Peptic Ulcer Flashcards
Stem: patient with known peptic ulcer disease, presented with hematemesis, OGD done showed bleeding gastric ulcer. Labs showed hypercalcemia. PMH: osteoarthritis on NSAID, smooker, CKD on dialysis.
Stem: patient with known peptic ulcer disease, presented with hematemesis, OGD done showed bleeding gastric ulcer. Labs showed hypercalcemia. PMH: osteoarthritis on NSAID, smooker, CKD on dialysis.
Q1. What is the definition of an ulcer!
Local defect in the mucus membrane or skin due to disintegration of surface epithelial cells.
Q2. What are the major risk factors of peptic ulcers?
How can NSIADs cause PUD?
NSAIDs / H.pylori inf / smoking
…
irritating the epitheluim /
interfere with healing of mm /
decrease blood supply to mm /
Inhibit Cox-1 leading to suppression of PG synthesis
NB; Cox-2 which is anti-inflammatory
Q3. What’s H.pylori?
Gram negative microaerophilic spiral bacteria found in the stomach
Q4. After taking a gastric biopsy during endoscopy, what test can be done to the biopsy to confirm H.Pylori infection?
CLO test (Campylobacter-Like-Organism)
Describe how it’s done. CLO
Biopsy taken by endoscopy and put in a media contain urea and an indicator (Phenol red), urease production by H.Pylori converts urea to ammonia raising the PH and changing the color of the indicator from yellow to red (+ve test)
Other tests Stool Ag test / Urease breath test
Q4. How does H.Pylori manage to survive in the gastric acidic medium?
Produce Urease catalyze urea to ammonia and increase ph and decrease stomach acidity
Q. Other tests to Dx H.pylori ag?
Detection of ag in stool analysis /
Urea breath test /
Serology for Ab /
take biopsy for microbial culture
Q5. How can H.Pylori colonize the stomach and induce gastritis?
Flagella help its motility /
Uresae elevate ph /
adhesins adherence to faveolar cells /
toxins CagA involved in ulcer or cancer
Q6. What’s the type of cells in the gastric antral mucosa?
Simple Colum. With goblet cells
What are the types of gastric cancer caused H.Pylori infection? Which immune endocrine disease is associated with it?
Adenocarcinoma / Mucosal associated lymphoid tissue tumor MALTOMA
Hashimoto Thyroiditis
Q7. How to treat symptomatic H. Pylori infection?
7 days of PPI Full dose/ Metro 400 mg / Clarith 250mg
or 7 ds of PPI full / Amox 1gm / Clarith 500 mg
Q8. What’s the mechanism of action of proton pump inhibitors?
PPI binds irreversibly to H+/K+ ATPase enzyme (proton pump) on gastric parietal cells and blocks secretion of H+ ,which combine with Cl in the stomach lumen to form HCL.
Q9. What are the actions of gastric HCL?
Antimicrobial action / Activate pepsinogen to pepsin / Promote pancreatic enzymes / Enhances absorption of Ca and iron / Help secreation of CCK and secrtine.
Q10. What are the other possible causes of hematemesis in this patient?
Hypercalcemia increases release of gastrin and increase HCL which increase liability of bleeding from stomach
Q11. What are the common causes of hypercalcemia?
Malignancy / Renal Failure / HyperPTH
Q12. The patient had a history of recurrent (Flank pains) renal stones, what’s the possible cause?
HyperCa
Q13. What’s the commonest cause of primary hyperparathyroidism? What’s the meaning of adenoma?
Solitary adenoma in 80% of cases
benign tumor originating from epithelial cells and has glandular pattern or tumor arising from gland itself
Q14. How can the pararthyroid glands be localized. Where can they be found if not in their normal location?
Pre-op by sestamibi scan / Intra-op by frozen section
In sup mediastinum / because they follow the thymus gland originating the 3rd branchial pouch
Q15. What’s frozen section and it is performed in simple words?
FROZEN SECTION:
the surgeon takes a small piece of fresh tissue or tumor for Analysis,
the pathologist freezes this sample and sections are immediately cut,
the sections are stained and reported immediately by phoned back to theatre
Q16.Why parafin based histopathology is not convenient for intraopertive pathological testing?
Takes long time for stain to be imbedded in tissue
Q17. What’s the treatment of parathyroid adenoma?
Excision
The patient underwent excisin of the 4 parathroid glands. You were given the following pathology report.
. 1 gland 0.2 g chief cells.
. The other 3 glands ranging from 0.08 to 0.09 g composed of oxyphilic and fat cells.
Q18. What’s your interpretation?
Parathyroid adenoma in one gland / the other 3 are involuted (Atrophied)
Q19. What’s the histological features of parathyroid adenoma. And how does this compare to hyperplasia?
Polygonal chief cells which are uniform with small central nuclei and islets of oxyphil cells and rare type called oxyphil adenoma. Composed of non-neoplastic compressed normal tissue at periphery separated by fibrous capsule
PT hyperplasia is commonly from chief cells and less commonly water clear cells.
Q20. What are the types of hyperparathyroidism?
1ry – >Due to solitary adenoma / 2ry– > due to decrease Ca in CRF /
3ry – > following correction of any underlying renal disorder
Q21. how to treat acute hypercalcemia?
Hydration / Forced diuresis / Bisphosphonate / Calcitonin
Q. How to preserve Tissue sample?
By Formalin (preserve the specimen)