    A type of cancer originating from the smooth muscle tissue of the stomach.

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    Gastric Malignant Schwannoma

    A type of tumor originating from the glial cells of the nervous system, potentially found in the stomach.

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    Malignant Ulcer

    A type of stomach ulcer caused by malignant cells invading the stomach lining, often appearing with heavier edges and a necrotic base.

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    Well Differentiated (Intestinal Type) Gastric Carcinoma

    A malignant, aggressive tumor that can be found in the stomach, characterized by cells that have a well-differentiated appearance, resembling normal intestinal lining.

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    Mucinous Gastric Carcinoma

    A type of gastric carcinoma where malignant cells are well differentiated and form pools of thick mucus.

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    Study Notes

    Stomach Pathology

    • Stomach diseases: Include congenital abnormalities (e.g., pyloric stenosis), gastritis, hypertrophic gastropathy, peptic ulcers, gastric polyps (non-neoplastic), and stomach tumors.

    Congenital Abnormalities

    • Pyloric stenosis: Characterized by an abnormal thickening of the pylorus muscles. This causes a narrowing (stenosis) of the pyloric valve, hindering food passage from the stomach to the small intestine.
    • Incidence: More common in male infants (4:1 ratio compared to females).
    • Symptoms: Persistent projectile vomiting, usually appearing in the second week of life. A palpable epigastric mass (the thickened pylorus) may also be present.

    Gastritis

    • Acute gastritis: Inflammation of the stomach lining (mucosa). Transient inflammation.
    • Common causes: chronic use of NSAIDs (nonsteroidal anti-inflammatory drugs), particularly aspirin, irritation from heavy smoking, and excessive alcohol use.
    • Less common causes: Severe stress (e.g., burns, surgery), uremia, ischemia, shock, systemic infections, radiation, some chemotherapeutics, or ingestion of acids/alkalis.
    • Gross appearance (endoscopy): Mucosal edema (swelling) and hyperemia (redness). Ulceration of the superficial epithelium and hemorrhage.
    • Microscopic: Infiltration of the epithelial layer (the surface layer of the stomach lining) by neutrophils (a type of white blood cell).
    • Clinical symptoms: Epigastric pain and hematemesis (vomiting blood).
    • Chronic gastritis: Chronic inflammation leading to atrophy (wasting away) of the gastric mucosa. Two main types.

    Chronic Gastritis, Type A

    • Cause: Autoimmune atrophic gastritis
    • Location: Involves the fundus and body of the stomach.
    • Features: Autoantibodies to parietal cells and/or intrinsic factor are detected in the patient's blood.
    • Consequences: Decreased acid secretion (achlorhydria), increased serum gastrin (G-cell hyperplasia), and potentially pernicious anemia (megaloblastic anemia) due to intrinsic factor deficiency and resulting B12 malabsorption.

    Chronic Gastritis, Type B (H. Pylori Gastritis)

    • Cause: Infection by Helicobacter pylori bacteria.
    • Feature: Common disease.
    • Microscopic: Organisms visible in the mucosa. Chronic inflammation and lymphoid follicles (immune system cells) seen.

    Hypertrophic Gastropathy

    • Uncommon: Conditions involving stomach enlargement, most commonly of gastric folds.
    • Types: Two types are presented; Ménétrier disease (Type A) and gastric gland hyperplasia (Zollinger-Ellison syndrome) (Type B).
    • Ménétrier Disease (Type A): Classic triad is gastrointestinal symptoms (epigastric pain, anorexia, vomiting), peripheral edema, and giant gastric folds.
    • Gastric gland hyperplasia (Type B, Zollinger-Ellison syndrome): Excessive gastrin secretion by a gastrinoma (gastrin-secreting tumor in the pancreas). This stimulates gastric gland hyperplasia and excessive acid secretion.
    • Common symptoms: Excessive acid secretion due to parietal-cell hyperplasia. Multiple ulcers form in the stomach/duodenum. Symptoms can include abdominal pain, nausea, vomiting (which may be bloody), weight loss, and diarrhea.

    Chronic Peptic Ulcers

    • Definition: Open sores on the inner lining of the stomach and/or duodenum. Typically solitary ulcers.
    • Causes: Imbalance between gastro-duodenal mucosal defense mechanisms and damaging forces.
    • Defense mechanisms: include mucus, bicarbonate secretion, mucosal blood flow and rapid epithelial regeneration.
    • Damaging forces: Include excess gastric acid, pepsin, H. pylori infection, NSAIDs (like aspirin), cigarette smoking, and excessive alcohol intake.
    • Sites: Duodenal (80%) and gastric (20%).
    • Gross appearance: Generally round or oval, sharply demarcated with clean bases, radiating mucosal folds (gastric ulcers are larger than duodenal).
    • Microscopic: Necrotic debris at the base, active inflammation with granulation tissue, fibrous collagen, scarring.
    • Complications: Hemorrhage (hematemesis, melena), perforation causing peritonitis, penetration into an adjacent solid organ (e.g., liver or pancreas), healing with pyloric stenosis. Malignant change (carcinoma) possible in about 1% of gastric ulcers (duodenal ulcers rarely malignant).
    • Duodenal ulcers: more common than gastric ulcers, usually accompanied by H. pylori infection, increased gastric acid secretion, and increased rate of gastric emptying.

    Gastric Polyps

    • Nature: Usually hyperplastic or inflammatory (90%).
    • Location: common in chronic gastritis.
    • Malignancy: Lack malignant potential.
    • Gross appearance: Typically multiple, smooth surface, sessile, or pedunculated.
    • Microscopic: Composed of tubules and cysts lined by columnar cells, with an inflammatory stroma.

    Gastric Tumors—Benign

    • Adenomas (adenomatous neoplastic polyps): 90% of all gastric benign tumors. Polyp-like mass, single or multiple, sessile or pedunculated. Potential for malignant transformation.
    • Other benign tumors: Leiomyoma, lipoma, hemangioma.

    Gastric Tumors—Malignant

    Gastric Carcinoma (Stomach Cancer)

    • Pathogenesis (risk factors): Dietary factors (preservatives in food, lack of fresh fruits/vegetables), H. pylori infection with chronic gastritis, autoimmune gastritis, cigarette smoking, gastric adenoma.
    • Gross appearance: Sites most commonly in the lesser curvature of the gastric antrum. Different morphological types include:
      • Exophytic/polypoid: a projecting intraluminal mass
      • Excavated/ulcerative: heaped-up margins, necrotic floor, and indurated base
      • Flat/infiltrating: invades entire stomach wall, leading to a contracted stomach (linitis plastica).
    • Microscopic appearance: Adenocarcinoma (pattern may be well differentiated, intestinal type; mucinous forming pools of mucin, signet-ring cell carcinoma).
    • Clinical features: Asymptomatic (90% until late), weight loss, epigastric pain/fullness, occult bleeding in stool.
    • Prognosis: 5-year survival (early, resected gastric cancer is 90%; advanced 10%).
    • Other less common malignant gastric tumors: Lymphoma (MALT lymphoma), leiomyosarcoma, carcinoid tumor, gastric malignant schwannoma.

    Comparison between Peptic Ulcer and Malignant Ulcer

    • Based on patient age, gastric acidity, and ulcer shape.

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