3. Pathology of the Stomach Peptic Ulcer & Gastric Malignacies

Question 1

H. pylori and NSAIDs can lead to what?

Answer 1

peptic ulcer - impalance/impairment in mucous production

Question 2

normal gastric and duodenal mucosa is protected from digestive actions of pepsin and acid by

Answer 2

secretion of mucous
production of bicarbonate
removal of excess acid by normal blood flow
rapid renewal and repair of epithelial cell injury

Question 3

peptic ulcers are commonly associate with what disease

Answer 3

chronic gastritis

Question 4

what are common symptoms of peptic ulcers?

Answer 4

gnawing or burning pain
bloating
nausea and vomitting
unintentional weight loss
loss of appetite

Question 5

what are common complications of peptic ulcers?

Answer 5

progressive dysphagia
iron deficiency anemia
perforations
hemorrhage
melena (black stools for bleeding)

Question 6

Describe the histology of peptic ulcers

Answer 6

Fibrinous ulcer exudate
zone of granulation tissue
zone of fibrosis
muscularis propria

Question 7

What are the two way to diagnose a peptic ulcer

Answer 7

endoscopic evaluation +/- biopsy (Forrest classification)

H. Pylori test (stool and breath test)

Question 8

Stages of the Forrest classification

Answer 8

Ia, Ib, IIa, IIb, IIc, III

Question 9

(Forrest Classification) Ia

Answer 9

spurting bleed
rapid, very dangerous, life-threatening

Question 10

(Forrest Classification) IIb

Answer 10

adherent clot
very dark

Question 11

(Forrest Classification) IIc

Answer 11

flat spot ulcer crater
black spot is indicative of necrosis and the tissue is dead

Question 12

(Forrest Classification) III

Answer 12

clean base ulcer
still see debris and necrotic tissue but still see a clot
cleanest type of ulcer

Question 13

(Forrest Classification) Ib

Answer 13

oozing bleed
most common than other stages
blood loss in capillaries

Question 14

(Forrest Classification) IIa

Answer 14

non-bleeding visible vessel
very visible vessels

Question 15

Medical management of peptic ulcer

Answer 15

PPI
H2-receptor blockers
antibiotics in the case of H. pylori

Question 16

Surgical management of peptic ulcer

Answer 16

endoscopic
partial gastrectomy (or full depending on stage)
selective vagotomies

Question 17

what is selective vagotomies

Answer 17

surgical cutting of the vagus nerve to reduce acid secretion in the stomach

Question 18

What is partial gastectomy

Answer 18

connect stomach with small intestine

Question 19

For peptic ulcers, what foods should be avoided?

Answer 19

consumption of :
alcohol (beer, wine, )
caffeine
spices

Question 20

For peptic ulcers, why should alcohol be avoided

Answer 20

it can cause superficial mucosal damage
increase gastric secretions

Question 21

For peptic ulcers, why should coffee be avoided

Answer 21

caffeine stimulates acid secretion
decaffeinated coffee also has the same effect because of other ingredients that lead to further irritation

Question 22

For peptic ulcers, why should spices be avoided

Answer 22

increase gastric secretion

cause small erosions and inflammation of the mucosal lining

Question 23

For peptic ulcers, what are misconceptions

Answer 23

milk for ulcers (not a buffer for gastric secretion)
pH for food has little therapeutic importance

Question 24

For peptic ulcers, what are nutritional management techniques

Answer 24

consume a high-quality diet (nutrient-dense)
frequent small meals
not eating 2-3hrs before sleeping

Question 25

For peptic ulcers, why are probiotics good

Answer 25

they increase good bacteria that will increase metabolites that will promote a good response

Question 26

For peptic ulcers, why is omega-3 good

Answer 26

anti-inflammatory properties

Question 27

For peptic ulcers, why are frequent small meals good

Answer 27

decreased the chance of acid reflux
stimulate gastric blood flow
increase gastric output