Gastric disease

Question 1

Incisura

Answer 1

Angle connecting the lesser curvature to the antrum

Question 2

Rapid gastric emptying

Answer 2

Post gastric surgery. Dumping syndrome, rapid entry of food into duodenum. Results in abdo systmptoms. Undigested food in duodenum, large particle osmotically active- distended duodenum, osmotic diarrhoea.

Question 3

Delayed gastric emptying

Answer 3

Most common in diabetes due to autonomic neuropathy.

Question 4

Achlorhydria

Answer 4

Absent or low acid (e.g. in pernicious anaemia)

Question 5

Acid secretion daily

Answer 5

By parietal cells secrete up to 2/L per day (a

Question 6

Condition that causes excessive gastric acid (1)

Answer 6

Gastrinoma (tumour where tutor cells produce gastrin)

Question 7

Conditions that cause decreased gastric acid (4)

Answer 7

Pernicious anaemia (Autoimmune condition where antibodies attack parietal cells and IF)
Gastric surgery (specifically in antrum where parietal cells are)
Vagotomy (vagal trunk cut and loss of vagus nerve innervation reduced ACh)
Drugs- proton pump inhibitors, or histamine receptor antagonists

Question 8

Prostaglandins in the stomach

Answer 8

Protective role in repair of gastric mucosa

Question 9

Control of gastric acidity: Cephalic phase

Answer 9

Vagus nerve/enteric nerves release ACh and gastric releasing peptide, stimulates parietal, ECL and G cells and mucous cells

Question 10

Control of gastric acidity: Gastric phase

Answer 10

Distention of the stomach causes enteric nerves to release more ACh.
Amino acids from food stimulate G cells.

Question 11

Intestinal phase

Answer 11

Food exits stomach, excessive acid in stomach stimulates D cells to release somatostatin which inhibits G cells.
Fats, proteins and acid in duodenum stimulate CCK and secretin release which in turn reduce gastric acid, stimulates bile and pancreatic enzyme release and stimulate HCO3- from pancreatic and biliary ductal cells

Question 12

Peptic ulcer disease, aetiology, symptoms, manifestations and treatment

Answer 12

H.pylori most common cause, also NSAIDs, describe ulceration in stomach or duodenum. Cause epigastric pain, bleeding, perforation, obstruction (swelling), stricture.
Surgery, less common.
Medications to reduce acid, treat H. pylori infection.

Question 13

Helicobactor pylori infection

Answer 13

• H.pylori infection typically in childhood. Live in antrum.
• Chronic inflammation (gastritis)
• Inflammation may result in gastric mucosa being damaged resulting peptic ulceration occur (bleeding).
• Increases risk of gastric cancer
• Increases risk of MALToma mucosa associated lymphoid tissue lymphoma (non-aggressive)

Question 14

Gastric adenocarcinoma, two kinds. Which one is associated with H.pylori?

Answer 14

Intestinal and difffuse
Intestinal- well differentiated (differentiated structures), H. pylori increase risk of this kind.
Diffuse- host of cells without structures. Can cause infiltration of gastric wall.

Question 15

Treatment of H pylori

Answer 15

Triple therapy: omeprazole (proton pump inhibit, reduces acidity that H. pylori likes), amoxycillin, clarithromycin

Question 16

H. pylori and cancer, why is risk increased?

Answer 16

Inflammation destroys parietal cells, low acid, bacterial overgrowth, carcinogens from bacteria.