Diseases Of The Stomach

Question 1

Mucous cells of the stomach secrete….

Answer 1

Alkaline mucus that protects the epithelium against shear stress and acid

Question 2

Parietal cells secrete

Answer 2

HCl and intrinsic factor

Question 3

Chief cells secrete

Answer 3

Pepsin, a proteolytic enzyme

Question 4

G cells secrete

Answer 4

Hormone gastrin, which signals parietal cells

Question 5

ECL cells of the stomach secrete

Answer 5

Histamine

Question 6

Dyspepsia

Answer 6

Aka indigestion
Symptoms include episodic epigastric pain, nausea, heartburn, bloating, dissension,

Food intake precipitates
No identifiable organic cause

Question 7

Types of dyspepsia

Answer 7

Ulcer vs non-ulcer

Question 8

Causes of dyspepsia

Answer 8

PUD
GERD
Erosive esophagus
Gastric cancer
Biliary colic
Pancreas disease
Chronic mesenteric ischemia
Gastroparesis

Question 9

Dyspepsia, bad warning signs

Answer 9

New symptoms at older age
Weight loss
Dysphasia
GI bleeds
Failed response to acid blockade

Question 10

Gastroparesis symptoms

Answer 10

Nausea
Early satiety 
Vomiting
Bloating
Pain

Question 11

Gastroparesis management

Answer 11

Multiple small meals
Low fat/fiber diet
Glucose control
Prokinetics (metoclopramide)

Question 12

Causes of gastroparesis

Answer 12

Diabetes
Connective tissue disorders
 Antichoinergic medications
Vagotomy
Preganancy
Thyroid disorder

Question 13

Pernicious anemia pathophys

Answer 13

Antibodies attack parietal cells, decreased acid production, decreased intrinsic factor

Cant absorb b12
Leads to anemia

Question 14

Signs of an ulcer

Answer 14

Episodic epigastric pain
N/V
GI bleeds
Weight loss
Iron deficient
Gastric outlet obstruction
Perforation

Question 15

PUD breaks the mucosa and extends through the ___________ ___________

Answer 15

Muscularis mucosa

Question 16

Causes of PUD

Answer 16

#1: NSAIDS
#2: H. Pylori

Also: zollinger Ellison syndrome
Infection (HSV, CMV, TB , syphillis) in immunocompromised
Stress
Radiation/chemo

Question 17

How to diagnose an ulcer

Answer 17

EGD w Bx
Barium

H. Pylori test and NSAID history for causation

Question 18

Ulcer treatment

Answer 18

Treat h pylori with abx
Stop smoking
Stop NSAID

Short term PPI therapy for 2 months
Re-scope to confirm healing

Question 19

PUD complications

Answer 19

Mortality
Bleeding
Perforation
Gastric outlet obstruction
Penetrate pancreas

Question 20

What do H pylori do?

Answer 20

Secrete urease to hydrolyze urea into ammonia
Neutralize gastric acid
Penetrate gastric mucus layer
Adhere to gastric mucosa

Question 21

H pylori can cause…

Answer 21

Gastritis
PUD
MALT lymphoma
Gastric adenocarcinoma

Question 22

How do we diagnosis H pylori?

Answer 22

Gastric biopsy
Serum IgG
Stool Ag
Urea breath test

Question 23

Gastric adenocarcinoma presentation

Answer 23

Asymptomatic, presenting at late stage

Pain, early satiety, N/V, weight loss, anorexia, gastric ulcers

Question 24

Ulcers seen in the duodenum, what does this patient have?

Answer 24

zollinger-Ellison syndrome

Question 25

Zollinger Ellison Syndrome pathophys

Answer 25

Acid hyper Secretion due to gastrinoma Excess gastrin means increased parietal cell stimulation and acid production. Hyperacidity means ulcers Tumor location: pancreas or duodenum Sporadic or part of MEN1 syndrome (parathyroid, pancreas, pituitary tumors) 50% malignant

Question 26

Zollinger Ellison syndrome presentation

Answer 26

Pain PUD (unusual, unexplained locations) Diarrhea, villous atrophy

Question 27

Causes of upper GI bleeding

Answer 27

PUD or variceal bleeds most common Differential: AVMs, dieulafoy's lesion, watermelon stomach, connective tissue disorder, tumor

Question 28

Watermelon stomach

Answer 28

Gastric antrum is vascularized AVMs here ooze and cause anemia Tx: cauterize via scope

Question 29

Dieulafoy's lesion

Answer 29

Small arteriole at surface, no ulcer just vessel bleeding

Question 30

GI bleed risk ranking

Answer 30

Clean base. > flat spot > adherent clot > nonbleeding visible vessel > active bleed

Question 31

Complications post gastric bypass

Answer 31

Can still get ulcers from NSAIDS traveling in blood stream Cant do ERCP for gallstones Need to do laparoscopic imaging