stomach pathology
Terms
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- cardia of stomach
- portion near gastric esophageal junction
- fundus of stomach
- (body) middle portion of stomach
- antrum of stomach
- area between fundus and the pylorus
- parietal cells
- produce hydrochloric acid and are located in the fundus
- chief cells
- produce pepsinogen and are also located in the fundus
- mucous neck cells
- found in the fundus; cardia; and antrum and produce mucous and are the mucosa progenitor cells
- G cells
- produce gastrin and only found in antrum
- phases of secretion of acid
- 1 cephalic; vagal activity; stimulated by taste smell; and swallowing; 2 gastric phase; vagal component via direct stimulation of parietal cells or indirectly thru g cell production of gastrin; 3 antral phase: presence of food in stomach stimulates gastrin and stimulation of parietal cells; 4 intestinal phase; ends gastric secretion when food leaves stomach and exposes duodenum to acid food contents
- gastric defenses against autodigestion
- 1 mucous secretion 2 bicarbonate secretion; 3 cellular barriers (tight junctions, rapid migration and proliferation of epithelial cells); 4 mucosal blood flow: highly sensitive to requirements of gastric bed, removes excess H+
- Acute gastritis etiologies
- 1 drugs (aspirin, nsaids for eg); 2 alcohol; 3 smoking; 4 chemotherapy; 5 food poisoning, staphylococcal enterotoxin; 6 uremia (renal failure); 7 shock (esp/ sepsis); 8 helicobacter pylori
- pathogenesis of acute gastritis
- A: gastric mucosal barrier breakdown: agents may break down protective barrier; B blood flow; blood may be shunted away from area, resulting in injury to mucosa
- complications of acute gastritis
- ulceration or erosion of the mucosa; GI bleeding
- chronic gastritis risk factors
- 1 h pylori; 2 autoimune conditions such as pernicious anemia; 3 reflux of bile especially after gastric surgery; 4 miscellaneous: smokeing, alcohol, etc
- chronic active gastritis
- used when neutrophil component is sidnificant and h pylori is present in superficial mucous layer
- chronic superficial gastritis
- chronic inflammatory cell infiltrate peredominates
- chronic atrophic gastritis
- atrophy of gastric glands
- autoimmune gastritis morphology
- fundus most severely affected
- h pylori gastritis morphology
- antral injury predominates
- chronic peptic ulcer disease
- chronic, usually solitary ulcers occurring at any level of the GI tract exposed to acid pepsin juices
- etiologies of peptic ulcer disease
- 1 psychological factors; 2 environmental factors, such as aspirin and nsaids, alcohol, coffee, cola, cigarettes; 3 bacterial: h pylori; 4 altered gastric secretion (increased secretion in duodenal ulcers, but usually normal in gastric)
- pathogenesis of duodenal ulcers
- 1 hypersecretion of acid and pepsin; 2 increased responsiveness of gastric mucosa to stimulation to secrete acid; 3 rapid gastric emptying
- morphology of peptic ulcers
- punched out appearance, 80% chronic peptic solitary; may be very deep, thru wall
- most common sites of chronic peptic ulcers
- 1 anterior wall of first portion of duodenum; 2 posterior wall of first portion of duodenum; 3 second portion of duodenum; 4 antral region of stomach along the lesser curvature; 5 other sites: other parts stomach, lower esophagus, malformation of GI (meckels) stomal ulcers (anastomoses from prev surgery)
- differences between acute and chronic peptic ulcers
- Number(multiple vs single); size (smaller vs larger); depth (shallow vs deep); scarring (no vs yes); margins (ragged vs sharp); chronic gastritis (no vs yes)
- acute gastric ulcers causes
- 1 acute brain damage or neuroseurgery (cushing’s ulcers); 2 extensive burns (curling’s ulcers); 3 shock, especially septic shock; 4 trauma esp to brain; 5 aspirin, large or chronic doses; 6 nsaids
- morphology of acute peptic ulcers
- superficial, usually multiple, small, anywhere in stomach; ragged edges, fibrinoid necrosis, granulation tissue, little if any scar tissue
- gastric carcinoma morphology
- gross appearance usually exophytic fungating tumor arising from mucosa. some are flat or excavated with ulceration. 80% 2-10 cm.
- linitis plastica
- results when stomach is diffusely involved by carcinoma and has the characteristics of a leather bottle