Diseases of the Upper GI: Stomach

Question 1

Solid emptying is mediated by ____________.

Answer 1

vagal nerve stimulation

Question 2

The ___________ glands are in the _________ and secrete gastrin.

Answer 2

pyloric; antrum

Question 3

What three pathways stimulate acid secretion?

Answer 3

• Neural pathway (acetylcholine on M3 receptors)
• Gastrin pathway (hormonal secretion from gastric cells landing on CCK2 receptors)
• Histamine from ECL cells on H2 receptors

Question 4

The cardinal finding of Menetrier’s disease is _____________.

Answer 4

mucous-cell hyperplasia

Question 5

What is Zollinger-Ellison syndrome?

Answer 5

• Neuroendocrine tumor in pancreas or duodenum

- The excess gastrin secretion (from the neuroendocrine tumor) leads to increased acid secretion and many ulcers

Question 6

The stomach of someone with ______________ will lack rugae. What causes this?

Answer 6

autoimmune atrophic gastritis (AAG); attack on parietal cells –leading to pernicious anemia and increased risk of cancer

Question 7

Infection with Helicobacter pylori tend to have what chronological presentation?

Answer 7

Chronic

Question 8

What are some features of H. pylori?

Answer 8

• Suited to live in acidic environment
• Spiral shape with multiple flagella
• Produces urease with breaks down urea to ammonia (which neutralizes pH)
• Microaerophilic
• CagA injected into epithelium to adhere
• VacA to inhibit T cells

Question 9

Antibiotics prevent _____________ in those with H. pylori infection.

Answer 9

ulcer recurrence

Question 10

Most H. pylori infection leads to ______ gastritis.

Answer 10

pan (80%); about 15% only have antral inflammation

Question 11

In whom should you consider testing for H. pylori infection?

Answer 11

• Active PUD
• History of PUD without treatment
• Gastric neoplasia

Question 12

By what non-endoscopic tests can you test for H. pylori? (Endoscopic tests use a small histologic sample –high sensitivity/specificity.)

Answer 12

• Blood antibody tests
• Stool sample
• Urea breath test

Question 13

Consider treating even if the patient is ____________.

Answer 13

asymptomatic

Question 14

What are treatment guidelines for H. pylori?

Answer 14

• PPI, clarithromycin, and amoxicillin (14 days)
• PPI, bismuth, metronidazole, and tetracycline (14 days)
• Sequential therapy

Question 15

What are gastropathies?

Answer 15

Injury in the absence of inflammation

Can be caused by ethanol, NSAIDs, stress, cocaine, or bile reflux

Question 16

How does alcohol injure the stomach?

Answer 16

It disrupts the mucosa and increases acid secretion. This only occurs with high concentrations of alcohol.

Question 17

Why do NSAIDs injure the stomach?

Answer 17

Because the production of mucus and bicarb (both of which are protective) depend on prostaglandins

Question 18

True or false: most people with peptic ulcers are asymptomatic.

Answer 18

True!

Question 19

The lifetime prevalence of peptic ulcer disease is _______.

Answer 19

5% - 10%

Question 20

How is PUD treated?

Answer 20

• PPI therapy (allowing the ulcer to heal)
• H. pylori test and treat (preventing recurrence)
• Risk-factor avoidance (e.g., smoking, NSAIDs)

Question 21

Gastrointestinal stomal tumors originate from which cell type? (This is the most common mesenchymal stomach cancer.)

Answer 21

Interstitial cells of Cajal (pacemaker cells)

Question 22

Cardiac glands contain _______________.

Answer 22

mucus-secreting cells that also produce some pepsinogen

Question 23

Oxyntic glands are found in the ____________ and contain the following cell types: ____________.

Answer 23

fundus and body; mucous cells, parietal cells, chief cells, endocrine cells, and enterochromaffin cells

Question 24

The pyloric glands contain which cell types?

Answer 24

Mucous and endocrine

Question 25

Activation of receptors in the proximal small intestine does what to gastric emptying?

Answer 25

Slows it (so that the small intestines don’t become overwhelmed with contents)

Question 26

The disease that presents with mucous-cell hyperplasia has what presenting signs/symptoms?

Answer 26

Hypoalbuminemia
Gastric bleeding
Abdominal pain
Weight loss

Question 27

Which type of polyp can result from long-term PPI use?

Answer 27

Fundic polyp

Question 28

True or false: fundic polyps are associated with a high risk of malignancy.

Answer 28

False. No risk.

Question 29

From what cells do carcinoid tumors generally arise?

Answer 29

Enterochromaffin or enterochromaffin-like cells

Question 30

______________ is both the second-most-common cancer and the second-most-common cause of cancer deaths worldwide.

Answer 30

Gastric adenoma