Gastroduodenal disorders Flashcards
List the five basic functions of the stomach
- storage
- mixing and mechanical breakdown
- proteolytic digestion
- absorp water, salts, alcohol, some drugs
- secretion of digestive hormones.
Which portions of the stomach perform exocrine functions?
Body and fundus
Which portions of the stomach largely function as adaptive storage regions?
Body and fundus
Which regions of the stomach perform endocrine functions?
Antrum (and pylorus)
Which regions of the stomach function in propulsion?
Antrum (and pylorus)
Describe normal gastric motility
controlled by the gastric pacemaker, and modified by the vagus nerve, and the rest of the enteric nervous system
What are the consequences of diabetic gastroparesis?
delayed gastric emptying, early satiety, post-prandial abdominal pain, nausea and vomiting
List the cell types in the stomach that have exocrine roles and their functions
- Mucus cells line the superior surface of the gland and produce mucus and bicarbonate.
- Parietal cells secrete HCl and intrinsic factor.
- Chief cells produce pepsinogen, primarily in the fundus.
- Enterochromaffin–like cells secrete histamine; primarily in the body.
List the cell types in the stomach that have endocrine roles and their products
- G cells: produce gastrin which stimulates gastric acid production/ release
- D cells: produce somatostati which inhibits acid production/ release
List the phases of gastric acid secretion
- basal rate of gastric acid secretion, diurnal, greatest in the evening and least in the early morning.
- cephalic phase, eating or thinking about food, stimulates gastric acid production via the vagus nerve.
- gastric phase, acid production is stimulated (via gastrin) by antral distention and presence of protein.
- intestinal phase modulates acid secretion via endocrine pathways as food is digested and absorbed in the intestine
________ is the final common pathway to gastric mucosal injury
Prostaglandin deficiency
_______ are the most potent acid suppressing medications available
PPIs
What conditions are PPIs used to treat?
Peptic ulcer disease, GERD, H pylori eradication
List examples of PPIs
Omeprazole, pantoprazole, lansoprazole, esomeprazole, rabeprazole, dexlansoprazole
Why are H2 antagonists less potent at suppressing acid than PPIs?
Suppress histamine, just one of the pathways to increase acid secretion
What conditions can H2 antagonists be used to treat?
Peptic ulcer disease, GERD
List the alarm symptoms seen with dyspepsia in peptic ulcer disease. What must be done when alarm symptoms are present?
Bleeding Anemia Age>50 Early satiety Unexplained weight loss Dysphagia or Odynophagia Recurrent vomiting Family hx of GI cancer
Requires urgent endoscopy
Describe how NSAIDs, hypersecretory states, and H pylori contribute to peptic ulceration
- NSAIDs decrease mucosal defenses, causes mainly gastric ulcers
- Hypersecretory states increase acid and pepsin, causes mainly duodenal ulcers
- H pylori does both
List complications of ulcer disease
- bleeding (10-20%)
- gastric outlet obstruction (2%)
- perforation (2%)
Duodenal ulcers are almost always in the _____, almost always benign, and often overly the _________ artery
bulb
gastroduodenal artery
Ulcers in the 2nd or 3rd duodenum are suspicious for hypersecretory states such as hypergastrinemia due to __________
Zollinger-Ellision Syndrome
A gastrinoma produces unregulated acid production
Gastric ulcers have ______ potential and should be examined with repeat endoscopy after a regimen of acid suppression
Malignant
May biopsy at follow up endoscopy if no active bleed
What might explain the decrease in hospitalizations and surgeries related to peptic ulcer disease?
More effective acid suppression- PPIs
Recognition and treatment of H pylori
List aggressive factors contributing to ulcer production
H. pylori NSAIDs inhibit PGE production, local irritant Acid Pepsin Bile acids Pancreatic enzymes Tobacco, caffeine, alcohol Heredity Delayed emptying Stress, steroids
List factors that are protective against ulcer formation
Mucus
Bicarbonate
Mucosal blood flow
Prostaglandins
________ is a preferred method of peptic ulcer disease diagnosis, because biopsies can be performed at the same time
Upper endoscopy (as compared to upper GI X ray)
List complications of H pylori infection
Chronic active gastritis
Duodenal OR gastric ulcers
Gastric adenocarcinoma
MALToma
The local host response to H pylori infection is ____ biased, which usually occurs in response to intracellular pathogens
Th1- paradoxical because H pylori is not intracellular
H pylori causes _______ of epithelial cells and increases ______ release
apoptosis
gastrin
Increased ______ in response to H pylori infection activates neutrophils
IL-8
List methods that can be used to diagnose H pylori
Biopsy by upper endoscopy for histopathology/ microscopic examination or urease testing
Urea breath test
Stool antigen
Serology
List situations in which it is appropriate to test for H pylori
Dyspepsia without “alarm” signs
Peptic ulcer disease
Gastric cancer
Gastric lymphoma
The urea breath test and H pylori stool antigen test sensitivity is reduced by:
PPIs, antibiotics, bismuth
Patients must be off for two weeks before test of cure by these methods
Describe therapy of ulcer disease
6-8 weeks of PPI (or H2 blocker)
Discontinue aspirin and NSAIDs
Describe treatment of H pylori infection
First line:
PPI for 8 weeks + clarithromycin and amoxicillin (or metronidazole) for 10-14 days
Alternate:
PPI, bisuth, metronidazole, tetracycline
_______for treatment and diagnosis of bleeding has greatly reduced number of PUD patients needing surgery
Endoscopy
What are indications for ulcer surgery?
Refractory outlet obstruction Unresponsive GI bleeding Perforation Malignancy Recurrent ulcers
