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GI & Liver Fall 2013 CBD > Path Peptic disease > Flashcards

Path Peptic disease Flashcards

1
Q

mucus cells

A

secrete mucus around entrance to gastric pit

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2
Q

parietal cells: what they produce
how do they produce it?

Triggered by what 4 things?

A

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

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3
Q

what causes ECL cells to secrete and what do they secrete?

A

Secrete histamine

chyme in duodenum -> CCK, secretin

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4
Q

what protects epithelium from acid in stomach?

A

mucus-bicarb

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5
Q

peptic ulcer disease (PUD)

A

defect in GI mucosa extending through muscularis mucosae.

on the decline

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6
Q

symptoms of peptic ulcer

A 
abdominal pain (80%, may be nocturnal or relieved with food)
nausea, anorexia
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7
Q

epidemiology of PUD

A

more common in elderly & those taking nsaids

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8
Q

risk factors for PUD (5)

A 
Helicobacter pylori gastritis
ASA, NSAIDS, clopidogrel
smoking
genetics
acid must be present
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9
Q

what must be present for PUD?

A

acid

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10
Q

chronic conditions associated with PUD? (4)

A

ICU & vent
cirrhosis
organ transplants
COPD

(prophylaxis common)

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11
Q

bacteria common in PUD & %

A

Helicobacter pylori in 70% of PUD

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12
Q

% of helicobacter pylori inhabited pts with PUD

A

10-15%

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13
Q

4 virulence factor of H. pylori

description

A

urease (resistance to HCl)
LPS (inflammation)
CagA (cytotoxin-associated gene A, -> p53)
T4SS pilus (syringe-like structure)

4-6 flagella. gram-negative, spiral-shaped

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14
Q

effect of eradication of H. pylori on PUD patients?

A

reduced recurrence observed in studies

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15
Q

Factors contributing to getting PUD & H pylori

A

genetic predisposition & family co-incidence

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16
Q

Ulcers from NSAIDS vs H. pylori

A

increasing, decreasing

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17
Q

rank of NSAIDs related death

A

15th most common cause of death in USA

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18
Q

high & moderate risk factors for NSAID GI tox

A

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

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19
Q

dx of PUD

A

UGI Ba X-ray of stomach (60-90% Sn)

upper endoscopy w/H pylori biopsy

20
Q

duodenal ulcer malignant?

gastric ulcer malignant?

A

never

maybe

21
Q

chance of rebleeding in duodenal ulcers

A

50%

22
Q

tx of PUD (4)

A

H2 blockers or PPIs 6-8 wks
kill H pylori
avoid smoking, NSAIDS, ASA
surg

23
Q

tests for H. pylori (4)

A

urea breath test
fecal antigen test
serological test (no good for tx evaluation)
biopsy of antrum

24
Q

gastritis definition

A

gastric inflammation of mucosa

25
Q

sign in EtOH-induced gastritis

A

subepithelial hemorrages

“blood under plastic wrap”

26
Q

common associated conditions with hemorrhagic gastritis (7)

A 
alcohol
nsaids
bile reflux
trauma
burns
sepsis
shock
27
Q

timeline for healing acute hemorrhagic gastritis

A

fast

28
Q

chronic gastritis causes (5, in a hokey way)

A

h pylori, h pylori, h pylori, autoimmune, bile reflux

29
Q

possible sequelae of H pylori gastritis

A 
gastric adenocarcinoma (1-3%)
low grade lymphoma/galtoma (0.1%)
30
Q

3 ways to test for H pylori

A

section, look for cell bodies in neck of gastric glands & neutrophils in center of gland

test tissue soln for urease

immunostain

31
Q

germinal centers in gastric wall

A

chronic follicular gastritis due to H pylori. also seen with immunostain for h. pylori

32
Q

another name for stomach epithelium

A

foveolar epithelium

33
Q

signs of intestinal metaplasia due to H pylori

A

inflammatory cells

intestinal metaplasia with presence of goblet cells

34
Q

What is CagA & what does it do?

A

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)

35
Q

CagPAI

A

cytotoxin-associated gene A pathogenicity island

36
Q

autoimmune gastritis

A

<10% of chronic gastritis
Ab to parietal cells (achlorhydria)
Ab to intrinsic factor (pernicious anemia)

37
Q

achlorhydria

A

Ab to parietal cells, an autoimmune gastritis

38
Q

pernicious anemia

A

Ab to intrinsic factor, an autoimmune gastritis

39
Q

PUD signs of benign ulcer

A 
punched out
deep
flat or overhanging margins
round
small <2 cm
solitary
radiating rugal folds
40
Q

PUD signs of malignant ulcer

A 
nonradiating folds
irregular shape
nodular
shallower
sloping
shaggy base
bigger >3cm
41
Q

Cushing ulcer

A

brain injury-related stress ulcer

42
Q

Curling ulcer

A

burn-related stress ulcer

43
Q

stress ulcer description

A 
deep
single
hemorrhagic
small <1 cm
patechiae, hemorrages.
44
Q

acute hemorragic gastris associated with

A

alcohol, trauma, sepsis, shock

45
Q

chronic gastritis associated with

A

H pylori, or (uncommonly) autoimmune

GI & Liver Fall 2013 CBD (16 decks)

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