Diseases of the stomach Flashcards
types of gastritis
infectious, lymphocytic, eosinophilic, gastritis associated with systemic disease
autoimmune attack of parietal cells and IF –> pernicious anemia, achlorhydria
EGD –> gastric atrophy, intestinal metaplasia
autoimmune atrophic gastritis
complications of autoimmune atrophic gastritis
gastric carcinoid tumor, gastric cancer
Most significant cause of infectious gastritis
H. pylori
H pylori epidemiology
most common human bacterial infection. life-long for most
About H. pylori
15% urease –> urea converted to ammonia –> neutralizes H+
corkscrews into mucus
H pylori VacA exotoxin
pores in membrane, inhibits T cells
relationship of acid secretion and severity of H pylori gastric body gastritis
inverse relationship
diagnosis of H pylori
Endoscopy: histology, rapid urease test
Blood antibody test, stool antigen test, urea breath test
Triple therapy of H pylori infection
PPI + clarithromycin + amoxicillin 10-14 days
Rescue quadruple therapy for H pylori infection
PPI + metronidazole + tetracycline + bismuth
Gastropathies
injury in absence of significant inflammation:
NSAIDs, EtOH, stress ulceration, cocaine, bile reflux
SUBEPITHELIAL HEMORRHAGE, increased acid secretion
ethanol gastropathy
all gastric protective factors (mucus, bicarb, mucosal blood flow) are dependent on…
prostaglandins
GI side effects associated with NSAID use
heartburn, nausea, vomiting, abd pain
PUD epidemiology
5-10% lifetime prevalence, slightly male predominant
increased incidence in COPD, cirrhosis, chronic renal failure, post-transplantation, smokers
Associated with ICU patients (CNS injury, burns, prolonged mechanical ventilation > 48h, coagulopathy
impaired mucosal protection, increased acid secretion
stress ulcers
Where are stress ulcers commonly found?
fundus and body
Complications of peptic ulcers
abd pain, anemia, bleeding (30%), hematemesis, melena, perforation (5%), gastric outlet obstruction-duodenal ulcer
treatment for PUD
PPI, treat H pylori,
avoid NSAIDs, smoking
2nd most common cancer worldwide, 2nd most common cause of death from cancer worldwide
gastric adenocarcinoma
distinctive stromal tumor that is the most common mesenchymal tumor of the stomach
insterstitial cell of Cajal. mutation at CD117
GIST
treatment of GIST
gleevac
prognosis of GIST
worse than other stromal tumors
neuroendocrine tumor in fundus/body
gastric carcinoid
associated findings with gastric carcinoid
autoimmune atrophic gastritis (hypochlorhydria, elevated gastrin –> ECL cell stim; antrectomy), ZE syndrome
