peptic ulcer diseases Flashcards
histological layers of the gastric wall?
epithel lamina propria muscularis mucosa sub mucosa musculris externa circular longditual serosa
cells that line the stomach’s glands
foveola- surface mucus neck mucus parietal endocrine cheif
parietal cells acid production inducing receptors
gastrin (g cells, antrum, endocrine)
achetylcholin (vagus)
histamine (entrochromaffin like cells, paracrine)
which cells responsable for the gastric mucin layer?
foveolar cells
most potent acid production inducer in parietal cells
histamine
what stimulates acid prduction in parietal cells (phase wise)
chephalic- vagus
gastric- amino acids and distention
small intestine- distantion
which cell produce pepsin and due to what stimuli?
chief cells
gastrin (g cells, antrum, endocrine)
achetylcholin (vagus)
histamine (entrochromaffin like cells, paracrine)
in what PH does pepsin seize to work?
greater than 4
which cell produce histamin and due to what stimuli
entero-chromaffin like cells
due to gastrin secreted by G cells (endocrine)
by which cell does G cell regulate negatively ?
D cells, somatostatin (paracrine)
to which stimuli does G cell regulate possitivly?
food in antrum
achetycholin (vagus)
which cell produce secretin and to what stimuli?
s. cells
acidic food in the deodenum
what do secretin do?
increase secrition of bicabonate at pancrease
inhibit gastric motility
decrease bile secretion
what stimulate CCK release (and from where?)
I-cells
indigested FF+ AA in deodenum
what does CCK do?
increase bile secretion
increase pancreatic enzymes flow
pre-epithelial mechanism for mucosal integrity?
mucus- bicarbonate
surface active phospholipids layer
epithelial cells mechanism for mucosal integrity?
tight junctions
ion pumps
cell renewal
post-epithelial cells mechanism for mucosal integrity?
mucosal blood flow (PGE2, PGI2 vasodialition)
which system operates the gastric emptying while fasting?
migratory motor complex (every 90min)
what does the vaso-vagal reflex do when food enters the stomach?
receptive relaxition and accomodition of fundus
later on, perylstasis
what is the differance between erosion and ulceration?
ulcer involves the sub-mucosa
favored area of peptic ulcers?
antrum and body of stomach
1st part of deodenum
peptic ulcers empidemiology?
g.ulcers represent malignancy whilst d.ulcers do not
bening g.ulcers locate typically distal to antrum
H.pyloric associated g.ulcers associate with chronic gastritis
NSAIDS -dont cause chronic gastritis
peptic ulcers epidemiology?
g.ulcers less common than d.ulcers
M>F
60’s
location at which H.pylori is found?
deep parts of the mucus layer of the stomach
between epithel layer to mucus layer
toxins H.pylori produce?
cag A
vaculating cytotoxin a
trasmission of H.pylori?
oral-oral
facal-oral
usually occurs in first decade of life
what can antral predominant gastritis caused by H.pylori
deteriorate to?
asymptomatic H.infection
or
dudenal ulceration (HCL production is up)
what can non-atrophic pangastritis cause by H.pylori
deteriorate to?
asymptomatic H.infection
B-cells lymphoma
what can corpus (body) predominant atrophic gastritis cause by H.pylori deteriorate to?
asymptomatic H.infection
gastric ulcers
gastric cancer
location at which H.pyloric induced gastritis produce most HCL?
antral > non-atropic > adenocarcinoma
clinical outcomes of H.pyloric inflammation response?
d.ulcer
B-cell lymphoma
non cardia gastric adenocarcinoma
non invasive H.pyloric tests?
serology (not for iradication, after first possitive test all shall be positive ever on)
urea breath test
stool antigen
which test wont be used to check for H.pyloric eradication?
serology, after first possitive test all shall be positive ever on
H.pylori treatment?
PPI+ amoxicillin+clarithromicin+metronidazole (10-14 days)
PPI+ Bismuth + tetracyclin + metronidazole (10-14 days)
