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Gastrointestinal ` gastrointestinal—PatHology Gastrointestinal ` gastrointestinal—PatHology seCtion iii 379
Gastritis
Acute gastritis Erosions can be caused by: Especially common among alcoholics and
NSAIDs— PGE gastric mucosa patients taking daily NSAIDs (eg, patients with
2
protection rheumatoid arthritis)
Burns (Curling ulcer)—hypovolemia Burned by the Curling iron
mucosal ischemia
Brain injury (Cushing ulcer)— vagal Always Cushion the brain
stimulation ACh H production
+
Chronic gastritis Mucosal inflammation, often leading to atrophy
(hypochlorhydria hypergastrinemia) and
intestinal metaplasia ( risk of gastric cancers)
H pylori Most common. risk of peptic ulcer disease, Affects antrum first and spreads to body of
MALT lymphoma stomach
+
+
Autoimmune Autoantibodies to the H /K ATPase on parietal Affects body/fundus of stomach
cells and to intrinsic factor. risk of pernicious
anemia
Ménétrier disease Hyperplasia of gastric mucosa hypertrophied rugae (look like brain gyri A ). Causes excess
A mucus production with resultant protein loss and parietal cell atrophy with acid production.
Precancerous.
Presents with Weight loss, Anorexia, Vomiting, Epigastric pain, Edema (due to protein loss)
Stomach (WAVEE).
Gastric cancer Most commonly gastric adenocarcinoma; Virchow node—involvement of left
lymphoma, GI stromal tumor, carcinoid (rare). supraclavicular node by metastasis from
A
Early aggressive local spread with node/liver stomach.
metastases. Often presents late, with weight Krukenberg tumor—bilateral metastases to
loss, abdominal pain, early satiety, and in some ovaries. Abundant mucin-secreting, signet ring
cases acanthosis nigricans or Leser-Trélat sign. cells.
Associated with blood type A. Sister Mary Joseph nodule—subcutaneous
Intestinal—associated with H pylori, dietary periumbilical metastasis.
nitrosamines (smoked foods), tobacco Blumer shelf—palpable mass on digital rectal
smoking, achlorhydria, chronic gastritis. exam suggesting metastasis to rectouterine
Commonly on lesser curvature; looks like pouch (pouch of Douglas).
ulcer with raised margins.
Diffuse—not associated with H pylori; most
cases due to E-cadherin mutation; signet
ring cells (mucin-filled cells with peripheral
nuclei) A ; stomach wall grossly thickened
and leathery (linitis plastica).
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