Disease of stomach

Question 1

Describe the epidemiology of H. pylori infection

Answer 1

more common in developing countries
most common human bacterial infection, >50% of world
associated with peptic ulcers, atrophic gastritis and gastric cancer

Question 2

pathophysiology of H. pylori infection

Answer 2

Fecal oral route-
Cag A protein- injected into host cells, causes inflammation, associated with cancer, decreased cell adhesion
Vac A- exotoxin makes poresin membrane, inhibits T cells

superficial infection–>gastric atrophy–> intestinal metaplasia, dysplasia–> gastric adenocarcinoma

Question 3

treatment of H. pylori infection

Answer 3

triple therapy
-PPI + clarithromycin + amoxicillin 10-14 days
-test for H. Pylori stool antigen
rescue quad therapy
-PPI + metronidaole+tetracycloine+bismuth

Question 4

• Identify the causes of gastritis

Answer 4

infectious- h pylori, syphilis, tb
-candida, aspergillosus, histoplasmosis, mucormycosis
-giardia, cryptopyridiosis, anisakiasis, strongyloidiasis
-cmv
lymphocytic
eosiniphilic- ulceration, early satiety, nausea, vomiting
-increased eos in blood, biopsies
-rare cause unknown
systemic disease
autoimmune atrophic- attack against parietal cells and IF
-lack of acid, B12 deficiency, atrophy

Question 5

• Describe peptic ulcer disease pathogenesis

Answer 5

H. Pylori, NSAIDS, Smoking, other—» disruption of mucosal integrity + acid/Pepsin–> ulceration

Question 6

• Explain peptic ulcer disease treatment

Answer 6

antibiotics, if H.Pylori is implicated
Acute Bleeds- IV resucitation--restore intravascular volume
-acid suppresion-PPI
-endoscopy
-angiography coils, surgery
Perforation- surgery
avoid NSAIDS, smoking
chronic PPI if NSAID necessary-cardiac disease

Question 7

• List the 5 most common types of gastric neoplasms

Answer 7

Gastric Polyps
-hyperplastic (found near gastritis)
-Adenoma-premalignant FAP
-Fundic gland polyps-benign chronic PPI, unrelated to H pylori
Gastric adenocarcinoma- 2nd most common cancer world wide, 2nd most common cancer death
Linitis Plastica
GIST- stromal tumor- bad prognosis tx w/ Gleevac
-interstitial cell of cajal (pacemaker) ckit postive (TYR Kinase)
Gastric Carinoid- neuroendocrine tumor
-found in fundus or body
-Autoimmune, ZE syndrome (gastrinomas), sporadic (more dangerous)
Malt Lymphoma- H. Pylori related, tx of H. pylori can sometimes eradicate tumor

Question 8

is antral infection of H. Pylori correlated with increased or decreased acid production? Is whole stomach infection correlated with increased or decreased acid?

Answer 8

increased–> duodenal ulcers, decreased

Question 9

what tests are for Dx of H . Pylori

Answer 9

Blood antibody test, *stool antigen test urea, breath test

Question 10

Stress ulcers: cushings, Curlings

Answer 10

cushings- cns injury.
curlings- burns

tend to occur in fundus and body, impaired mucosal protection