10.4 Stomach

Question 1

Congenital malformation of the anterior abdominal wall leading to exposure of abdominal contents (NOT covered by peritoneum)

Answer 1

Gastroschisis

Question 2

Persistent hernia of bowel into umbilical cord due to failure of herniated intestines to return to the body vacuity during development; contents are covered by peritoneum and amnion of umbilical cord

Answer 2

Omphalocele

Question 3

Congenital hypertrophy of pyloric smooth muscle; more common in males; presents 2 weeks after birth

Answer 3

Pyloric stenosis

Question 4

Pyloric stenosis presents two weeks after birth with:

Answer 4

1. projectile non bilious vomiting
2. visible peristalsis
3. olive like mass in the abdomen

Question 5

pyloric stenosis treatment

Answer 5

myotomy

Question 6

3 stomach defenses against acid

Answer 6

1. mucin layer produced by foveolar cells
2. bicarb secretion by surface epithelium
3. normal blood supply (provides nutrients and picks up leaked acid)

Question 7

Why does severe burn –> acute gastritis (curling ulcer)?

Answer 7

Curling ulcer - hypovolemia –> decreased blood supply

Question 8

why do NSAIDS –> acute gastritis?

Answer 8

Decreased PGs –> decreased BF, mucus, bicarb… other stuff! look up!

Question 9

why does increased intracranial pressure –> acute gastritis (cushing ulcer)?

Answer 9

increased stimulation of vagus nerve –> increased ACh –> stimulates parietal cell to produce more HCl

Question 10

6 risk factors for acute gastritis

Answer 10

1. Severe burn
2. NSAIDs
3. Heavy alcohol consumption
4. Chemotherapy
5. Increased ICP
6. Shock

Question 11

what do you call loss of superficial epithelium in stomach?

Answer 11

erosion

Question 12

what do you call loss of mucosal layer (and a bit of submucosa) in stomach?

Answer 12

ulcer

Question 13

what are the two types of chronic gastritis?

Answer 13

chronic autoimmune and chronic H pylori

Question 14

where are parietal cells located?

Answer 14

body and fundus

Question 15

chronic AI gastritis pathogenesis mediated by

Answer 15

T cells (type IV hSR)

Question 16

chronic AI gastritis is associated with antibodies against

Answer 16

parietal cells and/or intrinsic factor (but it’s the T cells causing the real damage!)

Question 17

3 clinical features of chronic AI gastritis

Answer 17

1. atrophy of mucosa with intestinal metaplasia
2. achlorhydria with increased gastrin levels and antral G-cell hyperplasia
3. Megaloblastic (pernicious) anemia due to lack of IF

Question 18

Chronic AI gastritis increases risk for

Answer 18

gastric adenocarcinoma (intestinal type)

Question 19

What H pylori proteins (along with inflammation) weaken mucosal defenses ?

Answer 19

ureases and proteases

Question 20

most common site for H pylori gastritis

Answer 20

antrum

Question 21

H pylori gastritis presentation

Answer 21

epigastric abdominal pain

Question 22

H pylori gastritis increases risk for three things

Answer 22

1. peptic ulcer disease
2. gastric adenocarcinoma (intestinal type)
3. MALT lymphoma

Question 23

H pylori gastritis treatment

Answer 23

triple therapy!

• PPI
• clarithromycin
• amoxicillin

Question 24

confirm H pylori eradication with?

Answer 24

negative urea breath test, lack of stool antigen

Question 25

most common location for solitary mucosal peptic ulcer

Answer 25

proximal duodenum

Question 26

Causes of duodenal ulcer

Answer 26

H pylori (95%) or ZES (5%)

Question 27

Epigastric pain that improves with meals

Answer 27

duodenal ulcer

Question 28

diagnostic endoscopic biopsy of duodenal ulcer shows ulcer (duh) with hypertrophy of

Answer 28

Brunner glands

Question 29

Submucosal glands in duodenum above the hepatopancreatic sphincter (Sphincter of Oddi) that produce a mucus-rich alkaline secretion

Answer 29

Brunner glands

Question 30

where do duodenal ulcers most commonly arise?

Answer 30

anterior duodenum

Question 31

artery behind posterior duodenum?

Answer 31

gastroduodenal

Question 32

posterior duodenal ulcer rupture may lead to

Answer 32

bleeding from gastroduodenal artery or acute pancreatitis

Question 33

gastric ulcer causes

Answer 33

H pylori (75%), NSAIDs, bile reeflux

Question 34

Epigastric pain that worsens with meals

Answer 34

gastic ulcer

Question 35

most common location for gastric ulcer

Answer 35

less curvature of antrum

Question 36

artery next to lesser curvature of antrum

Answer 36

left gastric artery

Question 37

gastric ulcers can be caused by what type of carcinoma?

Answer 37

gastric carcinoma (intestinal subtype)

Question 38

three characteristics that would make you think a gastric ulcer was benign

Answer 38

- small () | - surrounded by radiating folds of mucosa

Question 39

malignant gastric ulcer appearance

Answer 39

large and irregular with heaped up margins

Question 40

malignant proliferation of surface epithelial cells in stomach

Answer 40

gastric adenocarcinoma

Question 41

two types of gastric adenocarcinoma

Answer 41

intestinal & diffuse types

Question 42

Gastric carcinoma that presents as a large, irregular ulcer with heaped up margins; most commonly involves the lesser curvature of the antrum

Answer 42

intestinal type (more common)

Question 43

3 risk factors for intestinal type of gastric carcinoma

Answer 43

1. intestinal metaplasia (H pylori or AI gastritis) 2. nitrosamines in smoked foods (Japan) 3. blood type A

Question 44

Gastric carcinoma that is characterized by signet ring cells; desmoplasia results in thickening of stomach wall lining (linitis plastica)

Answer 44

diffuse type

Question 45

presents late with weight loss, abdominal pain, anemia, early satiety; rarely acanthosis nigricans or Leser-Trelat sing

Answer 45

Gastric carcinoma

Question 46

Pt presents with dozens of seborrheic keratoses all of a sudden

Answer 46

Leser-Trélat sign (gastric carcinoma)

Question 47

Gastic cancer can spread to the left supraclavicular node, which is also called

Answer 47

Virchow node

Question 48

distant metastasis of gastric cancer most commonly involves

Answer 48

liver

Question 49

name for intestinal-type gastric cancer mets to periumbilical region

Answer 49

Sister Mary Joseph nodule

Question 50

name for diffuse-type gastric cancer mets to bilateral ovaries

Answer 50

Krukenberg tumor