gastric disorders Flashcards
what is the difference between acute and chronic gastritis?
acute - neutrophil infiltration
chronic - lymphocyte, plasma cells and macrophages
what are the two most common causes of chronic gastritis ?
autoimmune
h.pylori
what are the symptoms of gastritis ?
dyspepsia
often worsened by food
what is the mechanism in which gastritis occurs ?
inflammation from too much acid or a loss of gastric mucosa protection
what are the causes of acute gastritis ?
NSAIDS
alcohol
chemotherapy
h pylori
what is a curling ulcer ?
occurs in burn patients
loss of skin - loss of fluids - dehydration
results in acute gastritis and ulcers
what is a cushing ulcer ?
acute gastric ulcer
caused by an increase in intracranial pressure
increased vagal stimulation - increase in Ach to stomach - increased acid production
what are stress ulcers ?
patients in shock , sepsis
happens due to poor mucosal perfusion
which then leads to a loss of protective barrier of mucosa and bicarb
what is the prophylactic therapy for stress ulcers ?
proton pump inhibitors
what are the two types of chronic gastritis ?
type A and Type B
type A - autoimmune - pernicious anemia
type B - bacteria H pylori
what are the features of pernicious anemia ?
autoimmune destruction of the parietal cells
loss of secretion of intrinsic factor
IF is necessary for B12 absorption in the terminal ileum
which part of the stomach is more associated with autoimmune gastritis ?
fundus and the body
what is the genetic association with pernicious anemia ?
HLA-DR antigens
what risk is carried with pernicious anemia ?
gastric adenocarcinoma
where in the stomach does H pylori affect the stomach ?
in the antrum of the stomach
why can h pylori survive in the stomach ?
urease positive
what are the two malignancies associated with h pylori ?
gastric adenocarcinoma
MAlt lymphoma
how is a diagnosis of h pylori made ?
biopsy
urea breath test
stool antigen
what is the classic treatment for h pylori ?
triple therapy for 7-10 days
proton pump inhibitor
clarithromycin
amoxicillin/metronidazole
what is the result of intestinal metaplasia ?
chronic inflammation leads to intestinal metaplasia
the key finding is the presence of goblet cells in the stomach
where do peptic ulcer disease most commonly happen ?
in the proximal duodenum
what is the most common cause of duodenal ulcers ?
h.pylori
what is a rare cause of duodenal ulcer ?
zollinger ellison syndrome (gastrin secreting tumor)
ulcer beyond the bulb
what are the symptoms of a duodenal ulcer ?
epigastric pain that improves with meals
pain worse at night
where are brunners gland seen ?
only in the duodenum , they secrete bicarb , found in the submucosa
what happens to brunners gland in peptic ulcer disease ?
brunners gland hypertrophy
what are the complications associated with duodenal ulcers ?
most duodenal ulcers are anterior
complications happen to the posterior ones
1- associated with upper GI bleeding , source is gastroduodenal artery
2- pancreatitis
3- perforation
what finding is associated with perforated peptic ulcers ?
causes pneumoperitoneum
air under the diaphragm on chest x ray
what is the most common place for the presence of gastric ulcers ?
lesser curvature of the stomach
what is the presentation and complication associated with gastric ulcer ?
pain that worsens with meals
rupture : left gastric artery
what are the symptoms of gastric carcinoma and what are the two different types ?
usually asymptomatic until advanced
weight loss , abdominal pain
early satiety
2 different types are : intestinal and diffuse
what is the difference in appearance between intestinal and diffuse type of gastric carcinoma ?
intestinal type - appears as a large ulcer with irregular margins , similar to colonic adenocarcinoma , common in the lesser curvature
diffuse type - stomach is diffusley thickened , early satiety
what are the risk factors associated with the development of gastric cancer ?
smoking
nitrosamines - smoked meats
type A blood
what are the findings associated with diffuse type of gastric carcinoma ?
linitis plastica
signet ring cells
what is the most common site of metastasis of gastric cancer ?
the liver
followed by the ovary - giving krukenberg tumor
what type of dermatological finding is associated with gastric malignancy ?
acanthosis nigricans
leser-trelat sign ( explosive onset of multiple itchy seborrheic keratosis )
what are the other special clinical findings associated with gastric carcinoma ?
virchow’s node
sister mary joseph nodules
what type of gastric tumor is more associated with krukenberg tumor ?
diffuse type - hence the finding of signet cell
what is hypertrophic gastropathy ?
rare disorder that causes enlarged rugal folds
caused by hypertrophy - non inflammatory
what is the treatment for disal esophageal spasm ?
NItrates and CCB
what is the gross pathology associated with menetrier disease ?
wavy like brain gyri
what are the symptoms of menetriers disease ?
WAVEE
weight loss
vomiting
epigastric pain
edema
what is blumer shelf ?
palpable mass on DRE suggesting metastasis to rectouterine pouch
from gastric cancer
what is the cause of diffuse gastric cancer ?
usually associatd with e cadehrin mutation
signet ring cells seen
linitis plastica
