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5 GI Path Chronic Gastritis, Gastric Ca

Terms in this set (78)

What's the most common cause of chronic gastritis?
H.pylori
What's the most common cause of atrophic gastritis?
autoimmune gastritis
What is the most common form of chronic gastritis in pts w/o H.pylori infection?
autoimmune gastritis
Which portion of the stomach does H.pylori gastritis typically affect?
antrum
Risk of which type of ulcer is increased in pts w/ H. pylori gastritis?
duodenal
Which cancer is associated w/ pangastritis?
adenocarcinoma
H.pylori is found in pts with gastric and _______ ulcers.
duodenal
Which demographics are associated w/ H.plylori infection/
low socioeconomic status, large, crowded households, uneducated
What's the likely transmission of H.pylori?
oral-oral, fecal-oral, environmental spread
What are the 4 virulence factors of H.pylori?
1. flagella
2. urease
3. adhesins
4. toxins
Does H. pylori inc or dec acid production?
inc
What might H. pylori gastritis progress to?
pangastritis resulting in multifocal atrophic gastritis
Which gene is linked with development of pangastritis after H. pylori infection?
IL-1B
How does H.pylori chronic gastritis usually present?
asymptomatic
(sx's include: non-ulcer gastric pain, nasuea, anorexia, bloating or weight loss)
What's the colonization of H.pylori like?
w/i the superficial mucous of the antrum, distribution is patchy
What is the diagnostic test for H.pylori chronic gastritis?
antral biopsy
What does antral mucosa look like on endoscopy w/ h pylori chronic gastritis?
erythmatous
Where are the neutrophils in h pylori chronic gastritis?
in lamina propria, gastric pits creating pit abscesses, plasma cells in
Intraepithelial neutrophils & subepithelial plasma cells are characteristic of which dz?
H. pylori
What is the only way chronic gastritis can be established?
on histologic grounds
How can you i.d. hypolori non-invasively?
1. serologic test for AB's to H. pylori
2. fecal bacterial detection
3. urea breath test
4. rapid urease test
5. bacterial DNA detection by PCR
What 2 things are measured to determine gastric secretory function?
1. serum pepsinogen I
2. gastrin
What are serum PGI & gastrin levels like in h pylori chronic gastritis?
PGI is inc
gastrin is normal
(parietal cell & intrinsic factor AB's & pernicious anemia are absent)
What is usually associated w/ autoimmune gastritis?
adult pernicious anemia @ 60 yo
loss of parietal cells & therefore absence of acid production stimulating gastrin release & hypergastrinemia & hyperplasi of antral gastrin-producing G cells.
Autoimmune gastritis
Why is pernicious anemia associated w/ autoimmune gastritis?
lack of intrinsic factor disables ileal B12 absorption, causing B12 deficiency & slow-onset memgaloblastic anemia (pernicious anemia).
Are chief cells lost in addition to parietal cells in autoimmune gastritis?
yes
What does the loss of chief cells result in?
dec serum pesinogen I & achlorydria
What attacks the parietal cells in autoimmune gastritis?
CD4+ T cells
(attack at the H+K+ ATPase (proton pump).
What part of the stomach is damaged in autoimmune gastritis?
body & fundus
loss of parietal & chief cells
loss of rugae, thin fundus
fibrosis of lamina propria
atrophy of acid-producing mucosa
autoimmune gastritis
does hyperplasia of antral G (enterochromaffin-like) cells develop in autoimmune gastritis?
yes
In autoimmune gastritis, which comes first, hypergastrinemia, or G cell hyperplasia?
hypergastrinemia
(G cell hyperplasia results from chronic hypergastrinemia)
Inflammatory infiltrate consists of lymphocytes, macs, & plasma cells. Is this h pylori or autoimmune gastritis?
autoimmune
inflammatory reaction is deep & centered on gastric glands:
autoimmune gastritis
Are AB's to parietal cells & intrinsic factor part of the pathogenesis of autoimmune gastritis?
no
When do AB's to parietal cells & intrinsic factor present in the disease course?
early
How long does it take to see gastric atrophy in autoimmune gastritis?
2-3 decades
What's the median age of dx in autoimmune gastritis?
60 yo
Is autoimmune gastritis associated w/ other autoimmune dz?
often times, yes
What are signs of B12 deficiency?
atrophic glossitis - smooth beefy red
subacute combined degeneration of spinal cord causing myelopathy
What part of the spinal cord is affected in subactue combined degeneration d/t B12 deficiency?
dorsal columns of lower cervicals & upper thoracics, later axonal degeneration & neuronal death
numbness, weakness, paresthesia of extremities, affectin legs more than arms
B12 deficiency
unsteady gait, poor coordination, bowel/bladder dysfunction:
b12 deficiency
Loss of position & vibration sense ataxia, vision changes & change of mental state:
B12 deficiency
What are the lab studies for autoimmune gastritis?
1. antiparietal and anti-intrinsic factor (IF) antibodies in the serum
2. achlorhydria, both basal and stimulated
3. low serum pepsinogen I concentrations and low pepsinogen I/pepsinogen II ratio; 4. hypergastrinemia which reflects G cell hyperplasia
5. low serum cobalamin (vitamin B12) levels (< 100 pg/mL)
is risk of gastric adenocarcinoma higher in ppl w/ pernicious anemia?
yes
Are gastric fundic gland polyps (FGP's) benign and exclusive to the fundus?
yes, yes
FGP's can be sporadic, familial or caused by ________.
proton pump inhibitors
numerous adenomatous polyps in the colon that predispose to colon cancer
familial adenomatous polyposis (FAP)
germ line mutation in APC gene
FAP
B-catenin mutation
sporadic FGP
What are gastric hyperplastic polyps associated w/?
H. pylori & autoimmune gastritis
sessile & pedunculated
hyperplastic polyps
develop in apparently normal, non-atrophic mucosa
gastric adenomas of gastric phenotype
APC gene inactivation
Gastric adenoma
What is the strongest risk factor for stomach cancer?
Chronic bacterial infection w/ H. pylori
How does H. pylori favor the development of stomach cancer?
mutagenic substances are formed by mutagenic stubstances through inflammatory mediators by inducing DNA methylation or by impairing the mismatch repair pathway
nitrosamines
gastric cancer
what are some hereditary syndromes that have a predisposition for stomach cancer?
hereditary nonpolyposis colorectal ca, Li-fraumeni syndrome, familial adenomatous polyposis, Peutz-Jeghers syndrome
Which part of the stomach does gastric cancer favor?
distal stomach, lesser curvature of antrum & prepyloric region
(rare in fundus)
What are the 3 major macroscopic types of gastric cancer?
1. polypoid/fungating
2. ulcerating
3. diffuse schirrous
solid mass, several cm's in diameter that projects into stomach lumen, 1/3 of gastric ca
polypoid gastric carcinoma
shallow ulcers, lateral margins are irregular & base is ragged,surrounding tissue is raised & nodular, 1/3 of gastric ca
ulcerating gastric carcinoma
no true tumor mass seen, diffuse thickening & firmness, 10% of gastric ca
scirrhous gastric carcinoma (aka diffuse or infiltrating adenocarcinoma)
linitis plastica tumor
entire stomach involved in scirrhous/diffuse gastric carcinoma
desmoplastic reaction (fibrosis of submucosa & muscularis) & leather bottle-like appearance
scirrhous/diffuse gastric carcinoma
Where does well-differentiated adenocarcinoma arise from?
intestinalized gastric mucosa
What is the most common site of metastasis from well-differentiated adenocarcinoma?
liver
How do poorly-differentiated carcinoma appear?
signet-ring cells diffusely infiltrate gastric wall
Where are metastases of poorly-differentiated carcinoma appear?
serosa or lymph nodes
What is the most common type of metastatic spread of gastric carcinoma?
lymph nodes along greater & lesser curvature of stomach, & occasionally supraclavicular nodes (Virchows nodes) via the thoracic duct
periumbilical region nodes that gastric carcinoma can metastasize to:
Sister Mary Joseph nodule
What 2 structures are commonly involved in peritoneal metastatic spread?
b/l ovaries (Krukenberg's tumor) & rectal shelf (Bllumer's tumor)
loss of E-cadherin (and silencing of CDH1 promoter by hypermethylation) is associated with what?
gastric cancer
How does gastric cancer present?
weight loss, abdominal pain, epigastric, vague, nausea, early satiety, gastric outlet obstruction, occult gastrointestinal bleeding w/ or w/o iron deficiency anemia
Which antigen is elevated in gastric cancer?
carcinoembryonic antigen (CEA) (45-50%)
Cancer antigen (CA) (20%)
What is the preferred treatment for gastric adenocarcinoma?
resection, if metastatic, chemo or radiation
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