Chapter 17-Stomach Flashcards
What is the terminology used when there are neutrophils present at the lesion in gastritis
Acute gastritis
What is the terminology used when there are no inflammatory cells present in the gastritis lesion
Gastropathy
What are the diseases that fall under the category of hypertrophic gastropathy
- Menetrier disease
- Zollinger Ellison Syndrome
What is the mechanism that NSAIDs can cause gastritis or gastropathy
- NSAIDs inhibit COX
- COX stimulate prostaglandin synthesis
- Prostaglandins stimulate production all of the products protecting the stomach lining from harsh conditions
What stomach condition are people at higher altitudes at risk of developing
Decreased oxygen leads to acute gastritis
Patients with NSAID induced gastritis will respond to which treatments
PPI
Antacids
What are the stree related mucosal diseases
- Stress ulcers
- Severe burns or Ulcers (Curling ulcers)
- Intracranial disease (Cushing disease)
When are stress ulcers commonly seen in patients
Individuals with shock, sepsis or severe trauma
When are Curling ulcers commonly seen
Severe burns or trauma leading to ulcers in the proximal duodenum
When are Cushing ulcers commonly seen
Gastric, duodenal or esophageal ulcers in patients with increased intracranial disease
What are cushing ulcers commonly resulting in
Perforation
What is the common cause of stress related gastric mucosal injury
Local ischemia due to systemic hypotension of reduced bloody flow due to splanchnic vasoconstriction
Upregulation of what in the stomach that can cause ischemic gastric mucosal injury
iNOsynthase and release of endothelin 1 (causes vasoconstriction)
Upregulation of what in the stomach that can protect against ischemic gastric mucosal injury
COX2
How does increased intracranial pressure cause Cushing ulcers
Intracranial injury causes direct stimulation of vagal nuclei, causing hyposecretion of gastric acid
What is the location of acute stress ulcers and what are the number that they normally occur in
Anywhere in the stomach, and there are normally multiple lesions
What is the morphology of the stress ulcers
-Ulcer base is stained brown/black by digestion of extravasated blood
What is absent in acute stress ulcers that differentiate it from peptic ulcers
Scarring and blood vessel thickening
Most critically ill patients admitted to the ICU show signs of which condition
Histological evidence of gastric mucosal damage
What is the most important determination of clinical outcome of gastric mucosal damage
Correction of the underlying condition
What are the nonstress related caused of gastric bleeding
GAVE Disease
Dieulafoy lesion
What is the Dieulafoy lesion caused by
Submucosa artery does not branch within the wall of the stomach, leading to an enlarged mucosal artery
Where are Dieulafoy lesions commonly found
Along the lesser curvature, near the gastroesophageal junction
What is the result of the Dieulafoy lesion
Erosion of the overlying epithelium causes gastric bleeding