gastric disorders

Question 1

what is the difference between acute and chronic gastritis?

Answer 1

acute - neutrophil infiltration
chronic - lymphocyte, plasma cells and macrophages

Question 2

what are the two most common causes of chronic gastritis ?

Answer 2

autoimmune
h.pylori

Question 3

what are the symptoms of gastritis ?

Answer 3

dyspepsia
often worsened by food

Question 4

what is the mechanism in which gastritis occurs ?

Answer 4

inflammation from too much acid or a loss of gastric mucosa protection

Question 5

what are the causes of acute gastritis ?

Answer 5

NSAIDS
alcohol
chemotherapy
h pylori

Question 6

what is a curling ulcer ?

Answer 6

occurs in burn patients
loss of skin - loss of fluids - dehydration
results in acute gastritis and ulcers

Question 7

what is a cushing ulcer ?

Answer 7

acute gastric ulcer
caused by an increase in intracranial pressure
increased vagal stimulation - increase in Ach to stomach - increased acid production

Question 8

what are stress ulcers ?

Answer 8

patients in shock , sepsis
happens due to poor mucosal perfusion
which then leads to a loss of protective barrier of mucosa and bicarb

Question 9

what is the prophylactic therapy for stress ulcers ?

Answer 9

proton pump inhibitors

Question 10

what are the two types of chronic gastritis ?

Answer 10

type A and Type B
type A - autoimmune - pernicious anemia
type B - bacteria H pylori

Question 11

what are the features of pernicious anemia ?

Answer 11

autoimmune destruction of the parietal cells
loss of secretion of intrinsic factor
IF is necessary for B12 absorption in the terminal ileum

Question 12

which part of the stomach is more associated with autoimmune gastritis ?

Answer 12

fundus and the body

Question 13

what is the genetic association with pernicious anemia ?

Answer 13

HLA-DR antigens

Question 14

what risk is carried with pernicious anemia ?

Answer 14

gastric adenocarcinoma

Question 15

where in the stomach does H pylori affect the stomach ?

Answer 15

in the antrum of the stomach

Question 16

why can h pylori survive in the stomach ?

Answer 16

urease positive

Question 17

what are the two malignancies associated with h pylori ?

Answer 17

gastric adenocarcinoma
MAlt lymphoma

Question 18

how is a diagnosis of h pylori made ?

Answer 18

biopsy
urea breath test
stool antigen

Question 19

what is the classic treatment for h pylori ?

Answer 19

triple therapy for 7-10 days
proton pump inhibitor
clarithromycin
amoxicillin/metronidazole

Question 20

what is the result of intestinal metaplasia ?

Answer 20

chronic inflammation leads to intestinal metaplasia
the key finding is the presence of goblet cells in the stomach

Question 21

where do peptic ulcer disease most commonly happen ?

Answer 21

in the proximal duodenum

Question 22

what is the most common cause of duodenal ulcers ?

Answer 22

h.pylori

Question 23

what is a rare cause of duodenal ulcer ?

Answer 23

zollinger ellison syndrome (gastrin secreting tumor)
ulcer beyond the bulb

Question 24

what are the symptoms of a duodenal ulcer ?

Answer 24

epigastric pain that improves with meals
pain worse at night

Question 25

where are brunners gland seen ?

Answer 25

only in the duodenum , they secrete bicarb , found in the submucosa

Question 26

what happens to brunners gland in peptic ulcer disease ?

Answer 26

brunners gland hypertrophy

Question 27

what are the complications associated with duodenal ulcers ?

Answer 27

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

Question 28

what finding is associated with perforated peptic ulcers ?

Answer 28

causes pneumoperitoneum air under the diaphragm on chest x ray

Question 29

what is the most common place for the presence of gastric ulcers ?

Answer 29

lesser curvature of the stomach

Question 30

what is the presentation and complication associated with gastric ulcer ?

Answer 30

pain that worsens with meals rupture : left gastric artery

Question 31

what are the symptoms of gastric carcinoma and what are the two different types ?

Answer 31

usually asymptomatic until advanced weight loss , abdominal pain early satiety 2 different types are : intestinal and diffuse

Question 32

what is the difference in appearance between intestinal and diffuse type of gastric carcinoma ?

Answer 32

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

Question 33

what are the risk factors associated with the development of gastric cancer ?

Answer 33

smoking nitrosamines - smoked meats type A blood

Question 34

what are the findings associated with diffuse type of gastric carcinoma ?

Answer 34

linitis plastica signet ring cells

Question 35

what is the most common site of metastasis of gastric cancer ?

Answer 35

the liver followed by the ovary - giving krukenberg tumor

Question 36

what type of dermatological finding is associated with gastric malignancy ?

Answer 36

acanthosis nigricans leser-trelat sign ( explosive onset of multiple itchy seborrheic keratosis )

Question 37

what are the other special clinical findings associated with gastric carcinoma ?

Answer 37

virchow's node sister mary joseph nodules

Question 38

what type of gastric tumor is more associated with krukenberg tumor ?

Answer 38

diffuse type - hence the finding of signet cell

Question 39

what is hypertrophic gastropathy ?

Answer 39

rare disorder that causes enlarged rugal folds caused by hypertrophy - non inflammatory

Question 40

what is the treatment for disal esophageal spasm ?

Answer 40

NItrates and CCB

Question 41

what is the gross pathology associated with menetrier disease ?

Answer 41

wavy like brain gyri

Question 42

what are the symptoms of menetriers disease ?

Answer 42

WAVEE weight loss vomiting epigastric pain edema

Question 43

what is blumer shelf ?

Answer 43

palpable mass on DRE suggesting metastasis to rectouterine pouch from gastric cancer

Question 44

what is the cause of diffuse gastric cancer ?

Answer 44

usually associatd with e cadehrin mutation signet ring cells seen linitis plastica