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IM GASTRO > PUD > Flashcards

PUD Flashcards

1
Q

Gastroc mucosal Defense 3 Level Barrier

A
  • PREEPITHELIAL
    mucus bicarbonate e phospholipid layer surface epithelial cell
  • EPITHELIAL
  • SUBEPITHELIAL
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2
Q
  • generates hest shock proteins, trefoil factor family peptides and cathelicidins
  • restitution: EGF, TGF, FGF
  • has microvascular system that is the key component of subepithelial defense
A

EPITHELIAL SURFACE

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3
Q
  • 2 Principal gastric secretory products; capable of inducing injury
  • plays a role on digestion, absorption of iron and Vit B12 as well as killing bacteria
A
  • HCl
  • pepsinogen
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4
Q
  • occurs in basal and stimulated condition
  • the basal acid production occur in circadian rhythm (highest level during night, lowest during morning)
A

Gastric Secretion

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5
Q
  • influence by cholinergic input (vagus nerve) and histaminergic input (local gastric sources)
  • somatostatin, cholecystokinin, gherlin, obestatin, secretin, serotonin- plays a role in counterbalancing gastric acid secretion
A

Basal acid production

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6
Q

3 Phases of Gastric Secretion

  • sight, smell, taste of food
A
  • cephalic phase
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7
Q

3 Phases of Gastric Secretion

  • activated once food enters the stomach
A

gastic phase

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8
Q

3 Phases of Gastric Secretion

  • initiated as food enters the intestine
A

intestinal phase

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9
Q
  • located in oxyntic gland
  • also important in gastric secretory proceess
  • secretes intrinsic factor, IL11
  • express several stimulants of acid secretions (histamine 2, gastrin, Ach:M3)
  • express receptors for ligands that inhibit acid production (prostaglandins, somatostatin, EGF)
A

Parietal cell

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10
Q
  • responsible for generating large conc of H+
  • consist of alpha (active catalytic site) and beta subunit
  • usses chemical energy of ATP to transfer H+ ions from parietal cell cytoplasm to the secretory canaliculi
A

H+, K+- ATPase

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11
Q
  • found primarily in the gastric fundus
  • synthesizes and secretes pepsinogen- inactive precursor of pesin
  • pepsin activity significantly diminished at pH 4, irreversibly inactivated and denatured at pH >/=7
A

Chief cell

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12
Q

break in the mucosal surface >5mm in size w/ depth to the submucosa

A

Ulcer

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13
Q

most common risk factor

A

H. pylori & NSAIDs

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14
Q
  • often occur in the 1st portion, w/ 90% located w/in 3cm of pylorus
  • usually = to 1cm in diameter but occ’l can reach 3-6cm
  • sharply demarcated w/ depth at times reaching the muscularis propia
  • the base often consist of zone of eosinophilic necrosis w/ surrounding fibrosis
A

Duodenal Ulcer

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15
Q

account for the majority of DU

A

H.pylori and NSAID

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16
Q
  • attributed to either H.pylori or NSAID induced mucosal damage
  • gastric acid output tends to be normal or decreased
  • abnormalities in resting and stimulated pyloric sphincter pressure w/ increase in duodenal gastric reflux
A

Gastric Ulcer

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17
Q

Classification of Gastric Ulcer
-Type I
-Type II
- TYpe III
- Type IV

A
  • Type I: gastric body; ass w/ low gastric acid production
  • Type II: antrum; gastric acid vary from low to normal
  • Type III: occur w/in 3cm of pylorus; acccompanied by duodenal ulcerl normal -high gastric acid production
  • Type IV: found in cardia; low gastric acid secretion
18
Q

2 factors that predispose to high colonization rate

A
  • poor socioeconomic status
  • less education
19
Q

MOT of PUD

A
  • person-person
  • oral-oral
  • fecal-oral
20
Q

Risk Factors for H.pylori Infection

A
  • birth or residence in developing country
  • domestic crowding
  • unsanitary living condition
  • unclean food or water
  • exposure to gastric contents of an infected individual
21
Q

Pathogenic Factors Unrelated to H.pylori and NSAID in Aic Peptic Disease

A
  • cigarette smoking
  • genetic
  • diet
  • systemic mastocytosis
22
Q

Infection Causes of Ulcers

A
  • CMV
  • HSV
  • H. heilmannii
23
Q

Drug/Toxin Causes of Ulcers

A
  • biphosphonates
  • chemo
  • clopidogrel
  • crack cocaine
  • glucocorticoids
  • mycophenolate mofetil
  • KCl
24
Q

Clinical Features of PUD

A
  • abdominal pain: epigastric (burning or gnowing)
  • nausea & weight loss
  • tarry stools or coffee ground emesis
25
Q

Physical Exam in PUD

A
  • epigastric pain
  • tachycardia & orthostasis
  • presence of a succusion splash
26
Q

PUD related complications

A
  • GI bleeding: mc
  • perforation: 2nd
  • gastric ooutlet obstruction
27
Q

Dx Evaluation of PUD

A
  • Barium study
  • endoscopy
28
Q

Test for Detection of H.pylori
Invasive

A
  • rapid urease
  • histology
29
Q

Test for Detection of H.pylori
Non Invasive

A
  • serology
  • urea breath test
  • stool antigen
30
Q

Tx of PUD

A
  • eradication of H. pylori & therapy prevention of NSAID induced dse
  • acid suppressing drugs: antacids, H2 receptors antagonists, PPI
  • mucosal protectives
31
Q

Surgery that is performed only in DU

A

Vagotomy

32
Q

severe peptic diathesis secondary to gastric acid hypersecretion due to unrerlated gastrni release frm a non-beta cell endocrine tumor

A

Zollinger ELisson Syndrome

33
Q

Manifestation of Zollinger Ellison Syndrome

A
  • PUD-mc
  • diarrhea
34
Q

When to obtain fasting serum gastrin?

A
  • multiple ulcers
  • ulcers in unsual locations
  • ulcer px awaiting surgery
  • extensive fam hx for PUD
  • post 0- ulcer recurrence
    -basal hyperchloridria
  • unexplained diarrhea/ steathorrea
    -hypercalcemia
  • fam hx of pancreatic islet, pituitary, parathyroid tumor
  • prominent gastric/duodenal folds
35
Q

Tx for Zollinger Ellison Syndrome

A
  • directed at ameliorating the signs and symptoms related to hormone overproduction
  • PPI: tx of choice
  • surgery
36
Q

presence of inflammatory cell infiltrates (lympho, plasma cells, neutro)

A

Chronic Gastritis

37
Q

Types of Chronic Gastritis
- Superficial
- Atrophic
- Gastric atrophy
- Type A
- type B

A
  • Superficial: early phase
  • Atrophic: inflamm infiltrates extends deeper into the mucosa
  • Gastric atrophy: glandular structure are lost, there is a paucity of inflamm infiltrates
  • Type A: autoimmune, body predominant
  • type B: H.pylori related, antrall predominant
38
Q

Tx for Gastritis

A

aimed at the sequelea and not the underlying inflamm

39
Q

Miscellaneous form of gastritis
- lymphocytic:
- Eosinophilic:
- russel body:

A
  • lymphocytic: unknown etiology, described in px w/ celiac sprue
  • Eosinophilic: markerd eosinophilic infiltration involving any layer of the stomach
  • russel body: mucosal lesion of unknown etiology
40
Q
  • pseudotumural appearance
  • presence of numerous plasma cell containing RB that expresses kappa and lambda light chains
A

Russel body gastritis

41
Q
  • rare entity char. as large, totous gastric mucosal folds
  • massive foveolar hyperplasia
  • epigastric pain, nausea, vomit, anorexia, wt loss
  • gastric acid secretion reduced or absent
  • endoscopy w/ deep mucosal biopsy is required to dx
A

Menietriers dse

42
Q

Tx foe Menietriers dse

A
  • medical therapy- anticolinergic agents, prostaglandins, PPI, predisone, H2 receptr antagonist
  • subtotal gastrectomy

IM GASTRO (10 decks)

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