Gastric Disorders

Question 1

Most to least common peptic ulcers

Answer 1

Duodenal > Gastric > Esophageal

Question 2

Gastric vs duodenal ulcer cause

Answer 2

Gastric: Decreased mucosal barrier protection
Duodenal: Increased acid

Question 3

Gastric vs duodenal ulcer risk factors

Answer 3

Gastric: ASA/NSAIDs, smoking, stress, alcohol
Duodenal: Gastrin-secreting tumours (Zollinger-Ellison syndrome)

Question 4

Gastric vs duodenal ulcer association with H. pylori

Answer 4

Gastric: 70%
Duodenal: 100%

Question 5

Gastric vs duodenal ulcer risk of progression to carcinoma

Answer 5

Gastric: High
Duodenal: Low

Question 6

Gastric vs duodenal ulcer clinical presentation

Answer 6

Gastric:
- Weight loss
- Pain exacerbated by meals

Duodenal:
- Weight gain
- Pain relieved by meals

Question 7

Treatment for peptic ulcer disease (gastric and duodenal)

Answer 7

1. Eliminate H. pylori with triple therapy (PPI, amoxicillin, clarythromycin)
2. Acid suppression (H2 blocker, PPI)
3. Avoid ASA, NSAIDs, alcohol

Question 8

Complications for peptic ulcer disease (4)

Answer 8

1. UGIB: hematemesis, melena, coffe ground emesis
2. Iron deficiency anemia
3. Perforation -> peritonitis
4. Gastric outlet obstruction

Question 9

Gastric cancer types

Answer 9

Gastric adenocarcinoma
Lymphoma

Question 10

2 subtypes of gastric adenocarcinoma

Answer 10

Intestinal
Diffuse

Question 11

Intestinal vs diffuse adenocarcinoma risk factors

Answer 11

Intestinal: Chronic H. pylori infection, smoking, smoked foods (nitrosamines), chronic gastritis

Diffuse: unknown

Question 12

Intestinal vs diffuse adenocarcinoma histology

Answer 12

Intestinal: Intestinal and dysplasia metaplasia secondary to H.pylori infection
Diffuse: Signet ring cells

Question 13

Intestinal vs diffuse adenocarcinoma morphology

Answer 13

Intestinal: Exophytic masses, ulcerated tumours, on lesser curvature

Diffuse: Diffuse thickening and infiltration of stomach wall + effacement of gastric folds

Question 14

Specific type of diffuse adenocarcinoma and its associated symptom

Answer 14

Linitis Plastica (early satiety)

Question 15

Clinical presentation of both subtypes of gastric adenocarcinoma

Answer 15

• Asymptomatic early stages
• Non-specific symptoms (nausea, vomiting, anemia, weight loss, epigastric pain)

Question 16

Classic metastatic site for gastric adenocarcinoma

Answer 16

Left supraclavicular lymph node (Virchow node)

Question 17

2 common types of lymphoma (gastric cancer)

Answer 17

MALT lymphoma (H.pylori)
Diffuse large B cell lymphoma

Question 18

Peptic ulcer vs ulcerated tumour size

Answer 18

Peptic ulcer: small (<2cm)
Ulcerated tumour: large (>2cm)

Question 19

Peptic ulcer vs ulcerated tumour shape

Answer 19

Peptic ulcer: Round/oval, regular punched out borders
Ulcerated tumour: Irregular, thick borders

Question 20

Peptic ulcer vs ulcerated tumour borders

Answer 20

Peptic ulcer: Flat, edges touch the rugae
Ulcerated tumour: Elevated, rugae do not reach edges

Question 21

Peptic ulcer vs ulcerated tumour base

Answer 21

Peptic ulcer: Smooth base, sometimes with blood clot
Ulcerated tumour: necrotic base, irregular

Question 22

3 types of gastritis

Answer 22

Acute gastritis
Chronic H. pylori (atrophic) gastritis
Chronic autoimmune gastritis

Question 23

Causes/risk factors for acute gastritis (5)

Answer 23

ASA/NSAID use
High-dose steroids
Brain injury
Alcohol
Severe systemic stress (sepsis, burns)

Question 24

Complications of acute gastritis (2)

Answer 24

Hemorrhagic gastritis
Perforation -> peritonitis

Question 25

Acute gastritis treatment

Answer 25

Acid suppression (H2 blockers, PPIs) Acid neutralization (antacids) Mucosal protection (sucralfate)

Question 26

Chronic H. pylori gastritis - When is it usually acquired? - Persistent infection of...

Answer 26

Usually acquired in childhood Persistent infection of antrum Most common type of chronic gastritis

Question 27

Diagnosis of H. pylori gastritis

Answer 27

H. pylori detection via: - Urease breath test - Anti-H. pylori IgG - Endoscopic biopsy with urease test

Question 28

Complications of H. pylori gastritis

Answer 28

1. Adenocarcinoma (intestinal) 2. Peptic ulcer disease (duodenal) 3. MALT lymphoma 4. Achlorhydria 5. Malignancy

Question 29

Treatment for H. pylori gastritis

Answer 29

Triple therapy against H. pylori (PPI, clarythromycin, amoxicillin)

Question 30

Chronic autoimmune gastritis pathogenesis

Answer 30

Autoimmune destruction of parietal and chief cells

Question 31

Chronic autoimmune gastritis usually affects

Answer 31

fundus/body

Question 32

Clinical presentation of chronic autoimmune gastritis

Answer 32

Symptoms of anemia (pallor, fatigue, dyspnea) Symptoms of VB12 deficiency (numbness, weakness, paresthesias) Weight loss

Question 33

How can we diagnose autoimmune gastritis?

Answer 33

Anti-IF antibodies

Question 34

Complications of autoimmune gastritis

Answer 34

1. Pernicious anemia 2. Other autoimmune diseases 3. Achlorhydria 4. Increased risk of carcinoid tumours & gastric adenocarcinoma

Question 35

Treatment for autoimmune gastritis

Answer 35

Monthly VB12 injections