Diseases of the Upper GI: Stomach

Question 1

Describe Helicobacter pylori

Answer 1

a microaerophilic, gram-negative rod that produces abundant urease which produces ammonia and raises the local pH

Question 2

risk factors for developing H Pylori infection

Answer 2

Lower socioeconomic status
Household crowding/bed sharing
Contaminated water
From developing country

Question 3

what are the transfer mechanisms of H pylori

Answer 3

oral-oral and fecal-oral

Question 4

Early in life H. pylori infection results in ____

Answer 4

Acute multi-focal or pan-gastritis

Question 5

Later in life H. Pylori infection usually results in _____

Answer 5

Antral-predominant chronic active gastritis

Question 6

why can’t Antibody tests be used acutely for confirming eradication of H. pylori infection?

Answer 6

antibody titers decrease slowly over a period of many months and remain positive in about 40% of successfully treated patients even after 18 months.

Question 7

describe how the urea breath tests (UBT) works

Answer 7

urea labeled with either 13C or 14C is ingested with a liquid meal. If urease is present, labeled carbon dioxide will be split off and absorbed into the circulation where its presence can be determined by analysis of expired breath.

Question 8

A _____ test has performance characteristics similar to that of the UBT and is the most commonly used test in the outpatient setting to confirm eradication of H. pylori.

Answer 8

stool antigen

Question 9

what is a drawback of the stool antigen test

Answer 9

Patient compliance with bringing a stool sample can be an issue.

Question 10

describe the 2 bacterial virulence factors and how they cause disease

Answer 10

1) They Injects protein (CagA) that decrease cell adhesion-associated with both gastric and duodenal ulcers. Linked to cancer
2)release VacA (vacuolating cytotoxin), an exotoxin that makes pores in membrane (epithelial injury).
Inhibits T cells

Question 11

what is a host factor that plays a role in H pylori infection.

Answer 11

Polymorphisms in IL-1β control degree of achlorhydria (low hydrochloric acid secretion) and development of cancer

Question 12

what is a environmental factor in the pathogenesis of H. pylori infection

Answer 12

Use of NSAIDs, further thinning out mucus layer predisposes to PUD

Question 13

you see increased incidence of peptic ulcer disease in which populations?

Answer 13

COPD, 
cirrhosis, 
chronic renal failure, 
post-transplantation, 
smokers

Question 14

what is Menetrier Disease

Answer 14

This rare disease has hyptertrophic rugal folds, often sparing the antrum, and histologic features of massive foveolar hyperplasia with cystic dilation, which may penetrate into the submucosa. There is relatively little inflammation and H. pylori are usually absent

Question 15

what are the signs/sx’s of Menetrier Disease

Answer 15

abdominal pain, weight loss, N/V, hypoalbuminemia

Question 16

________ is when a gastrin secreting neuroendocrine tumor stimulates parietal cells and increases acid secretion.

Answer 16

Zollinger-Ellison syndrome

Question 17

describe the pathophys of Peptic ulcers

Answer 17

occurs when gastroduodenal mucosal defenses are unable to protect the epithelium from the corrosive effects of acid and proteases, such as pepsin. It is primarily a disease of failed mucosal integrity, not of excess acid/pepsin secretion.

Question 18

describe the Clinical Manifestations of peptic ulcers

Answer 18

most often present with burning epigastric pain, That is typically relieved with food or antacids and may often awaken a patient from sleep. Nocturnal pain relieved with antacids may be the most specific symptom of peptic ulcer. The pain comes and goes.

Question 19

what is the treatment for gastric ulcers

Answer 19

Proton pump inhibitor treatment and H. pylori eradication are the cornerstones of therapy. In severe acute bleeds PPI “drips” are used in the ICU to tightly control pH.

Question 20

Hyperplastic polyps are proliferations of gastric _______ cells and arise from chronic inflammation and are found in gastric body autoimmune gastritis and in H. Pylori infection with chronic atrophic gastritis

Answer 20

foveolar (mucus producing)

Question 21

Benign gastric tumors arising from the supporting tissues (stromal tumors) include leiomyomas and lipomas. These tumors may be _____ bulging into the gastric lumen; or _______, extending extraluminally; or both.

Answer 21

submucosal,

subserosal

Question 22

_______tumors are a type of neuroendocrine tumor that usually arise from enterochromaffin or enterochromaffin-like cells of the intestinal tract.

Answer 22

Carcinoid