2.1.3.7 Gastric Disorders
 

1. Pathology of Nonneoplastic Liver Diseases

2. Liver Masses

3. Diseases of the Gallbladder & Extrahepatic Bile Ducts

4. Diseases of the Pancreas

5. Nuclear Medicine Studies in Gastrointestinal Diseases

6. Esophageal Disorders (Driman)

7. Gastric Disorders (Driman)

8. Miscellaneous GI Tumors (Driman)

9. Colorectal Polyps & Cancer (Driman)

10. Intestinal Inflammation (Driman)

11. Malabsorption, Ischemia and Recap (Driman)

12. Abdominal Imaging

13. Barium Studies & Endoscopy

 

Objectives:

1. Describe the key anatomical and histological features of the stomach.

2. Classify the types of gastritis, and list the causes of each type.

3. Describe the features of H. pylori gastritis and the complications thereof.

4. Describe the pathogenesis of peptic ulcer disease.

5. List the clinical features and complications of peptic ulcer disease.

6. Discuss the epidemiology, pathogenesis, pathological and clinical features of gastric neoplasms.

 

1. Describe the key anatomical and histological features of the stomach.

 

2. Classify the types of gastritis, and list the causes of each type.

Acute Gastritis: erosions/superficial breaks in gastric mucosa.  Caused by 1) chemical injury - aspirin, NSAIDs, steroids, alcohol, bile 2) stress injury - erosive due to severe burns, trauma to CNS

Chronic Gastritis: caused by H.pylori infection, autoimmune, chemical injury, others

   Helicobacter pylori infection

   Autoimmune Gastritis: affects body/fundus, autoantibodies to parietal cells and intrinsic factor ~> pernicious anemia (Vit B12 def.)

   Chemical Injury: NSAIDs, bile refulx, alcohol

   Other types Gastritis: Granulomatous (Crohn's disease, sarcoidosis), Menetrier's (enlarged mucosal folds)

3. Describe the features of H. pylori gastritis and the complications thereof.

  • related to socioeconomic status, age
  • gram -'ve bacillus adapted to acidic environment via flagella (to burrow into mucus lining), urease secretion (urea ~> ammonia + bicarbonate ~> acid buffer), and adehesins
  • most severe in antrum, rarely resolves spontaneously

Complications:

  • H. pylori infection ~> chronic active gstritis ~> ulcers, MALT lymphomas, adenocarcinoma
  • Dx: serology, uerase based tests, histo/biopsy
  • Tx: combination antibiotics + PPIs

4. Describe the pathogenesis of peptic ulcer disease.

Imbalance of mucusal defences and damaging forces (acid, pepsin)

Duodenal ulcers - H.pylori (90%) vs NSAIDs (10%)

   Acid hypersectrion, first part duodenum

Gastric ulcers - NSAIDs (70%) vs. H. pylori (30%)

   Acid hyposecretion, lesser curvature of antrum/pylorus

5. List the clinical features and complications of peptic ulcer disease.

Clinical features: dyspepsia

Complications: bleeding, perforation, obstruction, penentration into adjacent organs 

6. Discuss the epidemiology, pathogenesis, pathological and clinical features of gastric neoplasms.

Epidemiology: geographic variation (higher in Japan, Russia, Peru, Chile, lower in North America), inc incidence cardia cancers, dec. incidence antral/distal cancers

Pathogenesis: inflammation ~> gastritis ~> intestinal metaplasia ~> dysplasia ~> cancer

   Risk factors: H. pylori, diet (carcinogens in smoked/pickled food, lack antioxidant fruits/veggies, nitrates ~> carcinogenic nitrosamines)

Pathology: along lesser curvature, distal stomach

  • early (confined to mucosa/submucosa) vs. advanced (penetration muscularis propria)
  • histo intestinal (malignant glands) vs. diffuse (signet ring cells, prod. "linitis plastica" (leather stomach) ~> contracted stomach w/ thick wall and no dom. tumor mass
  • Tumor: polypoid, ulcerating, or diffusely infiltrating 

Clinical Features: present late w/ distant metastases, anorexia, nausea, weight loss

Anatomy:

5 regions - cardia, fundus, body, antrum, pylorus

Blood supply -

arterial: celiac, hepatic, splenic arteries

venous: portal, splenic, sup. mesenteric veins

Lymphatics - regional nodes around lesser/greater curvature, pylorus

Histo - all lined by mucin-secr. columnar epith

Cardia - mucous secreting glands

Body/fundus - parietal cells (acid, intrinisic factor), chief cells (pepsinogen), endocrine cells (histamine)

Antrum - mucous sucreting glands, endocrine cells (gastrin)