Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Gastric Mucosal Barrier

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

A

Alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Gastric Mucosal Barrier

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

A

Bile Acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Gastritis

A
  • Inflammation of the Gastric Mucosa
    • Acute
    • Chronic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Gastritis

Acute Gastritis

& Stress

A

“Stress Ulcers”

  • Due to Serious illness or Trauma accompanied by profound physiologic stress
    • Vulnerable gastric mucosa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Gastritis

Acute Gastritis

Presentation/Complaints

A
  • Vary
  • Asymptomatch
  • Heartburn/Sour Stomach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Gastritis

Acute Gastritis

W/ Excessive Alcohol Consumption

A
  • W/ Excessive Alcohol:
    • Gastric Distress
      • Vomiting
      • possibly Bleeding & Hematemesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Gastritis

Acute Gastritis

Infectious Organism Toxins

A
  • Abrupt & Violent onset
    • Gastric Distress
    • Vomiting
      • ~5 hours post-eating bad food!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Gastritis

Chronic Gastritis

3 MAJOR Types

A
  • H. pylori
  • Autoimmune
  • Chemical gastropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Q

Gastritis

Chronic Gastritis

Chronic Autoimmune Gastritis

Clinical Presentation

A
  • Related to Anemia
    • <vit.>
      <li>Malabsorptive Diarrhea</li>
      <li>Neuropathies
      <ul>
      <li>Parasthesias &amp; Numbness</li>
      </ul>
      </li>
      <li>Cerebral Manifestations
      <ul>
      <li>Personality change, memory loss</li>
      </ul>
      </li>
      </vit.>
    </vit.>
26
Q

Gastritis

Chronic Gastritis

Chemical Gastropathy

A
  • Effects of chronic gastric injury
    • Result of reflux of
      • alkaline duodenal contents
      • pancreatic secretions
      • bile
  • Cause - Surgeries
    • Gastroduodenostomy
    • Gastrojejunostomy
27
Q

Peptic Ulcer Disease

A

Ulcerative D/Os in upper GI tract that are exposed to acid-pepsin secretions

Most common forms: Gastric & Duodenal

28
Q

Peptic Ulcer Disease

A Chronic Health Problem!

A
  • ~10% of population Have or Will Have one!
29
Q

Peptic Ulcer Disease

Quick Details

A
  • 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
Q

Peptic Ulcer Disease

2 Most Important Risk Factors

A
  • H. pylori
  • Aspirin & other NSAIDs
    • Aspirin = most ulcerogenic
31
Q

Peptic Ulcer Disease

NSAID-Induced Gastric Injury

A
  • Often asymptomatic!
    • can lead to life-threatening conditions
32
Q

Peptic Ulcer Disease

COX-2-selective NSAIDs

A
  • Less gastric irritation assc. w/ these
33
Q

Peptic Ulcer Disease

Independent Factors that augment effects

A
  • Advancing age
  • Prior peptic ulcer
  • multiple NSAID use
  • concurrent use of
    • Warfarin
    • Corticosteroids
  • Smoking - Impairs healing
34
Q

Peptic Ulcer Disease

Clinical Manifestations

A
  • Discomfort
  • Pain
    • ​Burning
    • Gnawing
    • Cramp-like
      • Most often when Stomach is EMPTY!

Pain is relieved by food or antacids.

35
Q

Peptic Ulcer Disease

Clinical Manifestations

Additional Characteristic of Ulcer Pain

A
  • Periodicity
    • ​Recurs @ intervals of weeks to months
36
Q

Peptic Ulcer Disease

Complications

A
  • Hemorrhage
  • Perforation
  • Penetration
  • Gastric Outlet Obstruction
37
Q

Peptic Ulcer Disease

Complications

Hemorrhage, pt. 1

A
  • ~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
Q

Peptic Ulcer Disease

Complications

Hemorrhage, pt. 2

A

Acute:

  • Weakness
  • Dizziness
  • Thirst
  • Cold
  • Passage of Loose, Tarry or even red stool
  • Coffee-ground emesis

Look out for signs of shock!

39
Q

Peptic Ulcer Disease

Complications

Perforation

A
  • Ulcer erodes all the way through the wall
  • 5% of persons
    • Usually Anterior Wall…
  • GI Contents enter peritoneum & cause
    • Peritonitis!
40
Q

Peptic Ulcer Disease

Complications

Perforation

Signs & Symptoms

A
  • Radiation of pain to Back
  • Night distress
  • Inadequate pain relief from eating/antacids
41
Q

Peptic Ulcer Disease

Complications

Penetration

A
  • Similar to Perforation
    • But
      • Ulcer crater erodes into Adjacent Organs!
  • Subtle presentation:
    • Gradual increase in severity & frequency of pain
42
Q

Peptic Ulcer Disease

Complications

Penetration

A
  • Similar to Perforation
    • But
      • Ulcer crater erodes into Adjacent Organs!
  • Subtle presentation:
    • Gradual increase in severity & frequency of pain
43
Q

Peptic Ulcer Disease

Complications

Outlet Obstruction

A
  • 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
Q

Peptic Ulcer Disease

Diagnosis

A
  • Hx taking
    • Aspirin? NSAIDs?
  • Labs
    • Anemia?
  • Radiology
    • XR w/ Barium - detects ulcer crater
  • Endoscopy
    • Visualize area & Biopsy!
    • Is H. pylori present?
45
Q

Peptic Ulcer Disease

Treatment

A
  • Goal: ERADICATE THE CAUSE & permanent cure
  • Avoid triggers/irritants
  • Neutralize & Inhibit Gastric Acid
  • Promote Mucosal Protection
  • Surgery when needed
46
Q

Peptic Ulcer Disease

Treatment

A
  • Goal: ERADICATE THE CAUSE & permanent cure
  • Avoid triggers/irritants
  • Neutralize & Inhibit Gastric Acid
  • Promote Mucosal Protection
  • Surgery when needed
47
Q

Peptic Ulcer Disease

Zollinger-Ellison Syndrome

A
  • 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
Q

Peptic Ulcer Disease

Zollinger-Ellison Syndrome

Diagnosis

A
  • Elevated Serum Gastrin & Basal Gastric Acid Levels
  • CT
  • Abd US
  • Selective angiography
    • Localize & stage
49
Q

Peptic Ulcer Disease

Zollinger-Ellison Syndrome

Treatment

A
  • Control Gastric Acid secretion by PPIs
  • Malignant + Not Metastasized? Surgery!
50
Q

Peptic Ulcer Disease

Stress Ulcers

aka “Curling ulcers”

A
  • 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
Q

Peptic Ulcer Disease

Stress Ulcers

Prevention & Treatment

A
  • H2 Receptor Antagonists
  • PPIs
52
Q

Cancer

of the

Stomach

A
  • Decreasing in Incidence in US
    • But huge cause of deaths
  • More common in :
    • Lower socioeconomic groups
    • Male-to-Female 2:1
53
Q

Cancer of the Stomach

Risk Factors

A
  • Genetics
  • Carcinogenic (in the diet)
    • Smoked/Preserved foods
  • Autoimmune Gastritis
  • Gastric Adenomas or Polyps
  • Chronic H. pylori = co-factor (not commonly)
54
Q

Cancer of the Stomach

Appearance

A
  • Bulky
  • Irregular shape
  • Firm, jagged edges

(versus smooth margins of gastric ulcers)

55
Q

Cancer of the Stomach

Symptoms

A
  • Bad: Asymptomatic until late in course
    • Vague sxs
      • Indigestion
      • Anorexia
      • Weight Loss
      • Vague epigastric pain
      • Vomiting
      • Abdominal Mass
56
Q

Cancer of the Stomach

Diagnosis

A
  • 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
Q

Cancer of the Stomach

Treatment

A
  • Depends on Location & Extent
  • Surgery:
    • Radical Subtotal Gastrectomy
  • Irradiation & Chemo = not very useful; more-so palliative

Julie W: Module 9 - GI (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions