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Gastro > Peptic Diseases and Gastritis (Jackson/Nichols) > Flashcards

Peptic Diseases and Gastritis (Jackson/Nichols) Flashcards

1
Q

gastric cells that make HCl

A

parietal

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2
Q

gastric cells that make pepsinogen

A

chief

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3
Q

gastric cells that make bicarbinate rich mucos

A

mucous cells

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4
Q

gastric cells that make gastrin

A

g cells

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5
Q

what intracellular processes drigger H/K ATPase activity

A

↑ Ca (thru IP3) and ↑ cAMP (thru AC)

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6
Q

exert a negative feedback on acid secretion in partial cells?

A

distention, low pH, somatostatin, and prostaglandins inhibit parietal cell H+ secretion

CCK and secretin inhibit action of gastrin

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7
Q

what is the cephalic phase of acid secretion

A

Taste, smell, and chewing food stimulates acetylcholine release via the vagal nerve → partial cells secrete HCl (30% of total secretion)

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8
Q

What is the gastric phase of acid secretion?

A

Chemical effects of food and distension of stomach causes:

  • release of gastrin by the G cells (indirect stim of parietal cells)
  • release of Ach from vagal N to directly act on parietal cells
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9
Q

how does gastric acid secretion in pts with DUODENAL ulcers compare to secretion in normal patients? GASTRIC ulcers?

A

Duodenal: ↑H+ (2x nml) and ↑gastrin

Gastric: ↓H+ and ↑gastrin (H+ leaks out due to damage to the mucosa and gastin ↑ to compensate)

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10
Q

what prevents auto digestion?

A

mucos-bicarb layer in stomach

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11
Q

how does duodenal bicarb secretion in pts with DUODENAL ulcers compare to secretion in normal patients

A

↓ basal [bicarb] and ↓ acid stimulated secretion of bicarb

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12
Q

definition of PUD

A

defect in GI mucose extending THROUGH THE MUSCULARIS MUCOSA

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13
Q

Risk factors for PUD

A

PUD HANGS around with H pyloir:

H pylori
ASA
NSAIDs
Genetics
Smoking
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14
Q

What chronic diseases is PUD assc with? how is it prevented in these conditions (i.e. what is the prophylactic treatment?)

A

Stress
Transplanted organs
Cirrhosis
COPD

prophylactic PPIs

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15
Q

symptoms of PUD

A

abd pain (nocturnal or with food)
nausea
anorexia
**may be asympomatic and present with complication = bleeding or perforation

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16
Q

morphology of H pylori

A

gram - spiral shaped with 4-6 flagella

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17
Q

pts infected with h pylori will have ↑ or ↓ response to gastrin/acid production. why?

A

↑ due to ↓somatostatin release

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18
Q

Since H pylori colonize gastric mucosa, how do they cause a duodenal ulcer?

A
  1. inhibit somatostatin secretion → gastrin → ↑H+ secretion
  2. inhibits duodenal HCO3- secretion → duodenal contents become abnormally acidic → mucosa eroded
  3. ↑ gastrin has trophic effect on parietal cells →↑H
  4. increased inflammatory cells and cytokines
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19
Q

top 2 causes of PUD

A

H pylori and NSAIDs

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20
Q

How does H pylori elicit an inflammatory response

A

secretes LPS and peptides that will cross gastric epithelium and are then chemotactic for neutrophils and monocytes in the lamina propria → monocytes secrete TNF< IL-1, O2-, Prostaglandins

21
Q

how does NSAID use leas to PUD

A

NSAIDS
▪︎ ↑HCl
▪︎ ↓bicarb
▪︎ ↓glutathione → ↑ROS

22
Q

pareital cell hyperplasia occurs as a result of

A

↑ vagal stimulation and gastrin

23
Q

how is the diagnosis of PUD made

A

UGI barium X ray

upper endoscopy **also allows for biopsy

24
Q

What are the complications of PUD?

A

bleeding → hematemesis, melana, anemi
perforation
penetration into adj organs (pancreas, liver, colon)
obstruction (due to edema or fibrosis)

25
Q

perforated duodenal ulcers are assc with

A

ZES, NSAIDs, cocaine

26
Q

Acute PUD → obstruction due to ____.

Chronic PUD → obstruction due to _____.

A

Acute PUD → obstruction due to edema.

Chronic PUD → obstruction due to fibrosis.

27
Q

Obstruction causes pt to _____ several hours after they eat

A

vomit

28
Q

Treatment of PUP

A

H2 blockers or PPIs

Abx

29
Q

can you assume a pt with a + serological test for H pyloru has an active H pylori infection

A

no, they may have cleared it but they still have Abs made to it

30
Q

defn of gastritis. How is this diff than the defn of PUD?

A 
gastritis = infalmmation of mucosa
PUD = inflammation and damage extends thru the muscularis mucosa
31
Q

common causes of gastritis:

A

H pylori
NSAIDs
alcohol
extreme stress (ICU

(less common: chemo, bile reflux, truama, burns, sepsis, shock)

32
Q

“blood under plastic wrap” on endoscopy indicates

A

multiple subepi hemorrhages without any breaks in mucosa = assc with alcohol use

33
Q

numerous petechiae and erosions of on gastric mucosa

A

acute hemorrhagic gastritis

34
Q

causes of chronic gastritis

A

H pylori > autoimmune and bile reflux

35
Q

chronic gastritis can lead to

A

atrophy, intestinal metaplasia/dysplasia/neoplasia

36
Q

WHere is the stomach is chronic gastritis due to H pylori likely to affect? autoimmune?

A

ABBA
Bacteria = Antrum
Autoimmune = Body

37
Q

what type of cells will predominate in chronic active gastritis

A

neutrophils = ACTIVE!!

38
Q

chronic gastritis due to (autoimmune or H pylori) commonly displays lymphoid follicles/germinal centers

A

H pylori

39
Q

where will the H pylori organisms be found in chronic gastritis

A

superficial MUCOUS layer (above the epi)

40
Q

most important virulence factors for H pylori

A

CagA protien degrades p53

also, T4SS (found in CagPAI)

41
Q

characteristics of autoimmune chronic gastritis

A

4 A’s
Abs to parietal cells
Achlorhydria
pernicious Anemia (Abs to intrinsic factor)
Atrophy*all chronic gastritis cuases atrophy, so maybe only 3 A’s?

42
Q

↑ risk for MALT lymphoma

A

H pylori chronic gastritis

43
Q

assc with G cell and partial cell hyperplasia

assc with parietal cell hyperplasia (No G cell)

A

BOTH: autoimmune chronic gastritis
**loss of parietal cells at the same time since there are Abs made against it

Parietal only: PUD (due to ↑Ach/vagal stim and gastrin)

44
Q

seen in histo of chronic PUD

A

NIGS

necrosis, inflammation, granulation tissue, scar

45
Q

bigger or smaller ulcers are signs of benignity

A

smaller

46
Q

deeper or shallow ulcers are signs of benignity

A

deeper

47
Q

stress ulcers occur with

A

Brain injury = Cushing ulcer (↑vagal stim → inc Ach and H+ secretion)
C(r)ush the brain and you may get stress ulcer

Burns = Curling ulcer (↓plasma volume → sloughing of gastric mucosa)
burned by a curling iron

48
Q

describe appearance of stress ulcer

A

deep, single, small (<1 cm) penis to DEEPly penetrate Katniss which makes her BLEED

You are welcome.

Gastro (25 decks)

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