Achalasia/hiatal herna/gastritis Flashcards

Question

Regions of the stomach

Answer 1

Region of the stomach: Cardia Region where food passes from the esophagus and into the stomach Fundus Dome-shaped region located above and to the left of the cardia Stores undigested food and gases Body Largest region of the stomach Pylorus Funnel-shaped region that connects to the duodenum Pyloric antrum: wider end Pyloric canal: narrow end Pyloric sphincter: smooth muscle that controls gastric emptying

Answer 2

Mucosa Forms large folds when the stomach is empty known as rugae Contains a protective alkaline mucus Gastric pits are depressions that mark entry to gastric glands Submucosa Contains the blood vessels, lymphatic vessels, and nerves Muscularis externa Responsible for mechanically breaking down food into smaller particles Layers: Inner oblique layer Middle circular layer Outer longitudinal layer

Answer 3

Secretes pepsinogen, the inactive proenzyme of pepsin

Answer 4

**Produce hydrochloric acid (HCl)** High acidity (pH 1.5-3.5) of the stomach Kill ingested bacteria Denatures proteins **Activates the digestive enzyme, pepsin** **Produces intrinsic factor** Glycoprotein necessary for the absorption of vitamin B12 in the small intestine Why is vitamin B12 vital to survival?

Answer 5

Secrete alkaline mucus

Answer 6

D cells secrete somatostatin – inhibitory G cells secrete gastrin stimulates parietal cells

Answer 7

Gastric enzymes have the potential to digest the stomach itself! Mucosal barrier Thick coating of bicarbonate-rich mucus Acts as a physical barrier Bicarbonate ions neutralize acid Tight junctions Block gastric juice from penetrating underlying tissues Stem cells Located at the junction of the gastric pits and gastric glands Replace damaged epithelial mucosal cells **Surface epithelium of the stomach is completely replaced every 3-6 days**

Answer 8

General term for a group of conditions in which there is histologic evidence of inflammation, irritation, or erosion of the lining of the stomach Acute (neutrophilic infiltration) or chronic (lymphocyte and plasma cell infiltration) Types: Erosive gastritis Nonerosive gastritis

Answer 9

Gastric mucosal erosion caused by damage to the mucosal defenses Superficial erosions and punctate mucosal lesions Typically occur in the **body** of the stomach

Answer 10

NSAIDs, ASA, bisphosphonates Alcohol Physiological stress Severe medical or surgical illness 5% of critically ill patients Incidence increases with duration of intensive care unit stay and length of time the patient is not receiving enteral feeding

Answer 11

Mild erosive gastritis – asymptomatic Moderate or severe erosive gastritis Develop within 2-5 days of the inciting event Dyspepsia (indigestion) Nausea and/or vomiting Epigastric pain GI bleeding Mild-moderate Hematemesis, “coffee grounds” emesis, and/or melena

Answer 12

**Most sensitive** method for diagnosis Performed within 24 hours of upper GI bleeding

Answer 13

Removal of the offending agent Bleeding Endoscopic hemostasis Acid suppression H2 blocker or proton pump inhibitor 4-8 week trial

Answer 14

## Footnote type A=autoimmune. Type B=bacteria. Type C=precancerous.

Answer 15

**Spiral gram-negative** bacterium that resides beneath the gastric mucosa layer causing mucosal inflammation with PMNs (neutrophils) and lymphocytes

Answer 16

Ammonia that erodes the mucus barrier Cytotoxins and mucolytic enzymes cause mucosal damage and lead to ulcerogenesis

Answer 17

Gastritis Peptic ulcer disease Gastric adenocarcinoma Low-grade B-cell gastric lymphoma Infection Increases with age 50% over the age of 60 infected Most common among blacks, Hispanics, and Asians Transmission Oral-oral or fecal-oral route

Answer 18

Also known as Type B gastritis Acute infection Transient illness for several days Nausea Abdominal pain - epigastric Chronic infection Most patients are asymptomatic (80%) Dyspepsia: Early satiety Postprandial fullness Gnawing or burning upper abdominal discomfort

Answer 19

Types: Mild diffuse gastritis **Antral-predominant gastritis** Increased gastrin production Gastrin: stimulates secretion of gastric acid (HCl) by the parietal cells Resultant hypersecretion of acid predisposes patients to developing **peptic ulcers and gastric adenocarcinoma** **Body-predominant gastritis** Destruction of acid-secreting glands resulting in gastric atrophy and decreased acid production **Predisposes patients to neuroendocrine tumors**

Answer 20

Screening of asymptomatic patients is not indicated initial Dx: 1. Stool (fecal) antigen immunoassay Similar sensitivity and specificity to that of urea breath test 2. Urea breath test 3. Oral dose of 13C or 14C-labeled urea (capsule) Infected patient – H. pylori will metabolize the urea and liberate labeled CO2 which is exhaled and quantified in breath samples taken 20-30 minutes after ingestion of the urea ## Footnote Prior to testing, proton pump inhibitors should be discontinued for 14 days and antibiotics should be discontinued for 28 days

Answer 21

Not recommended solely for the diagnosis of H. pylori Performed in patients with symptoms suggestive of upper gastrointestinal disease Gastric mucosal biopsy for histology and rapid urease test (RUT)

Answer 22

Due to the role of H. pylori in gastric cancer, all positive patients should be treated ## Footnote Infected patient with duodenal or gastric ulcers require continuation of acid suppression for at least 4 weeks Eradication can be confirmed with a urea breath test, stool antigen test, or endoscopy ≥ 4 weeks after completion of therapy

Answer 23

Also known as Type A gastritis Rare autoimmune disease **Parietal cells antibodies (PCA) and intrinsic factor antibodies (IFA)** Achlorhydria Impaired iron absorption Hyperplasia of G-cells → ↑ gastrin secretion Vitamin B12 malabsorption Destruction of chief cells → ↓ pepsinogen Typically restricted to the fundus and body of the stomach

Answer 24

Diagnosis Measuring anti-parietal cell and anti-intrinsic factor antibodies Serum gastrin Serum pepsinogen Endoscopic biopsy

Achalasia/hiatal herna/gastritis Flashcards

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