Gastro 4 - Upper GI Path Flashcards
What are the causes of acute gastritis?
NSAIDs and aspirin. Alcohol. Burns (Curling ulcer). Brain injury (Cushing ulcer).
What can chronic gastritis due to H.pylori cause in the long run?
MALT-lymphoma. Gastric cancer.
Stomach biopsy reveals neutrophils above the basement membrane, loss of surface epithelium, and fibrin-containing purulent exudate. What upper GI problem is this?
Acute gastritis.
Stomach biopsy reveals lymphoid aggregates in the lamina propria, columnar absorptive cells, and atrophy of glandular structures. What upper GI problem is this?
Chronic gastritis.
Diffuse thickening of gastric folds, elevated serum gastrin levels, biopsy reveals glandular hyperplasia w/o foveolar hyperplasia. What upper GI problem is this?
Zollinger-Ellison syndrome.
What is a peptic ulcer?
Gastric acid erodes thru mucosa into submucosal tissue.
What are the symptoms of a gastric ulcer?
Upper abdominal and epigastric pain after eating. Weight loss. 70% associated w/ H.pylori infection. Increased risk of gastric cancer.
What are the symptoms of duodenal ulcer?
Pain relieved by eating. Pain returns several hours after eating. Weight gain. 90% due to H.pylori. Ulcers have clean, smooth borders. May have hypertrophy of Brunner glands. May rarely caused by Zollinger-Ellison syndrome.
What are the complication of gastric ulcer?
Pain. Weight loss or gain. Hemorrhage (somatostatin, octreotide; decreases splachnic blood flow). Can perforate (especially duodenal ulcers), causing peritonitis.
What is the treatment of ulcers itself?
Triple therapy: PPI + clarithromycin + amoxicillin (or metronidazole). If resistant to clarithromycin, use Quadruple therapy: PPI + bismuth + metronidazole + tetracycline.
Calcium carbonate is an OTC antiacid. Why is it bad to use it chronically?
It can cause hypercalcemia, stimulating G cells to produce gastrin, leading to rebound excessive acid.
What can Magnesium hydroxide cause in chronic use?
Diarrhea, leading to hypokalemia. It is a smooth muscle relaxer.
What are the symptoms of chronic use of aluminum hydroxide?
Constipation. Hypophosphatemia. Proximal muscle weakness. Seizures. Osteodystrophy.
What are four H2 blockers?
Cimetidine. Famotidine. Nizatidine. Ranitidine. They all end in -dine, as in lets dine together.
What is the mechanism of H2 blockers?
Directly inhibit H2 histamine receptors on parietal cells.
What are the cumbersome side effects of Cimetidine?
Inhibits cytochrome P450. Anti-androgen effects: impotence, decreased libido, gynecomastia. Decreases methemogloblin levels. Thrombocytopenia.
What are three Proton pump inhibitors (PPIs)?
Omeprazole. Esomeprazole. Pantoprazole. All end in -prazole.
What is the mechanism of action of proton pump inhibitors (PPIs)?
Inhibit the H+/K+ ATPase.
When do we use Proton Pump inhibitors (PPIs)?
Severe GERD. Zollinger-Ellison syndrome. Erosive esophagitis. Peptic ulcers. Gastritis. H.pylori infection.
Why is bismuth useful in GERD?
Binds to tissue at base of ulcer and forms protective barrier.
Why is Misoprostol useful in GERD? Why is it deadly in pregnancy?
“Prost”: A prostaglandin analog. Aids in generation of gastric mucus barrier by trapping bicarb and protecting the mucus barrier. Side effect in pregnancy: It increases Utetine tone, causing an abortion. Can cause diarrhea.
What is Menetrier Disease?
A precursor to gastric cancer (Adenocarcinoma), causes hypertrophy of the mucus producing cells. Atrophy of parietal cells. Decreased in acid production. Causes enteric protein loss, causing hypoalbuminemia, causing edema.
What is the most common type of cancer of the GI track?
Adenocarcinoma. Except in the esophagus.
What are the risk factors of gastric cancer?
H.pylori. Chronic gastritis. Nitrosamines. Men over 50. Japanese people in Japan.
