2. Diseases of the Upper GI: Stomach (7)

Question 1

LO1: Causes of gastritis

Answer 1

1) Autoimmune -Pernicious Anemia
2)H. Pylori Infxn
or Non-H. pylori Infxn - CMV, Candidiasis
3) Eosinophilic gastritis - rare, cause unknown`
4) Lymphocytic
5) Associated w systemic dz

Question 2

LO2: Epidemiology of H. pylori

Answer 2

1) Most common human bx infxn, 50%

Question 3

LO2: Pathophys of H. Pylori

Answer 3

1) Spiral shape w multiple flagella
2) Colonize surface epithelium (neutral pH)
3) Produce urea -> alkaline ammonia + CO2-> neutralizes H+

Question 4

LO2: Tx of H. Pylori

Answer 4

1) Triple Tx: omeprazole, clarithromycin, and amoxicillin
2) Quad Tx: Bismuth, metronidazole, tetracycline, and omeprazole
3) confirm eradication w/ stool antigen

Question 5

Dx Tests for H. Pylori

Answer 5

1) blood antibody
2) stool antigen -active ifxn
3) Urea breath test
4) Endoscopic- Rapid urease test (CLOTest)

Question 6

LO3: 5 most common gastric neoplasms

Answer 6

1) Polyps
2) Adenocarcinoma
3) Stromal tumors
4) Neuro-endocrine tumors
5) Lymphoma

Question 7

LO3: Polyps

Answer 7

1) Hyperplastic -rare malignancy
2) Adenoma -premalignant
- FAP
3) Fundic gland polyp
- benign
- Chronic PPI use

Question 8

LO3: Gastric adenocarcinoma

Answer 8

1) 2nd most common CA in world
2) 2nd most common cause of CA death
3) Can follow H. Pylori infxn -gastric atrophy-intestinal metaplasia-dysplasia-adenocarcinoma

Question 9

LO3: Gastric CA Tx

Answer 9

1) Endoscopic removal for stage 0
2) Chemo
3) Rad Tx

Question 10

LO3:GIST

Answer 10

1) Cell of origin - Interstitial cell of Cajal
2) Histo - + for c-kit (CD117) mutation in RTK
3) 10-30% malignant
4) Tx- gleevac (RTK inhibitor)
- surgery

Question 11

LO3: Neuroendocrine tumor

Answer 11

1) Fundus/body
Predisposing factors
1) Autoimmune atrophic gastritis
2) ZE syndrome
-MEN1
3) sporadic -more dangerous
-elevated gastrin ->stimulates ECL cells

Question 12

MALT lymphoma

Answer 12

1) Low grade B-cell lymphomas arise in gastric MALT -stimulated by H. Pylori
2) Eradicate H. pylori -may induce lymphoma regression

Question 13

LO4: PUD Pathogenesis

Answer 13

1) H. pylori or NSAIDs
2) Smoking or other factors ->
3) Disruption of mucosal integrity + acid ->
4) ulceration

Question 14

LO5: PUD Tx

Answer 14

1) PPI - ulcer heal in 4-8 weeks
2) H. Pylori test and tx
3) Risk factor avoidance
- NSAIDS, smoking
- Chronic PPI if NSAID is necessary

Question 15

LO5: Severe PUD Tx

Answer 15

Acute bleed
1) IV resuscitation
2) IV PPI - improves clotting
3) Endoscopy
4) Angiography
5) Surgery
Perforation
1) Surgery

Question 16

PUD complications

Answer 16

1) Abd pn
2) Anemia - Iron deficient from chronic blood loss - hematemesis or melena
3) Perforation -acute abd pn
4) Gastric outlet obstruction - N/v, abd pn