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Questions and Answers
What is a significant characteristic of a malignant gastric ulcer?
What is a significant characteristic of a malignant gastric ulcer?
In which age group is peptic ulcer disease more commonly found?
In which age group is peptic ulcer disease more commonly found?
Which type of gastric carcinoma shows the highest survival rate when detected early?
Which type of gastric carcinoma shows the highest survival rate when detected early?
What is a common clinical feature of ulcerative gastric carcinoma?
What is a common clinical feature of ulcerative gastric carcinoma?
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Which of the following tumors accounts for the least percentage of gastric tumors?
Which of the following tumors accounts for the least percentage of gastric tumors?
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Which type of cell is primarily involved in signet-ring cell carcinoma?
Which type of cell is primarily involved in signet-ring cell carcinoma?
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What distinguishes the microscopic appearance of gastric carcinoma from that of peptic ulcers?
What distinguishes the microscopic appearance of gastric carcinoma from that of peptic ulcers?
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What is the typical pattern of gastric acidity associated with malignant ulcers?
What is the typical pattern of gastric acidity associated with malignant ulcers?
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Which feature is indicative of a poorly differentiated gastric carcinoma?
Which feature is indicative of a poorly differentiated gastric carcinoma?
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What factor significantly affects the prognosis of gastric carcinoma?
What factor significantly affects the prognosis of gastric carcinoma?
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What is the primary cause of congenital pyloric stenosis in infants?
What is the primary cause of congenital pyloric stenosis in infants?
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Which symptom is most closely associated with acute gastritis?
Which symptom is most closely associated with acute gastritis?
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Which type of gastritis is typically linked to Helicobacter pylori infection?
Which type of gastritis is typically linked to Helicobacter pylori infection?
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What is a key histological feature of chronic atrophic gastritis?
What is a key histological feature of chronic atrophic gastritis?
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Which of the following is NOT a common cause of acute gastritis?
Which of the following is NOT a common cause of acute gastritis?
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What clinical manifestation is associated with congenital pyloric stenosis?
What clinical manifestation is associated with congenital pyloric stenosis?
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What is a significant risk associated with chronic atrophic gastritis?
What is a significant risk associated with chronic atrophic gastritis?
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What anatomical feature is notably affected in patients with fundic type gastritis?
What anatomical feature is notably affected in patients with fundic type gastritis?
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Which of the following is commonly observed in the microscopic examination of acute gastritis?
Which of the following is commonly observed in the microscopic examination of acute gastritis?
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What hematological disorder may result from autoimmune atrophic gastritis?
What hematological disorder may result from autoimmune atrophic gastritis?
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What is a key characteristic of Ménétrier disease?
What is a key characteristic of Ménétrier disease?
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Which of the following is a primary cause of gastric gland hyperplasia in Zollinger-Ellison syndrome?
Which of the following is a primary cause of gastric gland hyperplasia in Zollinger-Ellison syndrome?
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Which of the following ulcers is most commonly associated with peptic ulcers?
Which of the following ulcers is most commonly associated with peptic ulcers?
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What is the most significant complication of a peptic ulcer?
What is the most significant complication of a peptic ulcer?
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What best describes the gross appearance of peptic ulcers?
What best describes the gross appearance of peptic ulcers?
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What is one of the damaging forces contributing to the formation of peptic ulcers?
What is one of the damaging forces contributing to the formation of peptic ulcers?
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What symptom is commonly associated with Zollinger-Ellison syndrome?
What symptom is commonly associated with Zollinger-Ellison syndrome?
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Which element is NOT considered part of mucosal defense mechanisms against ulcers?
Which element is NOT considered part of mucosal defense mechanisms against ulcers?
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Which condition is characterized by giant gastric folds and peripheral edema?
Which condition is characterized by giant gastric folds and peripheral edema?
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What type of tissue is typically found at the active margins of a peptic ulcer?
What type of tissue is typically found at the active margins of a peptic ulcer?
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What is the most common site for duodenal peptic ulcers?
What is the most common site for duodenal peptic ulcers?
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Which of the following is NOT typically associated with duodenal peptic ulcers?
Which of the following is NOT typically associated with duodenal peptic ulcers?
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What is the primary type of gastric polyp found in chronic gastritis?
What is the primary type of gastric polyp found in chronic gastritis?
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What feature distinguishes the ulcerative type of gastric carcinoma?
What feature distinguishes the ulcerative type of gastric carcinoma?
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Which of the following is considered a benign gastric tumor?
Which of the following is considered a benign gastric tumor?
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Which dietary factor is a known risk for gastric carcinoma?
Which dietary factor is a known risk for gastric carcinoma?
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What is a clinical feature common to gastric peptic ulcers?
What is a clinical feature common to gastric peptic ulcers?
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What type of gastric polyp has the potential for malignant change?
What type of gastric polyp has the potential for malignant change?
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In Zollinger-Ellison syndrome, what is primarily increased?
In Zollinger-Ellison syndrome, what is primarily increased?
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Which characteristic is typically associated with hyperplastic or inflammatory gastric polyps?
Which characteristic is typically associated with hyperplastic or inflammatory gastric polyps?
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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.
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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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Description
Explore the various diseases and conditions related to the stomach, including congenital abnormalities like pyloric stenosis, as well as gastritis and peptic ulcers. This quiz delves into causes, symptoms, and the significance of these conditions in gastrointestinal health.
