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Julie W: Module 9 - GI > GI Conditions: D/O of Stomach - Porth, Chpt. 29 > Flashcards

GI Conditions: D/O of Stomach - Porth, Chpt. 29 Flashcards

1
Q

Disorders of the Stomach

Include

A
  • Gastritis
  • Peptic Ulcer
  • Gastric Carcinoma
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2
Q

Gastric Mucosal Barrier

A
  • Stomach lining, usually impermeable to its acid

What protects it?

  • Impermeable epithelial cell surface
  • coupled secretion of H+ and HCO3-
  • Gastric Mucus
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3
Q

Gastric Mucosal Barrier

How Aspirin jeporadizes this barrier

A
  • Rapid diffusion across lipid layer of barrier
    • Increases Mucosal Permability
    • Damages Epithelial Cells

Gastric Irritation & Occult Bleeding results.

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4
Q

Gastric Mucosal Barrier

When Aspirin & _______ are taken together, there is increased risk of gastric irritation.

A

Alcohol

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5
Q

Gastric Mucosal Barrier

Whenfrom the Duodenum are Refluxed into the stomach, gastric irritation can also occur.

A

Bile Acids

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6
Q

Gastric Mucosal Barrier

For every H+ secreted by the stomach, a _________ should also be secreted…. Otherwise, mucosal injury can occur.

A

HCO3-

Hydrogen & Bicarbonate secretion should be “in sync”

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7
Q

Gastric Mucosal Barrier

How do Prostaglandins protect the gastric mucosa?

A
  • Improve mucosal blood flow
  • Decrease acid secretion
  • Increase bicarb secretion
  • Enhance mucus production

NSAIDs inhibit PG synthesis =’s may contribute to gastric irritation

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8
Q

Gastritis

A
  • Inflammation of the Gastric Mucosa
    • Acute
    • Chronic
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9
Q

Gastritis

Acute Gastritis

A
  • Acute mucosal inflammatory process
    • may include some hemorrhaging
  • Assc. w/:
    • NSAIDs
    • ETOH
    • Bacterial Toxins
  • Self-limiting!
    • Regeneration & Healing w/in days
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10
Q

Gastritis

Acute Gastritis

& Stress

A

“Stress Ulcers”

  • Due to Serious illness or Trauma accompanied by profound physiologic stress
    • Vulnerable gastric mucosa
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11
Q

Gastritis

Acute Gastritis

Presentation/Complaints

A
  • Vary
  • Asymptomatch
  • Heartburn/Sour Stomach
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12
Q

Gastritis

Acute Gastritis

W/ Excessive Alcohol Consumption

A
  • W/ Excessive Alcohol:
    • Gastric Distress
      • Vomiting
      • possibly Bleeding & Hematemesis
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13
Q

Gastritis

Acute Gastritis

Infectious Organism Toxins

A
  • Abrupt & Violent onset
    • Gastric Distress
    • Vomiting
      • ~5 hours post-eating bad food!
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14
Q

Gastritis

Chronic Gastritis

A Separate Entity

A
  • Absence of grossly visible erosions
  • Presence of Chronic Inflammatory Changes
  • Leads to: Atrophy of Glandular Epithelium of Stomach
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15
Q

Gastritis

Chronic Gastritis

3 MAJOR Types

A
  • H. pylori
  • Autoimmune
  • Chemical gastropathy
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16
Q

Gastritis

Chronic Gastritis

H. pylori Gastritis

A
  • Antrum & Body of stomach
  • MCC of Chronic Gastritis in US & infects >1/2 world’s population!

Gram Negative buggers that colonize mucus-secreting cells of stomach

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17
Q

Gastritis

Chronic Gastritis

H. pylori Gastritis

Characteristics

A
  • Transmission: Unsure
    • Oral-Oral? Fecal-Oral?
  • Secrete Urease
    • =’s produces ammonia to buffer acidity of immediate environment
  • Has enzymes & toxins that interfere w/ mucosa protection & constant inflammatory response!
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18
Q

Gastritis

Chronic Gastritis

H. pylori Gastritis

Inflammatory Response

A
  • Results in varying degrees of Atrophy & Metaplasia
    • Gastric Epithelium turns into Intestinal-type Epithelium
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19
Q

Gastritis

Chronic Gastritis

H. pylori Gastritis

Cinical Course

A
  • Can be Acute
    • Couple days of discomfort + then, Asymptomatic Infxn
  • Can be Chronic
    • Gastric Atrophy
    • Peptic Ulcer
      • Accs. w/ Gastric Adenocarcinoma
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20
Q

Gastritis

Chronic Gastritis

H. pylori Gastritis

Detection!

A
  • Carbon (C) urea breath test
  • Stool Antigen Test
  • Endoscopic Biopsy
    • all detect Urease
  • Serology for antibodies
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21
Q

Gastritis

Chronic Gastritis

H. pylori Gastritis

Treatment

A
  • Goal: ELIMINATE ORGANISM!!!
  • Combo therapy:
    • 3 to 4-drug regimens
    • 10-14 days

Abx: Clarithromycin, Metronidazole, Amoxicillin, Tetracycline

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22
Q

Gastritis

Chronic Gastritis

Chronic Autoimmune Gastritis

A
  • <10% of cases
  • Assc. w/ other D/Os: DM, Addison’s…

Characterized by:

  • Autoantibodies to gastric parietal cells & intrinsic factor
  • Defective gastric acid secretion
  • & B12 deficiency

Spares the antrum (vs. H. pylori)

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23
Q

Gastritis

Chronic Gastritis

Chronic Autoimmune Gastritis

Complications

A
  • Atrophy of fundic pyloric & chief cells
    • Development of gastric adenocarcinoma
  • Absence of acid production =’s gastrin release
    • Hyperplasia of cells & hypergastrinemia
      • May lead to tumor formation
  • Lack of intrinsic factor
    • B12 deficiency –> Megoblastic anemia
24
Q

Gastritis

Chronic Gastritis

Chronic Autoimmune Gastritis

Note-worthy for:

A
  • Slow onset & variable progression
    • Several decades to atrophy
    • May have for several years before even being diagnosed
25
**Gastritis** Chronic Gastritis *Chronic Autoimmune Gastritis* Clinical Presentation
* Related to Anemia *
  • Malabsorptive Diarrhea
  • Neuropathies
    • Parasthesias & Numbness
  • Cerebral Manifestations
    • Personality change, memory loss
    •
    26
    **Gastritis** Chronic Gastritis *Chemical Gastropathy*
    * Effects of chronic gastric injury * Result of reflux of * alkaline duodenal contents * pancreatic secretions * bile * Cause - Surgeries * Gastroduodenostomy * Gastrojejunostomy
    27
    **Peptic Ulcer Disease**
    Ulcerative D/Os in upper GI tract that are exposed to acid-pepsin secretions Most common forms: Gastric & Duodenal
    28
    **Peptic Ulcer Disease** *A Chronic Health Problem!*
    * ~10% of population Have or Will Have one!
    29
    **Peptic Ulcer Disease** *Quick Details*
    * Can affect all or 1 layer of stomach * May extend into smooth muscle layers * May penetrate outer wall * Damaged muscle layers are replaced by scar tissue
    30
    **Peptic Ulcer Disease** *2 Most Important Risk Factors*
    * *H. pylori* * Aspirin & other NSAIDs * Aspirin = most ulcerogenic
    31
    **Peptic Ulcer Disease** *NSAID-Induced Gastric Injury*
    * Often asymptomatic! * can lead to life-threatening conditions
    32
    **Peptic Ulcer Disease** *COX-2-selective NSAIDs*
    * Less gastric irritation assc. w/ these
    33
    **Peptic Ulcer Disease** *Independent Factors that augment effects*
    * Advancing age * Prior peptic ulcer * multiple NSAID use * concurrent use of * Warfarin * Corticosteroids * Smoking - Impairs healing
    34
    **Peptic Ulcer Disease** *Clinical Manifestations*
    * **Discomfort** * **Pain** * **​**Burning * Gnawing * Cramp-like * Most often when _Stomach is EMPTY!_ Pain is relieved by food or antacids.
    35
    **Peptic Ulcer Disease** *Clinical Manifestations* Additional Characteristic of Ulcer Pain
    * **Periodicity** * **​**Recurs @ intervals of weeks to months
    36
    **Peptic Ulcer Disease** *Complications*
    * Hemorrhage * Perforation * Penetration * Gastric Outlet Obstruction
    37
    **Peptic Ulcer Disease** *Complications* Hemorrhage, pt. 1
    * ~20% of persons w/ peptic ulcer * Hematemesis or Melena * May be sudden or insidious * Same may have no symptoms of Pain assc. * esp if NSAID-induced
    38
    **Peptic Ulcer Disease** *Complications* Hemorrhage, pt. 2
    **Acute:** * Weakness * Dizziness * Thirst * Cold * Passage of Loose, Tarry or even red stool * Coffee-ground emesis *Look out for signs of shock!*
    39
    **Peptic Ulcer Disease** *Complications* Perforation
    * Ulcer erodes all the way through the wall * 5% of persons * Usually Anterior Wall... * GI Contents enter peritoneum & cause * **Peritonitis!**
    40
    **Peptic Ulcer Disease** *Complications* Perforation Signs & Symptoms
    * Radiation of pain to Back * Night distress * Inadequate pain relief from eating/antacids
    41
    **Peptic Ulcer Disease** *Complications* Penetration
    * Similar to Perforation * But * Ulcer crater erodes into Adjacent Organs! * Subtle presentation: * Gradual increase in severity & frequency of pain
    42
    **Peptic Ulcer Disease** *Complications* Penetration
    * Similar to Perforation * But * Ulcer crater erodes into Adjacent Organs! * Subtle presentation: * Gradual increase in severity & frequency of pain
    43
    **Peptic Ulcer Disease** *Complications* Outlet Obstruction
    * Caused by: * Edema * Spasm * Contraction of Scar Tissue * & Interference w/ free passage of gastric contents through pylorus/adjacent areas * Insidious presentation * Early satiety * Feeling of fullness/heaviness post-meals * GERD * Weight loss, pain * Severe = vomiting of undigested food
    44
    **Peptic Ulcer Disease** *Diagnosis*
    * Hx taking * Aspirin? NSAIDs? * Labs * Anemia? * Radiology * XR w/ Barium - detects ulcer crater * Endoscopy * Visualize area & Biopsy! * Is *H. pylori* present?
    45
    **Peptic Ulcer Disease** *Treatment*
    * Goal: ERADICATE THE CAUSE & permanent cure * Avoid triggers/irritants * Neutralize & Inhibit Gastric Acid * Promote Mucosal Protection * *Surgery when needed*
    46
    **Peptic Ulcer Disease** *Treatment*
    * Goal: ERADICATE THE CAUSE & permanent cure * Avoid triggers/irritants * Neutralize & Inhibit Gastric Acid * Promote Mucosal Protection * *Surgery when needed*
    47
    **Peptic Ulcer Disease** Zollinger-Ellison Syndrome
    * Rare condition * Caused by: _Gastrinomas_ * found in small intestine & pancreas * SO MUCH Gastrin Secretion due to these tumors that _Ulcers form_ * **\>2/3 are malignant!** * Symptoms = like peptic ulcer * 25% are due to Multiple Endocrine Neoplasia Type 1
    48
    **Peptic Ulcer Disease** Zollinger-Ellison Syndrome *Diagnosis*
    * Elevated Serum Gastrin & Basal Gastric Acid Levels * CT * Abd US * Selective angiography * Localize & stage
    49
    **Peptic Ulcer Disease** Zollinger-Ellison Syndrome *Treatment*
    * Control Gastric Acid secretion by PPIs * Malignant + Not Metastasized? Surgery!
    50
    **Peptic Ulcer Disease** Stress Ulcers *aka "Curling ulcers"*
    * Develop due to Physiologic Stress * Large burns, trauma, sepsis, ARDS, Liver failure... * Result from: * Ischemia * Tissue Acidosis * Bile Salts * *esp if decreased GI tract motility* * High risk in ICUs!
    51
    **Peptic Ulcer Disease** Stress Ulcers *Prevention & Treatment*
    * H2 Receptor Antagonists * PPIs
    52
    ## Footnote **Cancer** **of the** **Stomach**
    * Decreasing in Incidence in US * But huge cause of deaths * More common in : * Lower socioeconomic groups * Male-to-Female 2:1
    53
    **Cancer of the Stomach** Risk Factors
    * Genetics * Carcinogenic (in the diet) * Smoked/Preserved foods * Autoimmune Gastritis * Gastric Adenomas or Polyps * Chronic *H. pylori =* co-factor (not commonly)
    54
    **Cancer of the Stomach** Appearance
    * Bulky * Irregular shape * Firm, jagged edges ## Footnote *(versus smooth margins of gastric ulcers)*
    55
    **Cancer of the Stomach** Symptoms
    * Bad: _Asymptomatic_ until late in course * Vague sxs * Indigestion * Anorexia * Weight Loss * Vague epigastric pain * Vomiting * Abdominal Mass
    56
    **Cancer of the Stomach** Diagnosis
    * Barium XR Studies * Endoscopic Studies w/ Bx * Cytologic Studies (pap smear) of gastric secretions * Cytologic tests = useful for routine screening * Endoscopic US + CT = staging/spread
    57
    **Cancer of the Stomach** Treatment
    * Depends on Location & Extent * Surgery: * Radical Subtotal Gastrectomy * Irradiation & Chemo = not very useful; more-so palliative

    Julie W: Module 9 - GI (8 decks)

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