Gastric Disorders B&B

Question 1

state 4 common causes of acute gastritis

Answer 1

1. NSAIDs: block prostaglandin production (inhibits H+ secretion)
2. alcohol: direct mucosal damage
3. chemotherapy: inhibits epithelial cell replication
4. H. pylori

Question 2

which patients get Curling’s Ulcers?

Answer 2

burn patients

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

give PPP

Question 3

what is the cause of Cushing’s Ulcer?

Answer 3

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

Question 4

what is the mechanism of stress ulcers?

Answer 4

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

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

Question 5

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

Answer 5

1. pantoprazole
2. omeprazole

and others, obvs

Question 6

Type A vs Type B chronic gastritis

Answer 6

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

Question 7

describe the pathology of autoimmune gastritis

Answer 7

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

Question 8

intrinsic factor is needed for B12 absorption in the ______

Answer 8

terminal ilium

Question 9

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

Answer 9

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

Question 10

with which HLA genes is autoimmune gastritis associated?

Answer 10

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

Question 11

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

Answer 11

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

Question 12

which 2 malignancies are associated with H. pylori?

Answer 12

1. gastric adenocarcinoma
2. MALT lymphoma (B-cell)

Question 13

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

Answer 13

patients swallow radio-labeled urea

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

Question 14

what is the triple therapy for H. pylori infection?

Answer 14

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

testing often repeated to confirm eradication

Question 15

Zollinger-Ellison Syndrome

Answer 15

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

Question 16

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

Answer 16

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

Question 17

what would cause hypertrophy of Brunner’s Glands?

Answer 17

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

hypertrophy occurs in peptic ulcer disease

Question 18

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

Answer 18

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

Question 19

upper GI bleeding is that which occurs above…

Answer 19

… 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

Question 20

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

Answer 20

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)

Question 21

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

Answer 21

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

Question 22

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

Answer 22

usually occur in lesser curvature

pain is worse with meals due to stimulated acid release

Question 23

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

Answer 23

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

Question 24

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

Answer 24

gross: large ulcer with irregular margins

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

Question 25

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

Answer 25

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

Question 26

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

Answer 26

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)

Question 27

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

Answer 27

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

Question 28

isolated Virchow’s node should raise suspicion for…

Answer 28

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

isolated enlargement raises suspicion for gastric adenocarcinoma

Question 29

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

Answer 29

Virchow’s node: left supraclavicular node, drains stomach

Question 30

what is a Sister Mary Joseph nodule?

Answer 30

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

Question 31

Krukenberg tumor

Answer 31

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)

Question 32

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?

Answer 32

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)

Question 33

what is the cause of Menetrier’s Disease?

Answer 33

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

Question 34

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

Answer 34

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