Pathoma: Gastric Disorders Flashcards
_____ is a congenital malformation in the anterior wall that leads to the exposure of the abdominal contents to air
gastroschisis
What is an omaphacele?
Persistant herniation of the bowel into the umbilical cord. Bowel doesnt return into the body cavity as we develop => abdominal contents covered in peritoneum and amnoin.
When does pyloric stenosis present?
NOT at birth: 3-6 weeks because it takes time to develop.
Who is pyloric stenosis more common in?
M
Sx of pyloric stenosis?
3-6 weeks after birth
- Projectile nonbilous vomiting
- Olive like mass in abdomen and visible peristalsis
What is gastritis?
inflammation of the gastric mucosa
What are the 2 types of gastritis?
Acute gastritis => acid damage to the stomach due to imbalance between mucosal defenses and acid production => causes
- Superficial inflammation
- Erosion (loss of epithelium => extend to mucosa)
- Ulcer (loss of mucosa)
Chronic gastritis=> chronic inflammation of the stomach mucosa due to either H.pylori and AI gastritis.
What are the mucosal defenses?
- Mucosa defenses protect against acid
- Mucosa lined by epithelium (epithelial cells = foveolar cells = make mucus and layer)
- HCO3-
- Blood flow => provides nutrients and carry acid away
Risk factors for acute gastritis?
- Severe burn (Curling ulcer)
- Increased intracranial pressure (Cushing ulcer)
- Shock (multuple “stress” ulcers seen in ICU pt)
- NSAIDS (decreased PGE2 => NL; decrease acid production and increase mucus and bicarb and increase BF)
- Heavy alcohol consumption
Acid damage in acute gastritis causes what?
- Superficial inflammation
- Erosion
- Ulcers
Chronic AI gastritis causes chronic gastritis how?
-
T-cell mediated AI reaction (type 4) that destroys gastric parietal cells, located in the fundus and body.
- Produces Ab against parital cells or IF, which do not cause damage but are a side effect.
Chronic gastritis due to chronic AI gastritis
-
Atrophy of mucosa with intestinal metaplasia
- => increase risk for gastric adenocarcinoma (intestinal type)
- Achlorhydria => Increase in gastrin => G-cell hyperplasia in antrum
- Megaloblastic (pernicious anemia) d/t decreased IF (made by parietal cell) => decreased vit B12.
What do we see with intestinal metplasia of the gastric mucosa?
Goblet cells!
Chronic H.pyloris gastritis is due to..
H.pylori induced acute AND chrponic inflammation (most common form 90%) in the antrum
Sx of Chronic H.pyloris gastritis
- Epigastric abdominal pain
- Increase risk for ulceration (PUD)
- Gastric adenocarcinoma (intestinal type)
- MALToma (B-cell)
Triple therapy for Chronic H.pylori induced gastritis causes
- Resolves gastritis/ulcer
- Reverses intestinal metaplasia (metaplasia is reversible)
What confirms that H.pylori is gone
- Negative urea breath test
- Lack of stool antigen
PUD produces
solitary mucosal ulcer in the proximal duodunum (90%) or distal stomach (10%
Duodenal ulcers are due to ______
- H. pylori (90%)
- ZE syndrome: gastrinoma => increase gastrin => + parietal cell => increase acid production => duodenal ulcer
Duodenal ulcers presents with epigastric pain that ________ with meals
IMPROVES
duodenum makes HCO3- when stomach senses food
Diagnostic endoscopic biopsy shows what for duodenal ulcers
Ulcer with hypertophy of brunners glands (which makes mucus to protect)
Duodenal ulcers usually arise in the ______ duodenum; but when they arise in _________ duodenum, we can see…
- anterior duodenum
-
posterior duodenum
- Bleeding from the gastroduodenal A.
- Acute pancreatitis
Gastric ulcers are due to ______
H.pylori (75%) and others; NSAIDS/bile reflux
Gastric ulcers presents with epigastric pain that ________ with meals
worsens
Gastric ulcers usually arise in the ______ and can cause what
- Lesser curvature of antrum
- Rupture => bleed due to L. gastric A.
DDx of ulcers include _____
carcinoma
_______ ulcers are almost NEVER malignant and rarely biopsied
Duodenal
Gastric ulcers can be caused by ________
Gastric carcinoma (intestinal type)
On endoscopy, how can we tell the difference between a benign ulcer and malignant ulcer
- Benign ulcer: small (<3cm), punched out and surrounded by NL/flat margins
- Malignant ulcer: large, irregular with heaped up margins
What is required for definitive diagnossis of ulcer malignancy
biopsy