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MD1 GI - EXAM 1 > Estomac: pathologies > Flashcards

Estomac: pathologies Flashcards

1
Q

What is Helicobacter pylori?

A

Recent importance

Culture fastidieuse… why?

  • bacile microaérophile… < 5% O2

What does it secrete?

  • uréase: NH3 —> CO2

Which cytotoxine?

  • somatostatine (-), gastrine (+)

Prevalence and incidence?

  • High seropositivity, low seroconversion
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2
Q

What gastric pathologies are associated with H. pylori ? (5+1) (5+1)

A
  1. Gastrite antrale chronique (type B)
  2. Duodenal ulcers: 95%
  3. Gastric ulcers: 50-80%
  4. Gastric adenocarcinoma
  5. MALT carcinoma —> musoca associated lymphoid tissue carcinoma

Dyspepsie fonctionnelle (?)

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3
Q

What are the three main causes of peptic ulcers?

A
  1. H. pylori
  2. AINS
  3. too much HCl
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4
Q

What are the two main complications of peptic ulcers?

A

Haemorrhage

Perforation

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5
Q

What is the typical presentation of haemorrhage of a gastric ulcer?

A

Selles noirs

Hématémèse, méléna; choc hypovolémique

Tx? RÉANIMATION

  • Medicaments: IPP to dim. acid
  • Endoscopie: sclérose/coagulation ulcère
  • Artériographie: embolisation artérielle
  • Chirurgie: suture vaisseau hémorragique
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6
Q

What is the typical presentation of perforation of a peptic ulcer?

A

Acute and severe abdominal pain

Air sous les coupoles —> correspond à l’entrée d’air ou de gaz dans la cavité de l’abdomen

Abdomen de bois —> contraction rigide, tonique, permanente, douloureuse et invincible des muscles de la ceinture abdominale

Tx: Chirurgie -> suture perforation

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7
Q

How are ulcers diagnosed?

A

Typically visual diagnosis…

If in stomach:

  • Biopsy and follow up to look at healing

If in duodenum:

  • No need to biopsy… duodenal cancer is very rare
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8
Q

How is H. pylori’s presence detected? (4 main ways)

A
  1. Gastroscopie avec biopsie et culture
  2. Uréase:
    • CLO-test
  3. Détection et présence d’anticorps:
    • ELISA sérologie sérique (salivaire) pour detecter presence du IgG anti-H. pylori
    • Indicates previous exposure to H. pylori but does not identify if they currently have it vs. if its gone…
  4. Test de haleine
    • Give radioactive *urea… if H. pylori present will be converted into radioactive form of *CO2 —> breathed out and detected in breath
    • THIS TEST INDICATES IF YOU ARE A “PORTEUR ACTUEL”… bacteria must be present for this conversion to happen
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9
Q

How can H. pylori be treated? (6+2)

A
  1. Diet
  2. Stop consumption of cigarettes, alcohol and caffeine
  3. AINS —> stop taking if possible
  4. Antacids —> not enough to neutralize stomach acid
  5. Anti-H2 —> bloquers H2 supplantés par IPP
  6. IPP —> therapy typically used

***: cytoprotectors and prostaglandines —> peu utilisé ($$$)

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10
Q

What is the AINS strategy?

A

preventative treatment used to eradicate H. pylori

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11
Q

Are IPPs “inoffensifs”?

A

NO

If you stop taking them —> pH drops fast!

Dim. pH of stomach —> increase intestinal infections —> increase risk fo C. diff

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12
Q

What forms of treatment of H. pylori lead to its eradication?

A

Triple therapie:

  • neutralize acid
    • IPP, or pepto bismol

Two antibiotics of these 3:

  • Clarithromycin
  • Ampicillin
  • Metronidazole
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13
Q

What are some of the benefits of treating H. pylori ? (8)

A
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14
Q

What is a vagotomy?

A

A surgical operation in which one or more branches of the vagus nerve are cut, typically to reduce the rate of gastric secretion (e.g. in treating peptic ulcers).

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15
Q

What is an antrectomy?

A

procedure in which the distal third of the stomach (the gastric or pyloric antrum) is excised

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16
Q

What is Roux-En-Y surgery?

A
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17
Q

What are some indications for surgery?

A
  1. Resistance to medical treatment
  2. Cicatrisation sténosante au pylore —> dilation
  3. Hémorragie —> simple réparation
  4. Perforation —> simple réparation

Vagotomy and antrectomy are falling into a state of disuse

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18
Q

What are the two different types of chronic gastritis?

A
  1. Gastrite antrale:
    • secondary to H. pylori —> type B
  2. Gastrite fundique:
    • autoimmune —> type A
    • no digestive symptoms
    • presence of anti-parietal cell antibodies
    • (Hypochlorhydria —> hypergastrinemia)
    • Macrocytic anemia —> B12 deficit —> Megaloblastic anemia
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19
Q

Epidemiology of gastric adenocarcinoma:

A

2nd most prevalent cancer in the world

First cause of global cancer mortality:

  • Japan, China, Chili, Colombia, Costa Rica, Portugal
  • Six times less frequent in the Commonwealth, France, and Sweden

Decreasing prevalence in NA:

  • 38/100 000 to 5/100 000
  • 5 year survival rate: 20%
  • Only 3% of deaths due to cancer in Canada (2H:1F)
20
Q

What are some of the causes of gastric adenocarcinoma? (5)

A
  1. Diet: nitrites, preservation, lack of fruits and veggies
  2. H. pylori : gastritis, atrophy, intestinal metaplasia, dysplasia, carcinoma
  3. Gastritis: increase in renouvellement cellulaire —> increased chance of mutations
  4. Barrett: oesophagogastric junction
  5. Genetics: group A, family history, syndrome familial (2-3%), syndrome héréditaire cancer colon

NO LINK WITH: tobacco, alcohol, or antacids

21
Q

What are the two different ways to classify gastric adenocarcinoma according to histology?

A

Intestinal vs gastrique (diffus):

  1. Intestinal: bien différencié
  2. Gastrique (diffus): plus anaplasique et infiltratant —> bague à chaton (forme des cellules à la biopsie)… pas de masse à l’endoscopie

OMS/WHO: selon l’apparence histologique

  1. papillaire, tubulaire, musineux, bague à chaton
22
Q

What is linite plastique?

A

Stomach is like plastic… cannot distend anymore when eating

23
Q

What is a masse tumorale polypoïde?

A

Épaississement de la paroi gastrique… présentation tardive car il est non-obstructif

24
Q

What is gastric lymphoma?

A

The most frequent form of extranodal lymphoma

  • lymphocytes B —> tissu lymphoïde associés à la muqueuse (rxn hypertrophique)
    • MALT
  • Majority associated with H.pylori… if H. pylori is eradicated it’ll = eradication of MALT in 50% of cases
25
Q

How is gastric lymphoma treated?

A

Gastrectomy and/or chemo

26
Q

What are carcinoid tumours of the stomach?

A

Hypergastrinémie stimulates proliferation of ECl cells (histamine)

27
Q

What is GIST?

A

Gastrointestinal stromal tumour

28
Q

Where does GIST originate?

A

cellules interstitielles de Cajal —> neurones du plexus myentérique

Meissner (sous-muqueuse)

Auerbach (autour de la musculeuse)

29
Q

How is GIST identified?

A

Immunohistochimie (c-KIT antibody, CD-34): mutations inhibit apoptosis by activation of tyrosine kinase

30
Q

What is the treatment of GIST?

A

Tyrosine kinase inhibitor

31
Q

What are gastric polyps?

A

Masses/nodules qui dépassent le niveau de la muqueuse environnante

Hyperplasiques:

  • multiple (20+)
  • in response to trauma or stimulus (gastrine)
  • prolonged IPP use, gastinome

Adénomateux:

  • Cellules épithéliales dysplasiques —> potential of malignant transformation
32
Q

What is gastroparésie?

A
  1. Slowing of vidange gastrique, halitosis, perte pondérale
  2. Gastric dilation: typanisme
  3. Post-vagotomie: + pyloroplastie ou gastro-jéjunostomie
  4. Diabetes:
    1. chronic: neuropathie du nerf vague
    2. acute: glycémie > 12 mmol/l (n < 6 mmol/l)
  5. Idiopathic
33
Q

How is gastroparésie tx? (4)

A

Cholinergiques (urécholine —> rétention urinaire)

AChE inhibitors (néostigmine)

Antidopaminergiques (métaclopyramide)

Antagonistes de motiline (erythromycin, domperidone)

34
Q

What is dyspeptie fonctionelle (non-organique)?

A

Symptômes > 3 mois de mauvaise digestion de l’étage supérieur

type ulcereux: brûlures, crampes

type moteur: digestion lente, éructations post-prandiales

35
Q

Dyspepsie fonctionelle: medical history, E/P, labos de base dx -> if no pathology… should we investigate further?

A

Yes if:

  • < 3 months
  • 50 years old
  • weight loss
  • anemia
36
Q

What is syndrome de vomissements cycliques?

A

first eliminate possibilities of intestinal occlusion

une affection gastro-intestinale (GI) fonctionnelle qui occasionne des épisodes récurrents de nausées et de vomissements graves

37
Q

What is aerophagia?

A

Swallowing air… its normal and done unconsciously

Leads to eructation (burping) and flatulence

38
Q

What is rumination?

A

Volontary but unconscious act

Abdominal contraction… but NOT VOMITING

Patients repeatedly and unintentionally spit up (regurgitate) undigested or partially digested food from the stomach, rechew it, and then either reswallow it or spit it out

39
Q

What is Zollinger-Ellison Syndrome (gastrinoma)?

A

rare condition in which one or more tumors form in your pancreas or the upper part of your small intestine (duodenum). These tumors, called gastrinomas, secrete large amounts of the hormone gastrin, which causes your stomach to produce too much acid. The excess acid then leads to peptic ulcers, as well as to diarrhea and other symptoms

Hypergastrinimie —> multiple duodenal ulcers

Diarrhea: osmolaire, atrophie, maldigestion

Gastrinoma: benign or malignant neoplasia

40
Q

What is MEN?

A

Multiple endocrine neoplasia

  • Adénome hypophysaire: prolactine
  • Parathyroid hyperplasia: calcium/PTH
  • Pancreatic gastrinoma: gastrin
41
Q

How is MEN treated?

A

tumoral resection or gastrectomy… palliated with IPPs

42
Q

What is Menetrier gastritis?

A

Menetrier disease is not a true form of gastritis. A diagnosis of Menetrier disease should be reserved for individuals with large gastric folds due to overgrowth of mucous cells

  • Visually frank
  • Entéropathie exsudative… hypoalbuminémie
  • Biopsy: hypertrophy of goblet cells (à mucus)
43
Q

What is gastric volvulus?

A

abnormal rotation of the stomach of more than 180°, which creates a closed-loop obstruction that can result in incarceration and strangulation

44
Q

What is a gastric bezoar?

A

tightly packed collection of partially digested or undigested material that most commonly occurs in the stomach (ex: hair…)

45
Q

What is gastric perforation?

A

Air “libre” under diaphragm due to rupture of a gastric/ duodenal ulcer or another “viscère creux”

Symptoms:

  • intense spontaneous pain
  • dypsnea secondary to pain
  • abdomen de bois/ abdomen “chirurgical”
46
Q

What is a gastric hemorrhage?

A

Due to gastric ulcer

  • Acute: hématémèse
    • (rejet de sang généralement rouge par la bouche au cours d’un effort de vomissement)
  • Sub-acute: melena
  • Chronique: fatigue, dyspnée à l’effort

Symptoms:

No pain… caused by hypertension???, supple stomach during E/P

47
Q

What is Dieulafoy’s lesion (ulcère)?

A

Pas d’ulcère muqueux… ulcération d’une artère

treatment? clip gastroscopie

MD1 GI - EXAM 1 (15 decks)

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