Gastric Disorders B&B Flashcards

1
Q

state 4 common causes of acute gastritis

A
  1. NSAIDs: block prostaglandin production (inhibits H+ secretion)
  2. alcohol: direct mucosal damage
  3. chemotherapy: inhibits epithelial cell replication
  4. H. pylori
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

which patients get Curling’s Ulcers?

A

burn patients

loss of skin = loss of fluids/dehydration —> decreased plasma volume/ hypotension to stomach —> mucosal damage

give PPP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the cause of Cushing’s Ulcer?

A

increased intracranial pressure (tumor, hemorrhage) causes vagal stimulation —> ACh causes excess acid production

high ICP —> high vagal tone —> high ACh —> high H+ secretion

give PPP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the mechanism of stress ulcers?

A

shock/sepsis/trauma causes decreased mucosal perfusion —> loss of protective barrier of mucus/bicarb

common in ICU patients, PPP given prophylactically (pantoprazole, omeprazole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

name 2 proton pump inhibitors often given prophylactically to ICU patients to prevent stress ulcers (due to hypotension)

A
  1. pantoprazole
  2. omeprazole

and others, obvs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Type A vs Type B chronic gastritis

A

Type A = autoimmune (pernicious anemia)
Type B = H. pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

describe the pathology of autoimmune gastritis

A

aka pernicious anemia: autoimmune destruction of gastric parietal cells —> loss of intrinsic factor secretion, needed for B12 absorption in the terminal ileum

inflammation occurs in body and fundus of stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

intrinsic factor is needed for B12 absorption in the ______

A

terminal ilium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

where does inflammation occur in autoimmune gastritis, and with what cancer is this associated?

A

aka pernicious anemia: autoimmune destruction of gastric parietal cells —> loss of intrinsic factor secretion, needed for B12 absorption in the terminal ileum

chronic inflammation occurs in gastric body/ fundus, and associated with gastric adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

with which HLA genes is autoimmune gastritis associated?

A

aka pernicious anemia: autoimmune destruction of gastric parietal cells —> loss of intrinsic factor secretion, needed for B12 absorption in the terminal ileum

associated with HLA-DR antigens and more common in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

where do ulcers caused by H. pylori occur? (specifically)

A

pyloric antrum of stomach - distal end close to duodenum

does not invade mucosa, sits ontop of epithelial cells and secretes urease to survive low pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

which 2 malignancies are associated with H. pylori?

A
  1. gastric adenocarcinoma
  2. MALT lymphoma (B-cell)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how does the urea breath test work for diagnosing H. pylori infection?

A

patients swallow radio-labeled urea

when H. pylori secretes urease, it splits urea to produce isotope-labeled CO2, which is detected in exhaled breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the triple therapy for H. pylori infection?

A
  1. proton pump inhibitor (PPP)
  2. clarithromycin
  3. amoxicillin/ metronidazole

testing often repeated to confirm eradication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Zollinger-Ellison Syndrome

A

rare cause of duodenal ulcers, due to gastrin secreting tumor

cause development of multiple ulcers in duodenum, may also develop ulcers in distal duodenum or jejunum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

when is pain caused by duodenal ulcers worse, and why is this?

A

worst at night because stomach is empty

improve with meals because stimulated bicarb secretion (secretin/VIP in pancreas; Brunner’s glands in duodenum) raises pH

17
Q

what would cause hypertrophy of Brunner’s Glands?

A

Brunner’s glands: found in submucosa of duodenum, secrete alkaline fluid to protect from acidic stomach chyme

hypertrophy occurs in peptic ulcer disease

18
Q

upper GI bleeding is more common with duodenal ulcers that are [anterior/posterior]

A

complications more common with posterior duodenal ulcers because the gastroduodenal artery and pancreas are located at the posterior of the duodenum

—> upper GI bleeding, pancreatitis, perforation

19
Q

upper GI bleeding is that which occurs above…

A

… the ligament of Treitz - attaches broadly to the duodenum, then attaches like an apron to the back of the abdominal wall

suspends the distal duodenum

20
Q

how can stool color be used to distinguish upper vs lower GI bleeding?

A

upper GI bleeding causes dark/“tarry” stools because blood is exposed to acid and bacteria on the way out

lower GI bleeding is bright red (hematochezia)

21
Q

where (anatomically) do gastric ulcers most commonly occur, and which artery can they injure?

A

less common than duodenal ulcers, usually occur in lesser curvature - rupture can cause bleeding from the left gastric artery

pain is worse with meals due to stimulated acid release

22
Q

when is the pain worst with gastric ulcers, and why?

A

usually occur in lesser curvature

pain is worse with meals due to stimulated acid release

23
Q

contrast the 2 types of gastric adenocarcinoma (95% of gastric carcinomas)

A
  1. intestinal: appears as large ulcer with irregular margins (also occurs in lesser curvature), results from intestinal metaplasia, associated with older men, smoking/alcohol, nitrosamines (smoked meats), Type A blood
  2. diffuse: less common, few established risk factors, entire stomach is involved
24
Q

what is the gross and histological appearance of the intestinal type of gastric adenocarcinoma?

A

gross: large ulcer with irregular margins

histological: similar to colonic adenocarcinoma, results from intestinal metaplasia —> goblet cells, common in lesser curvature (where ulcers occur)

25
Q

what are the risk factors for the intestinal type of gastric adenocarcinoma? (4)

A
  1. older men
  2. smoking, alcohol
  3. nitrosamines - found in smoked meats
  4. Type A blood
26
Q

what is the characteristic pathology and biopsy finding of the diffuse type of gastric adenocarcinoma?

A

stomach becomes diffusely thickened - pathology shows linitis plastica (leathery stomach)

biopsy shows Signet ring cells - mucin inside cell pushes nucleus to periphery (like a ring)

27
Q

what are the dermatological findings associated with gastric adenocarcinoma? (2)

A
  1. acanthosis nigricans: hyperpigmented plaques on neck and axilla (folds), also seen with insulin resistance (more common)
  2. Leser-Trelat sign: explosive onset of many itchy seborrheic keratoses
28
Q

isolated Virchow’s node should raise suspicion for…

A

Virchow’s node: enlarged left supraclavicular node, which drains stomach

isolated enlargement raises suspicion for gastric adenocarcinoma

29
Q

which lymph node drains the stomach, and therefore may become enlarged (isolated) in gastric adenocarcinoma?

A

Virchow’s node: left supraclavicular node, drains stomach

30
Q

what is a Sister Mary Joseph nodule?

A

palpable nodule around umbilicus region, occurs when there is metastasis of gastric adenocarcinoma to the peri-umbilical region

31
Q

Krukenberg tumor

A

ovarian tumor secondary to metastasis from gastric adenocarcinoma (usually diffuse type)

causes bilateral ovarian metastasis, pathology will show Signet cells (sign of diffuse gastric adenocarcinoma)

32
Q

A woman has her ovaries removed due to bilateral masses. Biopsy of the mass afterwards shows the presence of mucous-filled cells that resemble a ring. Dx?

A

Krukenberg tumor: ovarian tumor secondary to metastasis from gastric adenocarcinoma (usually diffuse type)

causes bilateral ovarian metastasis, pathology will show Signet cells (sign of diffuse gastric adenocarcinoma)

33
Q

what is the cause of Menetrier’s Disease?

A

hyperplasia of gastric mucous cells —> excessive mucous secretions cause loss of acid (achlorhydria) and protein loss —> hypoalbuminemia (edema, facial swelling)

more common in men, can lead to gastric adenocarcinoma

34
Q

Pt is 28yo M presenting with facial swelling and LE edema. Imaging shows a stomach with enlarged rugal folds. Dx?

A

Menetrier’s Disease: caused by hyperplasia of gastric mucous cells —> excessive mucous secretions cause loss of acid (achlorhydria) and protein loss —> hypoalbuminemia (edema, facial swelling)

more common in men, can lead to gastric adenocarcinoma