GI: Stomach Flashcards
What is gastroschisis
congenital malformation of anterior abdominal wall leading to exposure of abdominal contents
what is omphalocele
- persistent herniation of bowel into umbilical cord
- failure of herniated intestines to return to body cavity during development
- contents covered by peritoneum and amnion of the umbilical cord
What is pyloric stenosis
congenital hypertrophy of pyloric smooth muscle
pyloric stenosis commonly occurs in who
male
when does pyloric stenosis present
2 weeks after birth
name 3 clinical symptoms for pyloric stenosis
- projectile nonbilious vomiting
- visible peristalsis
- Olive-like mass in abdomen
how is pyloric stenosis treated
myotomy
What is acute gastritis
acidic damage to stomach mucosa
what causes acute gastritis
imbalance b/w mucosal defenses and acidic environment
what are defenses of the stomach
- mucin layer produced by foveolar cells
- bicarbonate secretion by surface epithelium
- normal blood supply ( provides nutrients and picks up leaked acid)
what are 6 risk factors for acute gastritis
- severe burn ( Curling ulcer) - hypovolemia leads to decreased blood supply
- NSAIDS( decrease PGE2)
- Heavy alcohol consumption
- chemotherapy
- increased intracranial pressure ( Cushing ulcer) - increased stimulation of vagus nerve leads to increased acid production
- shock - multiple (stress) ulcers may be seen in ICU patients
acid damage in acute gastritis result in
superficial inflammation
erosion ( loss of superficial epithelium)
ulcer ( loss of mucosal layer)
What is chronic gastritis
chronic inflammation of stomach mucosa
what are 2 types of chronic gastritis
- chronic autoimmune gastritis
2. chronic H. pylori gastritis
what is chronic autoimmune gastritis
- antibodies against parietal cells and/or intrinsic factor (diagnostic)
- pathogenesis is mediated by T cells ( Type IV hypersensitivity)
what are clinical features for chronic autoimmune gastritis
- atrophy of mucosa with intestinal metaplasia
- achlorhydria with increased gastrin levels and antral G-cell hyperplasia
- megaloblastic (pernicious) anemia due to lack of intrinsic factor
chronic autoimmune gastritis is an increased risk for what
gastric adenocarcinoma ( intestinal type)
Where are gastric parietal cells located in the stomach
body and fundus
what is the most common form of gastritis
chronic H. pylori gastritis
what is chronic H. pylori gastritis
due to H. pylori-induced acute and chronic inflammation
- h. pylori ureases and proteases along with inflammation weaken mucosal defenses
what is the most common site for chronic H. pylori gastritis
antrum
how do patients present with chronic H. pylori gastritis
epigastric abdominal pain
chronic H. pylori gastritis increases the risk for what
- ulceration ( peptic ulcer disease)
- gastric adenocarcinoma ( intestinal type)
- MALT lymphoma
how is chronic H. pylori gastritis treated
triple therapy: resolves gastritis/ulcer and reverses intestinal metaplasia
what tests confirm eradication of H. pylori
negative urea breath test
lack of stool antigen
what is peptic ulcer disease
solitary mucosal ulcer involving proximal duodenum (90%) or distal stomach ( 10%)
what can cause peptic ulcer disease in duodenal
H. pylori
rare due to ZE syndrome
how would a patient clinically present with peptic ulcer disease in duodenum present
epigastric pain that improves with meals
what is diagnostic of peptic ulcer disease in duodenum
endoscopic biopsy shows ulcer with hypertrophy of Brunner glands
peptic ulcer disease in duodenum is usually located where and what are complications
- usually in anterior duodenum
- when present in posterior duodenum: rupture may lead to bleeding from the gastroduodenal artery or acute pancreatitis
what is the most common cause of gastric ulcers
H. pylori
other: NSAIDs and bile reflux
how does a patient present with gastric ulcers
epigastric pain that worsen with meals
where is gastric ulcer usually located
lesser curvature of antrum
when gastric ulcer rupture what are risks
bleeding from left gastric artery
Are duodenal ulcers malignent
almost never
physically describe benign gastric peptic ulcers
small ( less than 3 cm)
sharply demarcated (“punched-out”)
surrounded by radiating folds of mucosa
physically describe malignant gastric peptic ulcers
large and irregular with heaped up margins
what is done for definitive diagnosis for gastric ulcers
biopsy
what is gastric carcinoma
malignant proliferation of surface epithelial cells ( adenocarcinoma)
what are 2 categories of gastric carcinoma
- intestinal
2. diffuse types
What is the most common type of gastric carcinoma? what does it physically look like? location?
intestinal
- large, irregular ulcer with heaped up margins
- lesser curvature of the antrum ( similar to gastric ulcer)
What are risk factors for gastric carcinoma ( intestinal)
- intestinal metaplasia (due to H. pylori and autoimmune gastritis)
- nitrosamines ( in smoked foods - Japan)
- blood type A
characterize the diffuse type gastric carcinoma
- signet ring cells that diffusely infiltrate the gastric wall
- desmoplasia results in thickening of stomach wall ( linitis plastica)
What type of gastric carcinoma is not associated with H. pylori, intestinal metaplasia, and nitrosamines
diffuse type gastric carcinoma
what are late clinical symptoms of gastric carcinoma
- weight loss
- abdominal pain
- anemia
- early satiety
rarely presents as: acanthosis nigricans or Leser-Trelat sign
what lymph nodes can be involved in gastric carcinoma
left supraclavicular node ( Virchow node)
distant metastasis for gastric carcinoma go where
- liver
- periumbilical region ( Sister Mary Joseph Nodule) - intestinal type
- Bilateral ovaries ( Krukenberg tumor) - diffuse type
