Gastroduodenal Disorders Flashcards
Which sections of the stomach are considered “endocrine” and “exocrine” ?
antrum and pylorus: endocrine
body and fundus : exocrine
Review the cells of the exocrine stomach.
parietal cells: gastric acid and intrinsic factor enterochromaffine like cell: histamine chief cells: pepsinogen, gastric lipase D cells: somatostatin (inhibits acid) G cells: gastrin
Describe the stimuli that influence the proton pump and mucus protection of the stomach.
Gastrin from G cells
histamine from ECL
ACh via the vagus nerve
prostaglandins stimulates bicarbonate and mucus production
Define an ulcer
penetration past the mucosa in an erosion of the stomach
Summarize “aggressive factors” in ulcer formation.
H. pylori NSAIDs Acid pepsin bile acids pancreatic enzymes smoking stress, steroids heredity delayed emptying
Name “alarm” symptoms with dyspepsia that require urgent endoscopy.
>50yo bleeding- light headed, melana, vomitting blood anemia early satiety unexplained weight loss dysphagia or odynophagia recurrent vomiting family history of GI cancer recurrent vomiting family history of GI cancer
Discuss ho NSAIDS and H. pylori effect mucus and acid/pepsin secretion.
NSAIDs decrease mucosal defenses
H. pylori decrease in mucus and increase in acid and pepsin
What are the complications of peptic ulcer disease.
bleeding
gastric outlet obstruction
perforation
How are duodenal ulcers different than gastric ulcers
they are more common
“always” non-malignant, gastric require repeat endoscopy
almost always in the bulb (except Zollinger Ellison)
posterior wall ulcers have a higher risk of fatal hemorrhage
Describe the gram stain of Helicobacter pylori
gram negative rod
microaeorphilic, flagellated
urease producing, lives beneath mucus
infects only humans
How is H. pylori transmitted.
by person-person within families early in childhood
overcrowded living situations and poor water sanitation
GI lab workers
What are the ways to dx. H. pylori?
urea breath test (2 weeks off PPI, Abx and Pepto)
stool antigen test
histopathology or urease testing by EGD
serology possible
How do you treat H. pylori?
PPI BID and combination of 2-3 antibiotics
clarithromycin + amoxicillin OR metronidazole 10-14d
(stop NSAIDs)
endoscopic treatment for bleeding (reduces surgery)
When is surgery indicated in tx. for PUD
refractory outlet obstruction unresponsive GI bleeding perforation malignancy recurrent ulcers
antrectomy with vagotomy, tranquil vagotomy with pyloroplasty, highly selective vagotomy
