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GI_EB > Gastroduodenal disorders > Flashcards

Gastroduodenal disorders Flashcards

1
Q

List the five basic functions of the stomach

A
  1. storage
  2. mixing and mechanical breakdown
  3. proteolytic digestion
  4. absorp water, salts, alcohol, some drugs
  5. secretion of digestive hormones.
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2
Q

Which portions of the stomach perform exocrine functions?

A

Body and fundus

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3
Q

Which portions of the stomach largely function as adaptive storage regions?

A

Body and fundus

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4
Q

Which regions of the stomach perform endocrine functions?

A

Antrum (and pylorus)

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5
Q

Which regions of the stomach function in propulsion?

A

Antrum (and pylorus)

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6
Q

Describe normal gastric motility

A

controlled by the gastric pacemaker, and modified by the vagus nerve, and the rest of the enteric nervous system

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7
Q

What are the consequences of diabetic gastroparesis?

A

delayed gastric emptying, early satiety, post-prandial abdominal pain, nausea and vomiting

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8
Q

List the cell types in the stomach that have exocrine roles and their functions

A
  • 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.
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9
Q

List the cell types in the stomach that have endocrine roles and their products

A
  • G cells: produce gastrin which stimulates gastric acid production/ release
  • D cells: produce somatostati which inhibits acid production/ release
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10
Q

List the phases of gastric acid secretion

A
  • 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
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11
Q

________ is the final common pathway to gastric mucosal injury

A

Prostaglandin deficiency

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12
Q

_______ are the most potent acid suppressing medications available

A

PPIs

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13
Q

What conditions are PPIs used to treat?

A

Peptic ulcer disease, GERD, H pylori eradication

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14
Q

List examples of PPIs

A

Omeprazole, pantoprazole, lansoprazole, esomeprazole, rabeprazole, dexlansoprazole

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15
Q

Why are H2 antagonists less potent at suppressing acid than PPIs?

A

Suppress histamine, just one of the pathways to increase acid secretion

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16
Q

What conditions can H2 antagonists be used to treat?

A

Peptic ulcer disease, GERD

17
Q

List the alarm symptoms seen with dyspepsia in peptic ulcer disease. What must be done when alarm symptoms are present?

A 
Bleeding
Anemia
Age>50
Early satiety
Unexplained weight loss
Dysphagia or Odynophagia
Recurrent vomiting
Family hx of GI cancer

Requires urgent endoscopy

18
Q

Describe how NSAIDs, hypersecretory states, and H pylori contribute to peptic ulceration

A
  • NSAIDs decrease mucosal defenses, causes mainly gastric ulcers
  • Hypersecretory states increase acid and pepsin, causes mainly duodenal ulcers
  • H pylori does both
19
Q

List complications of ulcer disease

A
  • bleeding (10-20%)
  • gastric outlet obstruction (2%)
  • perforation (2%)
20
Q

Duodenal ulcers are almost always in the _____, almost always benign, and often overly the _________ artery

A

bulb

gastroduodenal artery

21
Q

Ulcers in the 2nd or 3rd duodenum are suspicious for hypersecretory states such as hypergastrinemia due to __________

A

Zollinger-Ellision Syndrome

A gastrinoma produces unregulated acid production

22
Q

Gastric ulcers have ______ potential and should be examined with repeat endoscopy after a regimen of acid suppression

A

Malignant

May biopsy at follow up endoscopy if no active bleed

23
Q

What might explain the decrease in hospitalizations and surgeries related to peptic ulcer disease?

A

More effective acid suppression- PPIs

Recognition and treatment of H pylori

24
Q

List aggressive factors contributing to ulcer production

A 
H. pylori
NSAIDs inhibit PGE production, local irritant
Acid
Pepsin
Bile acids
Pancreatic enzymes
Tobacco, caffeine, alcohol
Heredity
Delayed emptying
Stress, steroids
25
Q

List factors that are protective against ulcer formation

A

Mucus
Bicarbonate
Mucosal blood flow
Prostaglandins

26
Q

________ is a preferred method of peptic ulcer disease diagnosis, because biopsies can be performed at the same time

A

Upper endoscopy (as compared to upper GI X ray)

27
Q

List complications of H pylori infection

A

Chronic active gastritis
Duodenal OR gastric ulcers
Gastric adenocarcinoma
MALToma

28
Q

The local host response to H pylori infection is ____ biased, which usually occurs in response to intracellular pathogens

A

Th1- paradoxical because H pylori is not intracellular

29
Q

H pylori causes _______ of epithelial cells and increases ______ release

A

apoptosis

gastrin

30
Q

Increased ______ in response to H pylori infection activates neutrophils

A

IL-8

31
Q

List methods that can be used to diagnose H pylori

A

Biopsy by upper endoscopy for histopathology/ microscopic examination or urease testing
Urea breath test
Stool antigen
Serology

32
Q

List situations in which it is appropriate to test for H pylori

A

Dyspepsia without “alarm” signs
Peptic ulcer disease
Gastric cancer
Gastric lymphoma

33
Q

The urea breath test and H pylori stool antigen test sensitivity is reduced by:

A

PPIs, antibiotics, bismuth

Patients must be off for two weeks before test of cure by these methods

34
Q

Describe therapy of ulcer disease

A

6-8 weeks of PPI (or H2 blocker)

Discontinue aspirin and NSAIDs

35
Q

Describe treatment of H pylori infection

A

First line:
PPI for 8 weeks + clarithromycin and amoxicillin (or metronidazole) for 10-14 days

Alternate:
PPI, bisuth, metronidazole, tetracycline

36
Q

_______for treatment and diagnosis of bleeding has greatly reduced number of PUD patients needing surgery

A

Endoscopy

37
Q

What are indications for ulcer surgery?

A 
Refractory outlet obstruction
Unresponsive GI bleeding
Perforation
Malignancy
Recurrent ulcers

GI_EB (39 decks)

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