Path Peptic disease Flashcards
mucus cells
secrete mucus around entrance to gastric pit
parietal cells: what they produce
how do they produce it?
Triggered by what 4 things?
secretes HCl across H-K-ATPase
adenyl cyclase, cAMP pathway
triggered by ACh (vagal)
gastrin (from G cells)
Histamine (from ECL cells)
prostaglandin I/E
what causes ECL cells to secrete and what do they secrete?
Secrete histamine
chyme in duodenum -> CCK, secretin
what protects epithelium from acid in stomach?
mucus-bicarb
peptic ulcer disease (PUD)
defect in GI mucosa extending through muscularis mucosae.
on the decline
symptoms of peptic ulcer
abdominal pain (80%, may be nocturnal or relieved with food) nausea, anorexia
epidemiology of PUD
more common in elderly & those taking nsaids
risk factors for PUD (5)
Helicobacter pylori gastritis ASA, NSAIDS, clopidogrel smoking genetics acid must be present
what must be present for PUD?
acid
chronic conditions associated with PUD? (4)
ICU & vent
cirrhosis
organ transplants
COPD
(prophylaxis common)
bacteria common in PUD & %
Helicobacter pylori in 70% of PUD
% of helicobacter pylori inhabited pts with PUD
10-15%
4 virulence factor of H. pylori
description
urease (resistance to HCl)
LPS (inflammation)
CagA (cytotoxin-associated gene A, -> p53)
T4SS pilus (syringe-like structure)
4-6 flagella. gram-negative, spiral-shaped
effect of eradication of H. pylori on PUD patients?
reduced recurrence observed in studies
Factors contributing to getting PUD & H pylori
genetic predisposition & family co-incidence
Ulcers from NSAIDS vs H. pylori
increasing, decreasing
rank of NSAIDs related death
15th most common cause of death in USA
high & moderate risk factors for NSAID GI tox
High risk factors:
Hx of complicated ulcer, >2 risk factors
moderate risk factors:
Age >65, high dose NSAIDs, hx of uncomplicated ulcer, aspirin (any dose), glucocorticoids, anticoagulants
dx of PUD
UGI Ba X-ray of stomach (60-90% Sn)
upper endoscopy w/H pylori biopsy
duodenal ulcer malignant?
gastric ulcer malignant?
never
maybe
chance of rebleeding in duodenal ulcers
50%
tx of PUD (4)
H2 blockers or PPIs 6-8 wks
kill H pylori
avoid smoking, NSAIDS, ASA
surg
tests for H. pylori (4)
urea breath test
fecal antigen test
serological test (no good for tx evaluation)
biopsy of antrum
gastritis definition
gastric inflammation of mucosa
sign in EtOH-induced gastritis
subepithelial hemorrages
“blood under plastic wrap”
common associated conditions with hemorrhagic gastritis (7)
alcohol nsaids bile reflux trauma burns sepsis shock
timeline for healing acute hemorrhagic gastritis
fast
chronic gastritis causes (5, in a hokey way)
h pylori, h pylori, h pylori, autoimmune, bile reflux
possible sequelae of H pylori gastritis
gastric adenocarcinoma (1-3%) low grade lymphoma/galtoma (0.1%)
3 ways to test for H pylori
section, look for cell bodies in neck of gastric glands & neutrophils in center of gland
test tissue soln for urease
immunostain
germinal centers in gastric wall
chronic follicular gastritis due to H pylori. also seen with immunostain for h. pylori
another name for stomach epithelium
foveolar epithelium
signs of intestinal metaplasia due to H pylori
inflammatory cells
intestinal metaplasia with presence of goblet cells
What is CagA & what does it do?
virulence factor for H pylori that causes degradation of p53. Messes up cell polarization.
injected with T4SS (type IV secretion system) pilus structure in CagA pathogenicity island (CagPAI)
CagPAI
cytotoxin-associated gene A pathogenicity island
autoimmune gastritis
<10% of chronic gastritis
Ab to parietal cells (achlorhydria)
Ab to intrinsic factor (pernicious anemia)
achlorhydria
Ab to parietal cells, an autoimmune gastritis
pernicious anemia
Ab to intrinsic factor, an autoimmune gastritis
PUD signs of benign ulcer
punched out deep flat or overhanging margins round small <2 cm solitary radiating rugal folds
PUD signs of malignant ulcer
nonradiating folds irregular shape nodular shallower sloping shaggy base bigger >3cm
Cushing ulcer
brain injury-related stress ulcer
Curling ulcer
burn-related stress ulcer
stress ulcer description
deep single hemorrhagic small <1 cm patechiae, hemorrages.
acute hemorragic gastris associated with
alcohol, trauma, sepsis, shock
chronic gastritis associated with
H pylori, or (uncommonly) autoimmune
