A 45-year-old Caucasian female presents to your office with abdominal discomfort and distention that is especially bothersome after meals. She has noticed recently that she gets tired more easily. She feels "down", but denies any sleep difficulty, crying spells and suicidal ideation. She visited a doctor approximately one year ago due to similar complaints, and was told that the problem was psychological. She underwent myomectomy for a large uterine fibroid 8 years ago. She is not sexually active. Her family history is significant for pancreatic cancer in her father and a thyroid disease in her mother. The physical examination is significant for mild pallor of the conjunctivae. The abdomen is somewhat distended with no palpable masses. The laboratory values are: After taking the appropriate initial steps, you proceed with gastric endoscopy. Which of the following findings is more likely to be present in this patient?

Question

A 45-year-old Caucasian female presents to your office with abdominal discomfort and distention that is especially bothersome after meals.  She has noticed recently that she gets tired more easily.  She feels "down", but denies any sleep difficulty, crying spells and suicidal ideation.  She visited a doctor approximately one year ago due to similar complaints, and was told that the problem was psychological.  She underwent myomectomy for a large uterine fibroid 8 years ago.  She is not sexually active.  Her family history is significant for pancreatic cancer in her father and a thyroid disease in her mother.  The physical examination is significant for mild pallor of the conjunctivae.  The abdomen is somewhat distended with no palpable masses.  The laboratory values are:  After taking the appropriate initial steps, you proceed with gastric endoscopy.  Which of the following findings is more likely to be present in this patient?

Quizplus · Accepted Answer

Explanation: Pernicious anemia is associated with a type of gastritis called autoimmune metaplastic atrophic gastritis (AMAG). AMAG is caused by autoimmune aggression against gastric mucosa. An immune response is mainly directed against oxyntic cells and intrinsic factor. The three main components of AMAG are glandular atrophy, intestinal metaplasia and inflammation. Atrophy affects mainly the gastric body and fundus. (Choice B)Typically, little changes are observed in the gastric antrum. (Choices C and D)No erosions or ulcerations are usually observed. If present, these may indicate a high probability of malignancy. (Choice E)In advanced stages, the mucosa becomes thin and atrophic, and endoscopy may demonstrate absent gastric rugae in the body and fundus. Intestinal metaplasia replaces normal oxyntic glands; sometimes, the mucosa becomes villiform and resembles normal small intestine. Educational Objective: The three main components of AMAG (which is associated with pernicious anemia) are glandular atrophy, intestinal metaplasia and inflammation. Atrophy affects mainly the gastric body and fundus. Typically, little changes are observed in the gastric antrum. *High yield*

A 45-Year-Old Caucasian Female Presents to Your Office with Abdominal