Clinic-Gastritis Flashcards
gastritis vs gastropathy
gastritis = inflammation of gastric mucosa; gastropathy = damage without significant inflammation
clinical presentation for gastritis
dyspepsia (“boring” pain), N/V, do not correlate with pathology!
erosive gastritis is also known as?
reactive gastropathy
major etiologies of gastritis
DRUGS=Aspirin/NSAIDs/meds is a BIG one; INFECTION=h pylori, viral; INFLAMM=”non-specific”, eosinophilic
complications of atrophic gastritis (autoimmune)
achlorhydria leads to hypergastrinemia and gastric carcinoids; decreased IF leads to macrocytic “pernicious” anemia (impaired absorption of B12)
Menetrier’s disease results in hypertrophy of ____, leading to increased ____ and loss of ____ from the blood
gastric folds/rugae; mucus production; protein (severe hypoproteinemia)
symptoms of menetrier’s dz
abdominal pain, N/V, diarrhea, weight loss, anemia
who get’s menetrier’s dz
rare, more common in men
what is an ulcer?
a defect in mucosal surface penetrating through the muscularis mucosa
the number of uncomplicated gastric ulcers has ____ since 1970; the number of hemorrhagic gastric ulcers has ____ since 1970
decreased; increased (NSAID use)
peptic ulcer disease is due to an imbalance between?
aggressive and defensive factors in the GI tract
name 5 defensive factors in the stomach/duodenum
mucus barrier, bicarb secretion, prostaglandins, cellular resistance, mucosal blood flow
name 5 aggressive factors that degrade the stomach’s defenses
H. pylori, NSAIDs, gastric acid, alcohol, smoking
gastroduodenal mucus is ___% water; degraded by ___; slows diffusion of ____; secretes ____
95%; pepsin; H+; bicarb
what do prostaglandins do?
stimulate mucus and bicarb production; reduce acid secretion
celebrex is selective for inhibition of?
COX-2 only (does not cause ulcers)
name three components of cellular defense
tight junctions, mucosal restitution (reforms barrier through small cell breakage), regeneration (larger cell breaks)
mucosal restitution occurs by ____, while regeneration requires _____
migration, cell division
more than 50% of mucosa is vulnerable when ____ in reduced
mucosal blood flow
uncomplicated PUD presents with?
epigastric pain, nonspecific GI issues (nausea, bloating, fullness), or asymptomatic
a bleeding ulcer presents with?
melena, hematemesis, hematochezia if brisk
a perforated ulcer presents with?
toxic appearance/shock, peritoneal signs
an obstruction presents with?
vomiting, succussion splash
dx of PUD is usually through what two tests
endoscopy, barium enema with radiography
tx of uncomplicated PUD (2-4 things)
acid reduction with PPI, eradication of H pylori, reduce/stop NSAIDs, stop smoking
tx of bleeding ulcer
endoscopic therapy (ablation?)
tx of perforated ulcer
surgery to px peritonitis, sepsis, shock, and death
tx of obstruction
nasogastric suction, dilation/surgery
Zollinger-Ellison occurs when there is a ____, often in the ____,____, or _____ leading to hypersecretion of _____
gastrinoma; pancreas, pituitary, or parathyroid; gastrin
patients with Zollinger-Ellison syndrome have what three major symptoms?
refractory peptic ulcers, GERD, and steatorrhea (inactiv of pancreatic enzymes)
a serum gastrin greater than ____ is diagnostic for ZES, but it can be confirmed with a _____ test
1000; secretin stimulation
how is a gastrinoma localized?
somatostatin receptor scintigraphy, endosonography, more than 90% in the gastrinoma triangle
name two causes of hypergastrinemia with high gastric acid
ZES, gastric outlet obstruction
name two causes of hypergastrinemia with low gastric acid
PPI use, pernicious anemia
where does ZES usually metastasize?
LN, liver
