PEPTIC ULCER DISEASE 1.3 Flashcards
THERAPY OF NSAID-RELATED GASTRIC or DUODENAL INJURY - What is the recommended treatment if the NSAID is discontinued in an active ulcer?
H2 receptor antagonist
THERAPY OF NSAID-RELATED GASTRIC or DUODENAL INJURY - What is the recommended treatment if the NSAID is continued in an active ulcer?
PPI
THERAPY OF NSAID-RELATED GASTRIC or DUODENAL INJURY - What is the recommended prophylactic therapy for high-risk patients on NSAIDs?
Misoprostol, PPI, or selective COX-2 inhibitor
THERAPY OF NSAID-RELATED GASTRIC or DUODENAL INJURY - What is the treatment if H. pylori infection is present in an active ulcer or a history of peptic ulcer disease?
Eradicate H. pylori
PRIMARY PREVENTION - What medication is used for prophylaxis in patients taking COX-2 inhibitors or aspirin?
Misoprostol (200 µg qid) or PPI
PRIMARY PREVENTION - What is required for any patient considered for long-term NSAID therapy?
H. pylori testing and treatment if positive
APPROACH AND THERAPY: SUMMARY - What test should be used to confirm eradication of H. pylori?
Stool antigen test or urea breath test (UBT)
REFRACTORY ULCERS - What is a common cause of refractory ulcers?
Non-compliance, persistent H. pylori infection, NSAID use, smoking, malignancy
REFRACTORY ULCERS - What is the treatment for refractory ulcers?
High-dose PPI or surgery
ZOLLINGER ELLISON SYNDROME - What is the most common manifestation of ZES?
Peptic ulcers
ZOLLINGER ELLISON SYNDROME - What is the most common location for gastrinomas in ZES?
Duodenum
ZOLLINGER ELLISON SYNDROME - What genetic condition is associated with gastrinomas?
MEN 1 (Multiple Endocrine Neoplasia) Type I
ZOLLINGER ELLISON SYNDROME - What test is used to confirm ZES?
Fasting serum gastrin level >150-200 pg/mL
ZOLLINGER ELLISON SYNDROME - What test can cause false positives when testing for ZES?
H. pylori infection, gastric hypochlorhydria, renal insufficiency, PPI use
ZOLLINGER ELLISON SYNDROME - What is the treatment for ZES?
PPI therapy and resection of the gastrinoma
STRESS-RELATED MUCOSAL INJURY - What is the treatment of choice for stress prophylaxis in ICU patients?
PPI
STRESS-RELATED MUCOSAL INJURY - What is the most common presentation of stress-related mucosal injury?
GI bleeding
GASTRITIS - How is gastritis diagnosed?
Biopsy
GASTRITIS - What does not constitute the clinical diagnosis of gastritis?
Mucosal erythema seen during endoscopy
What are the types of acute infectious gastritis?
Bacterial (other than H. pylori), Helicobacter heilmannii, Phlegmonous, Mycobacterial, Syphilitic, Viral, Parasitic, Fungal
Which bacteria are commonly involved in phlegmonous gastritis?
Streptococci, Staphylococci, Escherichia coli, Proteus, Haemophilus species
What is the histological finding in chronic gastritis?
Inflammatory cell infiltrate consisting primarily of lymphocytes and plasma cells with very scant neutrophil involvement.
Which condition is a predisposing factor for gastric cancer?
Intestinal metaplasia
What is superficial gastritis characterized by?
Inflammatory changes limited to the lamina propria, with edema and cellular infiltrates separating intact gastric glands.
What occurs during atrophic gastritis?
Inflammatory infiltrate extends deeper into the mucosa, with progressive distortion and destruction of the glands.
How does gastric atrophy present histologically?
Loss of glandular structures and a paucity of inflammatory infiltrates.
What type of chronic gastritis is associated with pernicious anemia?
Type A (autoimmune) chronic gastritis
What is the treatment for pernicious anemia in Type A chronic gastritis?
Parenteral vitamin B12 supplementation (long-term basis)
What is the main cause of Type B chronic gastritis?
Helicobacter pylori infection
How does H. pylori infection affect the stomach?
It causes multifocal atrophic gastritis, gastric atrophy, metaplasia, and increases the risk of gastric adenocarcinoma.
How is gastric MALT lymphoma related to H. pylori?
Gastric MALT lymphoma is often associated with H. pylori, and its eradication can lead to tumor regression.
What is the characteristic feature of lymphocytic gastritis?
It is primarily an infiltrative process affecting the body of the stomach, consisting of mature T cells and plasma cells.
What is the treatment for eosinophilic gastritis?
Glucocorticoids
What are some conditions that present with eosinophilia?
Parasitic infections, allergic conditions (e.g., asthma, food allergies, dust allergies)
What is granulomatous gastritis associated with?
Crohn’s disease, histoplasmosis, candidiasis, syphilis, tuberculosis
What is Russell body gastritis characterized by on biopsy?
Presence of numerous plasma cells containing Russell bodies that express kappa and lambda light chains.
What is the rare form of gastritis with a pseudo-tumoral endoscopic appearance?
Russell body gastritis (RBG)
What is the treatment for immune checkpoint inhibitor-induced gastritis?
Glucocorticoids, IL-6 receptor blockers
What is Menetrier’s disease characterized by?
Large, tortuous mucosal folds, massive foveolar hyperplasia, and a marked reduction in oxyntic glands.
Which overexpression leads to Menetrier’s disease?
Overexpression of TGF-a, stimulating the epidermal growth factor receptor (EGFR) pathway.
What is the clinical presentation of Menetrier’s disease?
Epigastric pain, nausea, vomiting, anorexia, peripheral edema, weight loss, and protein-losing gastropathy.
What is the first-line treatment for Menetrier’s disease?
Cetuximab (EGFR inhibitory antibody)
Which surgical intervention may be needed for severe Menetrier’s disease?
Partial or total gastrectomy
