Clinicopathologic Considerations of Dyspepsia Flashcards
What demographic is affected by infectious esophagitis?
Immune compromised individuals
What is dyspepsia?
Indigestion
What is dysphagia?
Difficulty swallowing
What is odynophagia?
Painful swallowing
What does postprandial mean?
After eating
What is GERD?
Gastroesophageal reflux disease
5 causes of esophagitis?
- ) Chemical/physical
- ) Infections
- ) Reflux (GERD)
- ) GVHD (Graft vs host disease)
- ) Eosinophilic esophagitis (EE)
What can cause infectious esophagitis?
HSV
CMV
Candidiasis
What causes GERD?
Incompetent LES
What occurs in GERD?
Refluxed gastric acid overwhelms mucous defenses: Mucous, HCO3-
Treatment of GERD?
First elimination of risks
Proton pump inhibitors
What is eosinophilic esophagitis?
Allergic reaction causing esophagus inflammation
Where does GERD affect?
Only distal 1/3 of the esophagus
Where does eosinophilic esophagitis affect?
Throughout the entire esophagus
What are symptoms of EE?
Abundance of eosinophils in the throat and atopic (dermatitis)
What is the treatment for EE?
Dietary change (PPI’s don’t work)
What occurs in Barrett’s esophagus?
Squamous cells in distal 1/3 of esophagus changing to small intestinal epithelium with goblet cells; metaplastic (reversible)
What does Barrett’s esophagus put the patient at risk for?
Adenocarcinoma
Where does squamous cell carcinoma occur?
Proximal and distal end of esophagus
Where does adenocarcinoma occur?
Near the GE junction
Difference between erosion and ulcer:
Erosion: loss of epithelium
Ulcer: deep extension of erosion (submucosa)
What causes stress ulcers?
Severe trauma, shock, sepsis
What are Curling’s ulcers?
Proximal duodenum, severe trauma or burns
What are Cushing’s ulcers?
Gastric, duodenal, esophageal due to intracranial processes and vagal stimulation
What does H. pylori cause?
Decreased acid
Gastrin levels increased
Antral (pylorus) location and may progress to multifocal atrophic gastritis
What are virulence factors from H. pylori?
Flagella
Urease: ammonia generated from urea increasing tissue pH
Adhesins
Toxins (CagA)
What are the types of chronic gastritis?
Autoimmune
H. pylori
What are the key clinical features of autoimmune gastritis?
Abs against parietal cells Pernicious anemia (parietal cells cannot produce IF) Body and fundus affected not the antrum Achlorhydria Hypergastrinemia
