Disorders of the Stomach

Question 1

GASTRITIS/PEPTIC ULCER DISEASE/DUODENAL ULCER

• Patho
• Risk Factors
• Symptoms
• Diagnosis
• Treatment

Answer 1

Patho:

• Excessive acid production
• Decreased mucosal defense
• Motility defects
• Gastrtits/ duodenitis —> Peptic ulcer disease (Gastric or duodenal ulcer) —> GI Bleeding, perforation

Risk factors:

• NSAIDS
• H Pylori
• Smoking
• Psychological stress
• Alcohol use

Symptoms & Complications: 
-Dyspepsia (Indigestion)
-Epigastric pain (Bra-line level pain)
        Burning, gnawing
        Onset 90 min- 3 hrs post food
-Improved with meals (Duodenal ulcers)
        Food may exacerbate gastric ulcer
-Pain that awakens sleep (midnight and 3 am)
-Most common complication: GI bleeding

Diagnosis:

• Endoscopy
• H. pylori: Endoscopy, Urea breath test, Stool antigen

Treatment:

• PPIs
• Avoid Precipitating Agent (NSAIDs)
• Eradication of H. Pylori

Question 2

GASTROPARESIS

• Patho
• Symptoms
• Diagnosis
• Treatment

Answer 2

Patho:

• Chronic Delayed Gastric Emptying
• Altered neuronal transmission at pyloric sphincter: Diabetic neuropathy (Excessive tonic contraction)

Symptoms:

• N/V, Bloating
• Bezoars (large masses of undigested food)
• Erratic blood glucose control

Diagnosis: Gastric emptying study

Treatment: Gastric emptying stimulants (Metoclopramide, erythromycin, botulinum toxic pyloric injection)

Question 3

What is a risk factor for gastritis but not ulcers?

Answer 3

Alcohol use

Question 4

H. Pylori causes which ulcer more? Gastric or duodenal

Answer 4

Duodenal

Question 5

Survival Mechanisms of H. Pylori

Answer 5

• toxin production
• urease production
• Protease and phospholipase production

Question 6

NSAID Induced PUD: Risk factors

Answer 6

• age
• history of ulcer
• glucocorticoid usage
• high dose of NSAID
• multiple types of NSAIDs
• Anticoagulant use
• Antiplatelet use

Question 7

What does H. Pylori cause more? Gastritis or peptic ulcer disease?

Answer 7

Almost always causes gastritis

Only 10-15% develop peptic ulcer disease

Question 8

How do NSAIDs cause PUD?

Answer 8

Epithelial effects: NSAID causes prostaglandin depletion

• increase HCI secretion
• decrease mucin secretion
• decrease HCO3 secretion
• decrease surface active phospholipid secretion
• Epithelial cell proliferation

Endothelial effects: NSAIDs cause vasoconstriction —> stasis —> ischemia

Direct toxicity “ion trapping”