Page 415 - Concise Pathology for Exam Preparation ( PDFDrive )

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400 SECTION II Diseases of Organ Systems
Q. Write briefly on hypertrophic gastropathies.

Ans. Hypertrophic gastropathies include
1. Zollinger–Ellison (ZE) syndrome:
• This syndrome presents with hypergastrinaemia due to a gastrinoma (gastrin-producing
tumour); usual age of presentation is between 50 and 60 years. The gastrinoma is most
frequently found in the duodenum and peripancreatic soft tissues and originates from
endocrine cells of both gut and pancreas.
• Gastrin induces hyperplasia of mucous neck cells (causing diarrhoea), endocrine
cells and oxyntic mucosa (causing hypergastrinaemia which in turn induces hyper-
secretion of gastric acid causing ulcers in the usual sites like stomach and duodenum
and also in unusual sites like jejunum).
• Treatment is surgical resection of the tumour.
2. Menetrier disease:
• Patient aged 30–60 years presents with hypoproteinaemia, weight loss and
diarrhoea.
• There is cerebriform enlargement or hypertrophy of the rugal folds due to epithelial
hyperplasia which mainly affects mucous cells in the body and fundus. This is attrib-
uted to increased TGF-alfa.
• Dilated tortuous glands may be seen.
• Treatment is supportive only (parenteral nutritional supplementation).

Q. Differentiate between duodenal and gastric ulcer.
Ans. Differences between duodenal and gastric ulcer are listed in Table 14.2.

TABLE 14.2. Differences between duodenal and gastric ulcer

Features Duodenal ulcer Gastric ulcer
Age Younger patients (20–50 years) Older patients (.60 years)
Male-to-female ratio 3:1 1.5–2:1
Incidence More common Less common
H. pylori Stronger association (present in virtu- Less strong association (present in
ally all patients of duodenal ulcer); 70% of the cases of gastric ulcer);
hypersecretion of acid pepsin is im- disruption of mucosal barrier
portant in pathogenesis is most important pathogenetic
factor
Favoured location First part of duodenum (anterior wall) Along lesser curvature and pyloric
antrum
Acid level Usually high Usually normal; increased only if
gastrin level is increased
Pain Relieved after intake of food Aggravated after intake of food
Night pain Common No night pain
Melena More common Less common
Vomiting and haematemesis Less common More common
Weight loss No weight loss Marked weight loss

Q. Differentiate between benign and malignant peptic ulcer.

Ans. Differences between benign and malignant peptic ulcer are listed in Table 14.3.

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