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GASTROENTEROLOGY > PEPTIC ULCER DISEASE 1.3 > Flashcards

PEPTIC ULCER DISEASE 1.3 Flashcards

1
Q

THERAPY OF NSAID-RELATED GASTRIC or DUODENAL INJURY - What is the recommended treatment if the NSAID is discontinued in an active ulcer?

A

H2 receptor antagonist

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2
Q

THERAPY OF NSAID-RELATED GASTRIC or DUODENAL INJURY - What is the recommended treatment if the NSAID is continued in an active ulcer?

A

PPI

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3
Q

THERAPY OF NSAID-RELATED GASTRIC or DUODENAL INJURY - What is the recommended prophylactic therapy for high-risk patients on NSAIDs?

A

Misoprostol, PPI, or selective COX-2 inhibitor

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4
Q

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?

A

Eradicate H. pylori

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5
Q

PRIMARY PREVENTION - What medication is used for prophylaxis in patients taking COX-2 inhibitors or aspirin?

A

Misoprostol (200 µg qid) or PPI

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6
Q

PRIMARY PREVENTION - What is required for any patient considered for long-term NSAID therapy?

A

H. pylori testing and treatment if positive

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7
Q

APPROACH AND THERAPY: SUMMARY - What test should be used to confirm eradication of H. pylori?

A

Stool antigen test or urea breath test (UBT)

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8
Q

REFRACTORY ULCERS - What is a common cause of refractory ulcers?

A

Non-compliance, persistent H. pylori infection, NSAID use, smoking, malignancy

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9
Q

REFRACTORY ULCERS - What is the treatment for refractory ulcers?

A

High-dose PPI or surgery

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10
Q

ZOLLINGER ELLISON SYNDROME - What is the most common manifestation of ZES?

A

Peptic ulcers

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11
Q

ZOLLINGER ELLISON SYNDROME - What is the most common location for gastrinomas in ZES?

A

Duodenum

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12
Q

ZOLLINGER ELLISON SYNDROME - What genetic condition is associated with gastrinomas?

A

MEN 1 (Multiple Endocrine Neoplasia) Type I

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13
Q

ZOLLINGER ELLISON SYNDROME - What test is used to confirm ZES?

A

Fasting serum gastrin level >150-200 pg/mL

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14
Q

ZOLLINGER ELLISON SYNDROME - What test can cause false positives when testing for ZES?

A

H. pylori infection, gastric hypochlorhydria, renal insufficiency, PPI use

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15
Q

ZOLLINGER ELLISON SYNDROME - What is the treatment for ZES?

A

PPI therapy and resection of the gastrinoma

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16
Q

STRESS-RELATED MUCOSAL INJURY - What is the treatment of choice for stress prophylaxis in ICU patients?

A

PPI

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17
Q

STRESS-RELATED MUCOSAL INJURY - What is the most common presentation of stress-related mucosal injury?

A

GI bleeding

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18
Q

GASTRITIS - How is gastritis diagnosed?

A

Biopsy

19
Q

GASTRITIS - What does not constitute the clinical diagnosis of gastritis?

A

Mucosal erythema seen during endoscopy

20
Q

What are the types of acute infectious gastritis?

A

Bacterial (other than H. pylori), Helicobacter heilmannii, Phlegmonous, Mycobacterial, Syphilitic, Viral, Parasitic, Fungal

21
Q

Which bacteria are commonly involved in phlegmonous gastritis?

A

Streptococci, Staphylococci, Escherichia coli, Proteus, Haemophilus species

22
Q

What is the histological finding in chronic gastritis?

A

Inflammatory cell infiltrate consisting primarily of lymphocytes and plasma cells with very scant neutrophil involvement.

23
Q

Which condition is a predisposing factor for gastric cancer?

A

Intestinal metaplasia

24
Q

What is superficial gastritis characterized by?

A

Inflammatory changes limited to the lamina propria, with edema and cellular infiltrates separating intact gastric glands.

25
Q

What occurs during atrophic gastritis?

A

Inflammatory infiltrate extends deeper into the mucosa, with progressive distortion and destruction of the glands.

26
Q

How does gastric atrophy present histologically?

A

Loss of glandular structures and a paucity of inflammatory infiltrates.

27
Q

What type of chronic gastritis is associated with pernicious anemia?

A

Type A (autoimmune) chronic gastritis

28
Q

What is the treatment for pernicious anemia in Type A chronic gastritis?

A

Parenteral vitamin B12 supplementation (long-term basis)

29
Q

What is the main cause of Type B chronic gastritis?

A

Helicobacter pylori infection

30
Q

How does H. pylori infection affect the stomach?

A

It causes multifocal atrophic gastritis, gastric atrophy, metaplasia, and increases the risk of gastric adenocarcinoma.

31
Q

How is gastric MALT lymphoma related to H. pylori?

A

Gastric MALT lymphoma is often associated with H. pylori, and its eradication can lead to tumor regression.

32
Q

What is the characteristic feature of lymphocytic gastritis?

A

It is primarily an infiltrative process affecting the body of the stomach, consisting of mature T cells and plasma cells.

33
Q

What is the treatment for eosinophilic gastritis?

A

Glucocorticoids

34
Q

What are some conditions that present with eosinophilia?

A

Parasitic infections, allergic conditions (e.g., asthma, food allergies, dust allergies)

35
Q

What is granulomatous gastritis associated with?

A

Crohn’s disease, histoplasmosis, candidiasis, syphilis, tuberculosis

36
Q

What is Russell body gastritis characterized by on biopsy?

A

Presence of numerous plasma cells containing Russell bodies that express kappa and lambda light chains.

37
Q

What is the rare form of gastritis with a pseudo-tumoral endoscopic appearance?

A

Russell body gastritis (RBG)

38
Q

What is the treatment for immune checkpoint inhibitor-induced gastritis?

A

Glucocorticoids, IL-6 receptor blockers

39
Q

What is Menetrier’s disease characterized by?

A

Large, tortuous mucosal folds, massive foveolar hyperplasia, and a marked reduction in oxyntic glands.

40
Q

Which overexpression leads to Menetrier’s disease?

A

Overexpression of TGF-a, stimulating the epidermal growth factor receptor (EGFR) pathway.

41
Q

What is the clinical presentation of Menetrier’s disease?

A

Epigastric pain, nausea, vomiting, anorexia, peripheral edema, weight loss, and protein-losing gastropathy.

42
Q

What is the first-line treatment for Menetrier’s disease?

A

Cetuximab (EGFR inhibitory antibody)

43
Q

Which surgical intervention may be needed for severe Menetrier’s disease?

A

Partial or total gastrectomy

GASTROENTEROLOGY (3 decks)

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