Gastritis

Gastritis

Q. 1

Which of the following conditions would most likely be associated with chronic gastritis (Type A) resulting from autoimmune destruction of parietal cells?

 A

Decreased growth of luminal bacteria

 B

Decreased likelihood of developing gastric carcinoma

 C

Decreased plasma concentration of gastrin

 D

Increased production of macrocytic red blood cells

Q. 1

Which of the following conditions would most likely be associated with chronic gastritis (Type A) resulting from autoimmune destruction of parietal cells?

 A

Decreased growth of luminal bacteria

 B

Decreased likelihood of developing gastric carcinoma

 C

Decreased plasma concentration of gastrin

 D

Increased production of macrocytic red blood cells

Ans. D

Explanation:

Autoimmune destruction of parietal cells would lead to decreased secretion of gastric acid and intrinsic factor. The diminished availability of intrinsic factor would result in poor absorption of dietary vitamin B12. Over time, the vitamin B12 deficiency could lead to pernicious anemia, which is characterized by increased production of macrocytes (megaloblasts) by the bone marrow.

 
Because of the decrease in gastric acid secretion, luminal bacteria would most likely exhibit increased (not decreased) growth. One of the functions of HCl secreted by the parietal cells is to sterilize the gastric lumen.
 
Patients with Type A gastritis have an increased likelihood of developing gastric carcinoma.
A decrease in acid secretion leads to increased secretion of gastrin by antral G cells. This is because low gastric pH (less than 3) inhibits gastrin secretion via paracrine release of somatostatin from cells in the gastric mucosa that can sense the acidity. With decreased parietal cells, the pH of the gastric lumen would rise and remove this inhibitory component.

Q. 2

Type B gastritis –

 A

Body predominant

 B

Fundus predominant

 C

Antral predominant

 D

All

Q. 2

Type B gastritis –

 A

Body predominant

 B

Fundus predominant

 C

Antral predominant

 D

All

Ans. C

Explanation:

Ans. is ‘c’ i.e., Antral predominant

Chronic atrophic gastritis

o Chronic atrophic gastritis is a process of chronic inflammation of the stomach mucosa, leading to loss of gastric glandular cells and their eventual replacement by intestinal and fibrous tissue.

o Chronic atrophic gastritis is classified according to the predominant site of involvement :‑

1. Type ‘A’ gastritis

o It refers to body – predominant form involving fundus and body with sparing of antrum.

  • It is also called as autoimmune gastritis as the damage is due to autoimmunity.
  • It is less common of the two forms of chronic atrophic gastritis.

2. Type ‘B’ gastritis

  • It is called as antral predominant gastritis as antrum is involved predominantly. However, it is misnomer as the inflammatory process may progress to body and fundus and causing pangastritis.

o H. pylori infection is the cause of type B gastritis.

  • It is the most common cause of chronic gastritis and by for the most important etiological association with chronic gastritis is chronic infection with H. pylori.

Q. 3

True about autonomic atrophic gastritis

 A

Loss of parietal cell

 B

Hypertrophy of G cells

 C

Apoptosis of gland epithelial cell

 D

a and b

Q. 3

True about autonomic atrophic gastritis

 A

Loss of parietal cell

 B

Hypertrophy of G cells

 C

Apoptosis of gland epithelial cell

 D

a and b

Ans. D

Explanation:

Ans. is ‘a’ i.e., Loss of parietal cell; ‘b’ i.e., Hypertrophy of G cells

Autoimmune gastritis (Type A gastritisl

o Autoimmune gastritis is less common of the two forms and is characterized by :-

(i)         Presence of antibodies against parietal cells and intrinsic factor.

(ii)       Involvement of body and fundus with sparing of antrum.

o As the name suggests, autoimmune gastritis is due to autoimmune mediated damage :-

(i)Associated with other autoimmune disorders like Hashimoto thyroiditis, Vitiligo, Addison disease and type I DM. (ii) Associated with HLA – B8 and – DR3.

o The most common antibody present in patient with autoimmune gastritis is anti-parietal (against parietal cell). These antibodies are directed against proton pump (WIC ATPase).

o However, antibodies against intrinsic factor (anti-IF) are more specific (though these are less common). o These two antibodies (anti-parietal and anti-IF) have following consequences :‑

l. Achlorhydria :- Parietal cells are the source of acid secretion in stomach. These cells are the principal target of immune system in autoimmune gastritis. Damage to parietal cells result in achlorhydria.

2. Vitamin B12 deficiency & Pernicious anemia :- Intrinsic factor, which is essential for vitamin B 12 absorption, is also secreted by parietal cells. Parietal cells damage results in deficiency of IF. Further, there are antibodies against IF. Both of these (damage to parietal cells and anti-IF antibodies) cause IF deficiency and deficiency of IF results in vitamin B12 deficiency and its consequences (megaloblastic anemia, neurological dysfunction).

3.       Antral endocrine cell hyperplasia (G-cell hyperplasia) :- Normally gastric acid plays an important inhibitory role of gastrin release from G cells of antrum. Achlorhydria coupled with relative sparing of antrum (site of G cells) leads to G – cell hyperplasia and hypergastrinemia. ECL (enterochromaffin – like) cells hyperplasia with frank development of gastric carcinoid tumors may result from gastrin trophic effects.

4.          Reduced serum pepsinogen I concentration :- It is due to chief cell destruction. It should be noted that only pepsinogen I levels, which is secreted exclusively by chief cells of the body, are reduced; whereas, pepsinogen II levels, which is produced by both body and pyloric glands, remain relatively normal.


Q. 4

Erosive gastritis commonly occurs at –

 A

Body

 B

Fundus

 C

Lesser curvature

 D

a and b

Q. 4

Erosive gastritis commonly occurs at –

 A

Body

 B

Fundus

 C

Lesser curvature

 D

a and b

Ans. D

Explanation:

Ans. Two option are correct, ‘a’ i.e. Body & ‘b’ i.e. Fundus 

Quiz In Between



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