h.pylori and NSAIDS Flashcards
risk factor of serious GI events with NSAIDS?
aprior bleeding or ulcer anticoagulants corticosteroids dose age (from most to least)
NSAIDS targets?
cox1 (hematosis, gastric PG)
cox2 (peripheral inflammation)
what does cox 1 produce?
tranexamic acid
gastric PG
cox 1+2 inhibition results in
inhibition of PG synthesis which relives inflammation
removal of gastric mucosal protection
selective cox 2 inhibitors effect?
less gastric mucus disturbance
NSAIDS toxic effects on small intestine?
ulcers
strictures
excerbation of IBD
NSAIDS toxic effects on large intestine?
ulcers strictures excerbation of IBD diverticular bleading colitis
Traditional NSAIDS?
iboprofen
naxil
indomethacine
zollinger ellison (ZES) definition?
gastrinoma- gastric producing tumor
gastrin target site?
colecytokinin B receptors on ECL cells which secrete histamine in response
gastrin morphological outcomes?
trophic influence on gastric epithel
substential rugea
ZES location?
gastrinoma tringle (90%)
junction of 1+2 deudoneum
junction of neck and body of pancreas
junction of cystic and common bile ducts
ZES phathology?
tumors are malignant 60%
liver as primary metastatic site
multiple lession on first onset in 30-50%
when to think about gastrinoma?
PUD + diarrhea
PUD in unusual location or multiple location
PUD refractory to treatment
PUD with prominat gastric folds
MEN-1 suggestive findings
ulcerative complications (perforation, stricturs)
gastrinoma diagnosis?
fasting gastrin
gastrin with low PH
gastrinoma treatment ?
PPI
somatostatin analogues (D-cell)
resection
non H.pylori / NSAIDS / gastrinoma ulcers?
Infection (cmv, hepes a bit)
drugs (bisphosphonate, causties)
heterogenic (basophilia in myeloproliferative disease)
PUD symptoms
most are asymptomatic
burning epigastric pain with worsen by fasting
90% of dyspeptic patients have no PUD
complications without antecedant symptoms
dyspepsia?
upper abdominal discomfort
dyspepsia DD?
PUD NUD proximal GI tumors reflux billiary disease ischemic heart disease (usually caudal wall)
PUD physical exam?
epigastric tenderness- low predictor
rull-out complications:
tachycardia
lymphoadenopathy
PUD diagnosis tests?
endoscopy
Bx histopathology
Bx rapid urease test (H.pylori)
forrest classification for PU bleeding?
1a- arterial jet 1b- oozing 2a- visible vessle 2b- adherent clot 2c- black spot 3- clean base
follow up of PU?
DU- none usually
GU- bening and malignant look alike, thus check up till complete healing +Bx
PUD bleeding prognosis?
mortality (5-10)% mostly due to non bleding cause
50% bleed without preceding symptoms
melena (dark stool due bleeding)
hematochezia (passage of fresh blood per anus, usually in or with stools)
hypotension and tachycardia
syncope
ICU
bubble in right diaphragm?
probably a perforation of air feeld organ in peritoneal sack
Ringle’s sing?
intestinal walls are seen in x-ray due to air in abdomen
penetration?
perforation of ulcer bed tunnels into adjacent organ
DU- pancrease
GU- slpeen
gastrocolic
fistula?
connection of two empty vessles
PUD complications?
bleeding > prforation > obstruction
PUD associated obstruction symptoms?
vomitting bloating early sateity weight loss dehydration
PUD assiciated obstruction pathogenesis?
edema or scar of ulcer deminishing space,
usually in deudoneum
stress related mucosal injury pathopysiology?
HCL up mucosal ischemia systemic cytokins oxidative stress poor GI motility
stress related mucosal injury risk factors?
ICU:
coagulopathy
mechanical ventillation
stress related mucosal injury treatment?
PPI
ivesive- inefficient (due to it being diffusic problem)
Menertier disease morphology?
tortous gastric folds
massive foveolar hyperplasia
reduction of oxyntic glands, cheif @ parietal cells
Menetrier disease DD?
ZES
malignancy
infection- CMV, syphilis, H.pylori
Menetrier pathopysiology?
TGF-a production is up EGFR signaling is up intensive mucus secretion malabsorption protien losing gastropathy hypoalbuminemia edema
Menetrier treatment?
PPI CMV treatment H.pylori eradication centuximab when all fails gastrectomy
chronic gastritis A?
body of stomach
secondary to :
autoimmune
-pernicious anemia (B12, intrinsic factor antigens)
H.pylorichronic gastritis B?
antral H.pylori gastric atrophy intestinal metaplasia Adenoca
gastroparesis?
delayed gastric emptying of soilds without obstruction
gastroparesis etiology?
idiopathic 50% diabities meds viral autoimmune paraneoplastic (scc in lungs)
gastroparesis treatment?
lifestyle meds gastric pacing botox- dialition pylorus gastrostomy jejunostomy
