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GASTRITIS Flashcards

1
Q

what is the stomach?

A

J shaped muscle organ located in the left upper abdominal cavity inferior to the diaphragm

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2
Q

what is the pathophys of what the stomach does?

A

contributes to mechanical and chemical digestion of food from the esophagus before releasing it, as CHYME, to the small intestine

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3
Q

what is the greater curvature of the stomach?

A

convex lateral surface of stomach

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4
Q

what is the lesser curvature of the stomach?

A

concave medial surface of the stomach

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5
Q

what is the stomach held in place by?

A

greater omentum
lesser omentum

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6
Q

where is the greater omentum?

A

runs from the greater curvature to the posterior abdominal wall

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7
Q

where is the lesser omentum?

A

extends from liver to lesser curvature

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8
Q

what are the 4 regions of the stomach?

A
  1. cardia
  2. fundus
  3. body
  4. pylorus
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9
Q

what is the cardia of the stomach?

A

region where food passes from the esophagus and into the stomach

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10
Q

what is the fundus of the stomach?

A

dome-shaped region located above and to the left of the cardia
stores undigested food and gases

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11
Q

what is the body of the stomach?

A

largest region of the stomach

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12
Q

what is the pylorus of the stomach?

A

funnel shaped region that connects to the duodenum

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13
Q

what is the pyloric antrum ?

A

wider end of pylorus

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14
Q

what is the pyloric canal?

A

narrow end of pylorus

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15
Q

what is the pyloric sphincter?

A

smooth muscle that controls gastric emptying

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16
Q

what are the 3 physiology aspects about the mucosa of the stomach

A
  1. forms large folds when stomach is empty known as rugae
  2. contains a protective alkaline mucus
  3. gastric pits are depressions that mark entry to gastric glands
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17
Q

what is the in the submucosa of the stomach?

A

contains blood vessels, lymphatic vessels and nerves

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18
Q

what is the muscularis externa responsible for?

A

responsible for mechanically breaking down food into smaller particles

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19
Q

what are the layers of the muscularis externa?

A

inner oblique layer
middle circular layer
outer longitudinal layer

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20
Q

what do chief cells do?

A

secrete pepsinogen, the inactive proenzyme of pepsin

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21
Q

what 2 things to the parietal cells produce?

A
  1. HCl
  2. intrinsic factor
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22
Q

what is entailed in the HCl production of parietal cells?

A

-high acidity (pH 1.5-3.5) of stomach
> kill ingested bacteria
> denatures proteins
- activates digestive enzyme, pepsin

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23
Q

what is intrinsic factor? (produced by parietal cells)

A

glycoprotein necessary for the absorption of vitamin B12 in the small intestine

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24
Q

-WHY IS B12 VITAL TO SURVIVE?

A

its a cofactor in heme production -> Hgb

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25
what do mucous neck cells secrete?
alkaline mucus
26
what are the 2 types of enteroendocrine cells?
D cells and G cells
27
what do D cells secrete?
somatostatin - inhibitory
28
what do G cells secrete?
they secrete gastrin that then stimulates parietal cells
29
what do gastric enzymes have the potential to do?
digest themselves
30
what are the 3 things that protect the stomach from self-digestion?
1. mucosal barrier 2. tight junctions 3. stem cells
31
what is the mucosal barrier?
thick coating of bicarbonate-rich mucus that acts as a physical barrier. the bicarb ions neutralize the acid.
32
what are tight junctions?
they block gastric juice from penetrating underlying tissues
33
where are stem cells located?
they are located at the junction of gactric pits and gastric glands
34
what do stem cells do?
they replace damaged epithelial mucosal cells
35
when it eh surface epithelium of the stomach replaced?
it is completely replaced every 3-6 days
36
what is gastritis?
a general term for a group of conditions in which there is histologic evidence of inflammation, irritation, or erosion of the lining of the stomach
37
what is acute gastritis called?
neutrophilic infiltration
38
what is chronic gastritis called?
lymphocyte and plasma cell infiltration
39
what are the 2 types of gastritis?
1.erosive 2. nonerosive
40
what is erosive gastritis?
- gastric mucosal erosion caused by damage to the mucosal defenses - superficial erosions and punctate mucosal lesions
41
where does erosive gastritis occur?
typically occurs in the body of the stomach
42
what are the common causes of erosive gastritis?
1. NSAIDS, ASA, BISPHOSPHONATES 2. ALCOHOL 3. PHYSIOLOGICAL STRESS - severe medical or surgical illness >5% of critically ill patients >incidence increases with duration of intensive care unit stay and length of time the patient is not receiving enteral feeding
43
what are the s/sx of MILD erosive gastritis?
asx
44
what are the s/sx of MOD/SEVERE erosive gastritis?
-develop within 2-5 days of inciting event 1. dyspepsia (indigestion) 2. N and/or V 3. epigastric pain 4. GI bleeding - mild-mod - hematemesis, "coffee grounds" emesis, and/or melena
45
what is the dx study of choice for erosive gastritis?
ENDOSCOPY -most sensitive method for dx
46
when is endoscopy performed?
within 24 hrs of UPPER GI bleedwh
47
what is the tx of erosive gastritis?
1. REMOVAL OF OFFENDING AGENT IF POSSIBLE 2. endoscopic hemostasis (cautery, sclerotherapy) if bleeding 3. acid suppression w/ H2 blocker or PPI for 4-8 week trial (H2 mild, PPI severe)
48
what are the 3 types of non-erosive gastritis?
1. H. Pylori 2. pernicious anemia gastritis 3. gastric metaplasia A= AUTOIMMUNE- PERNICIOUS B= BACTERIA- H. PYLORI C= CANCER- METAPLASIA
49
What is the most common type of non-erosive gastritis?
h. pylori
50
what is H. pylori?
spiral gram-neg bacterium that resides beneath gastric mucosa layer causing mucosal inflammation with PMNs (neutrophils) and lymphocytes
51
what are the mechanisms of H. Pylori that allows it to survive the acidic environment of the stomach?
1. it gives off ammonia that erodes the mucus barrier 2. cytotoxins and mucolytic enzymes cause mucosal damage and lead to ulcerogenesis
52
what does h. pylori commonly cause?
gastritis PUD gastric adenocarcinoma low-grade B-Cell gastric lymphoma
53
what is the epidemiology of h. pylori infection?
increases with age 50% over age 60 infected
54
what is the transmission of h. pylori?
oral-oral or fecal-oral route
55
what ethnicity is h. pylori more common in?
blacks, hispanics, and asians
56
what is h. pylori also known as?
type b gastritis
57
what are the s/sx of acute H. pylori gastritis infxn?
-transient illness for several days -nausea -abdominal pain -epigastric
58
what are the s/sx of chronic H. pylori gastritis infxn?
most patients are asx (80%) -dyspepsia > early satiety > postprandial fullness > gnawing or burning upper abdominal discomfort
59
what are the types of chronic H. pylori gastritis?
1. mild diffuse gastritis 2. antral- predominant gastritis 3. body- predominant gastritis
60
what is the pathophys of antral- predominant gastritis?
1. increased gastrin production > gastrin: stimulated secretion of gastric acid (HCl) by the parietal cells 2. resultant hypersecretion fo acid predisposes the patient to developing PEPTIC ULCERS and GASTRIC ADENOCARCINOMA
61
what is the pathophys of body- predominant gastritis?
destruction of acid-secreting glands resulting in gastric atrophy and decreased acid production - predisposes patients to NEUROENDOCRINE TUMORS
62
what is the dx screening of choice for asx patients of h. pylori gastritis?
not indicated
63
what is the initial dx studies for h. pylori gastritis?
1. stool (fecal) antigen immunoassay (similar sensitivity and specificity to that of urea breath test) 2. urea breath test
64
what is entailed in the urea breath test for h. pylori gastritis?
- oral dose o 13c or 14c- labeled urea (capsule) - infected patient --H. Pylori will metabolize the urea and liberate labeled CO2 which is exhaled and quantified in breath samples taken 20-30 min after ingestion of the urea
65
what should patients do prior to urea breath test?
PPI's should be d/c for 14 days and abx should be d/c for 28 days
66
what dx study is performed in patients with sx that suggest upper GI disease related to h. pylori gastritis?
endoscopy
67
what should be done during endoscopy for h. pylori gastritis?
gastric mucosal biopsy for histology and rapid urease test (RUT)
68
is endoscopy recommended solely for dx of H. pylori?
no
69
why should all H. pylori positive patients be treated?
d/t the chance it turns into gastric cancer BAD
70
what are the 2 tx options for h. pylori gastritis?
1. triple therapy 2. quadruple therapy
71
what is the most frequent prescribed regimen for h. pylori gastritis?
triple therapy
72
what is the best initial h. pylori gastritis therapy in areas where the clarithromycin resistance rate is >15% ?
quadruple therapy
73
how long is the triple therapy tx duration? (for h. pylori infxn)
10-14 days
74
how long is the quadruple therapy tx duration? (for h. pylori infxn)
14 days
75
what is entailed in triple therapy for tx of h. pylori?
1. PPI X2 DAILY PO -> OMEPRAZOLE 2. AMOXICILLIN 1 G PO X2 DAILY ORRR METRONIDAZOLE 500 MG PO X3 DAILY 3. CLARITHROMYCIN 500 MG PO X2 DAILY
76
what is entailed in quadruple therapy for tx of h. pylori?
1. PPI X2 DAILY PO -> OMEPRAZOLE 2. BISMUTH SUBSALICYLATE 300 MG PO X4 TIMES DAILY 3. METRONIDAZOLE 250-500 MG PO X4 TIMES DAILY 4. TETRACYCLINE 500 MG PO X4 TIMES DAILY
77
in addition to triple or quadruple therapy for h. pylori infxn, what should a patient who has duodenal or gastric ulcers do?
they must continue their acid suppression therapy for at least 4 weeks
78
how can eradication of h. pylori be confirmed?
with a urea breath test, stool antigen test, or endoscopy > or equal to 4 weeks after completion of therapy
79
what is pernicious anemia gastritis also known as? (what type)
type A gastritis
80
what 2 antibodies are involved in pernicious anemia gastritis?
parietal cells antibodies (PCA) and intrinsic factor antibodies (IFA)
81
what is arguably the biggest thing that occurs in pernicious anemia gastritis?
achlorhydria - impaired iron absorption - hyperplasia of G-cells -> increase in GASTRIN secretion
82
what is the pathophys of pernicious anemia gastritis?
1. achlorhydria 2. vita b12 malabsorption 3. destruction of chief cells leading to decrease in pepsinogen
83
where is pernicious anemia gastritis located?
typically restricted to the fundus and body of the stomach
84
what is involved in the dx of pernicious anemia gastritis?
1. measuring anti-parietal cell and anti-intrinsic factor antibodies 2. serum gastrin 3. serum pepsinogen 4. endoscopic biopsy
85
what is gastric metaplasia?
- pre-cancerous changes characterized by histologic change from a normal gastric cardia, fundic, and antral mucosa to epithelium that resembles the small intestine
86
why does gastric metaplasia occur?
d/t chronic irritation and inflammation of stomach lining caused by various factors such as gastric acid, bile salts, H. Pylori infxn, smoking, alcohol, and environmental contaminants
87
what can gastric metaplasia lead to?
an increased risk of dysplasia leads to stomach cancer
88
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