Diseases of the stomach

Question 1

types of gastritis

Answer 1

infectious, lymphocytic, eosinophilic, gastritis associated with systemic disease

Question 2

autoimmune attack of parietal cells and IF –> pernicious anemia, achlorhydria

EGD –> gastric atrophy, intestinal metaplasia

Answer 2

autoimmune atrophic gastritis

Question 3

complications of autoimmune atrophic gastritis

Answer 3

gastric carcinoid tumor, gastric cancer

Question 4

Most significant cause of infectious gastritis

Answer 4

H. pylori

Question 5

H pylori epidemiology

Answer 5

most common human bacterial infection. life-long for most

Question 6

About H. pylori

Answer 6

15% urease –> urea converted to ammonia –> neutralizes H+

corkscrews into mucus

Question 7

H pylori VacA exotoxin

Answer 7

pores in membrane, inhibits T cells

Question 8

relationship of acid secretion and severity of H pylori gastric body gastritis

Answer 8

inverse relationship

Question 9

diagnosis of H pylori

Answer 9

Endoscopy: histology, rapid urease test

Blood antibody test, stool antigen test, urea breath test

Question 10

Triple therapy of H pylori infection

Answer 10

PPI + clarithromycin + amoxicillin 10-14 days

Question 11

Rescue quadruple therapy for H pylori infection

Answer 11

PPI + metronidazole + tetracycline + bismuth

Question 12

Gastropathies

Answer 12

injury in absence of significant inflammation:

NSAIDs, EtOH, stress ulceration, cocaine, bile reflux

Question 13

SUBEPITHELIAL HEMORRHAGE, increased acid secretion

Answer 13

ethanol gastropathy

Question 14

all gastric protective factors (mucus, bicarb, mucosal blood flow) are dependent on…

Answer 14

prostaglandins

Question 15

GI side effects associated with NSAID use

Answer 15

heartburn, nausea, vomiting, abd pain

Question 16

PUD epidemiology

Answer 16

5-10% lifetime prevalence, slightly male predominant

increased incidence in COPD, cirrhosis, chronic renal failure, post-transplantation, smokers

Question 17

Associated with ICU patients (CNS injury, burns, prolonged mechanical ventilation > 48h, coagulopathy

impaired mucosal protection, increased acid secretion

Answer 17

stress ulcers

Question 18

Where are stress ulcers commonly found?

Answer 18

fundus and body

Question 19

Complications of peptic ulcers

Answer 19

abd pain, anemia, bleeding (30%), hematemesis, melena, perforation (5%), gastric outlet obstruction-duodenal ulcer

Question 20

treatment for PUD

Answer 20

PPI, treat H pylori,

avoid NSAIDs, smoking

Question 21

2nd most common cancer worldwide, 2nd most common cause of death from cancer worldwide

Answer 21

gastric adenocarcinoma

Question 22

distinctive stromal tumor that is the most common mesenchymal tumor of the stomach

insterstitial cell of Cajal. mutation at CD117

Answer 22

GIST

Question 23

treatment of GIST

Answer 23

gleevac

Question 24

prognosis of GIST

Answer 24

worse than other stromal tumors

Question 25

neuroendocrine tumor in fundus/body

Answer 25

gastric carcinoid

Question 26

associated findings with gastric carcinoid

Answer 26

autoimmune atrophic gastritis (hypochlorhydria, elevated gastrin –> ECL cell stim; antrectomy), ZE syndrome