Let's move on to gastritis. With gastritis we
first begin by looking at type A gastritis.
And the reason that I specifically did not
mention autoimmune right now is because gastritis,
in a chronic nature there are two types. Type A
and type B. Once again, when you do gastritis,
you'll divide it into acute and chronic. The acute
is easy. The acute, we're dealing with a long term
NSAID use. Maybe the patient was drinking alcohol
for a long period of time. Acute gastritis.
But what I'm saying is those offending agents were
taken for a long period of time resulting in
acute gastritis. And then we move in to chronic
gastritis. With chronic gastritis, there is type A
and type B. You take the A in type A and use it to
your advantage to then call it autoimmune gastritis.
Autoantibodies attacking your parietal cell. Welcome
to pernicious anemia causing chronic type A gastritis.
Pernicious anemia. Knocking out the parietal cell.
Absolutely knocks out the acid. We call this achlorhydria.
Achlorhydria, couple of differentials you want
to keep in mind. VIPoma, Plummer-Vinson syndrome,
and obviously pernicious. Along with no acid there is
no intrinsic factor. Your patient is now rendered
B12 deficient. Keep this B12 deficiency caused by
pernicious anemia separate from all other B12 deficiencies.
By all others I mean maybe a patient, elderly,
nursing home, vegan for years, maybe out in the lakes.
In the great lakes there is a fish tapeworm called
Diphyllobothrium latum. Maybe there was Crohn's
disease with damage to the terminal ilium. You see,
you get my point. Keep this separate from all others.
Achlorhydria and B12 deficiency, oh no doubt this is
pernicious anemia. Anti-parietal cell antibodies
now not only is it anti-parietal cell antibody,
also keep in mind, remember this is autoantibodies,
right. These autoantibodies can prety much attack
whatever that it wants in that particular system.
What am I getting at. For example if it's Hashimoto,
don't you ever forget those autoantibodies not only
could they affect your thyroid peroxidase but those
autoantibodies could also attack your thyroglobulin.
Same concept here. Clinically often times the
autoantibodies not only would they affect the
parietal cells technically but because results in
B12 deficiency. It may have autoantibodies that
attacking your intrinsic factor is my point.
Autoimmune diseases. Whenever there is one autoimmune
disease, there are many others that you'll always
want to keep in mind. What are they? Well it could
be any of them. Rheumatoid arthritis, Sjogren,
maybe Hashimoto, so on and so forth. It is associated
with carcinoid tumor, gastric metaplasia and gastric
adenocarcinoma. Very important for you to pay
attention to that. Primary gastric adenocarcinoma
associated with pernicious anemia.
Chronic gastritis type A. Think about where your
parietal cells are located. Your parietal cells
are located in the fundus. And so therefore
that's what you're focusing upon here more so.
Specifically, could it be the antrum? Yes. But
because parietal cells are located in the fundus
and the body, really you're looking at anywhere in
the stomach but could it occur in the antrum? Sure.
However, type B referring to Helicobacter pylori.
B. HelicoBacter, type B chronic gastritis
which only only love to live or prefer to live in
the distal portion of the stomach by the antrum.
Therefore your type B would be found with the antrum
as being part of chronic gastritis. Once more,
just to make sure we're clear. Whenever there is
H. pylori, you are extremely worried about
those gastric cancers that we talked about.
Primary gastric adenocarcinoma
or a MALToma, lymphoma. Not going
to mention duodenal here.