Sketchy Path: Acute and Chronic Gastritis

Question 1

Two ways NSAIDs cause acute gastritis

Answer 1

Direct Mucosal Injury and decrease in COX which decreases prostaglandin synthesis and decreases mucosal protestion

Question 2

Besides NSAIDs, what two other substances have a direct toxic effect on mucosal epithelium?

Answer 2

Alcohol
Smoking
(guy NSAID fire-extinguisher smoking and drinking)

Question 3

What is the definition of erosion?

Answer 3

Thru the epithelium and lamina propria (Shallow Pot hole)

Question 4

What is the definition of ulcer?

Answer 4

Thru the epthelium, lamina propria, muscularis mucosa and into submucosa (Deeper pot hole with the rebar layer representing the muscularis mucosa)

Question 5

Curling ulcers develop when? What causes them?

Answer 5

Severe burns
(guy burns his hand on curling rebar)
Caused by hypovolemia which decreases blood flow to the mucosa leading to increase risk of damage
(Guy pooring water on the workers burned hands)

Question 6

Cushing ulcer occur when?

What causes them?

Answer 6

Cushing ulcers occur during increase ICP
(bucket falling on the mans head)
Increase stimulation of the vagus nerve stimulates gastrin leading to the parietal cells to secret acid
(Las Vagus billboard above guy who hit his head on bucket)

Question 7

Most common cause of Chronic Gastritis?

Answer 7

H. Pylori

H pylori helicopter

Question 8

Where do you find H pylori in the stomach? Location and layer

Answer 8

Most commonly found at the antrum (Helicopter lands near antrum)
comma shaped organism is found below the mucosa on the gastric epithelium
(Helicopter lands in puddle with comma shaped organism and is seen going thru the mucosa to sit on the concrete)

Question 9

Prominent infection with H Pylori shows what type of infiltrate?

Answer 9

Neutrophils

Neutrophil first responders running to the old man’s house

Question 10

Chronic infection with H pylori leads to what other disease?

Answer 10

Chronic atrophic gastritis-mucosal atrophy and decrease in gastrin and acid production
(thinning clothes hanging on clothes hanger)

Question 11

Chronic infection of H pylori does what to the gastric mucosa?

Answer 11

Intestinal Metaplasia with prominent goblet cells

Columnar wood beams surrounding old mans house

Question 12

Chronic H pylori infection can lead to the development of what type of cancer?

Answer 12

MALT lymphoma due to accumulation of lymphoid tissue

Pile of blue tissue paper by the helicopter

Question 13

How can you diagnose H pylori

Answer 13

Biopsy (guy holding stick in the puddle under the helicopter)
Urea breath test (guy spraying urease bottle with cloud of yellow smoke)

Question 14

Pathophys of autoimmune gastritis?

Answer 14

Autoantibodies attack the parietal cells of the stomach leading to a decrease in acid and intrinsic factor but an increase in gastrin
(Ab forklift with gatrin gas tank attacking the “parietal protestors” causing them to drop there lemons and “no intrinsic right “ sign)

Question 15

Autoimmune gastritis, also called autoimmune metaplastic atophic gastritis, can case what RBC disorder?

Answer 15

Megaloblastic Anemia due to decrease B12 from no intrinsic factor
(Protestors with her “No mega Blast” sign)

Question 16

What usually develops over a background of chronic gastritis?

Answer 16

PUD

Public Utilitis Department sign

Question 17

Gastric Ulcers usually occur where in the stomach?

Answer 17

Lesser curvature

Ulcer pothole in the lesser curvature of the asphalt stomach

Question 18

H pylori medaited chronic gastritis leads to destruction of what cells?

Answer 18

Delta Cells which decreases the release of somatostatin which leads to uninhibited gatrin secretion
(Helicopter knocks over Somatostatin stop sign- worker unloading gastrin gas tanks next to stop sign)

Question 19

What leads to duodenal ulcers in chronic gastritis?

Answer 19

Increase release of acid from the stomach to the duodenum

Acid pool flowing from gastrin worker into duodenal portion of construction zone

Question 20

For gastric ulcers does the pain get worse or better with eating?

Answer 20

Worse

guy eating over the gastric ulcer in lesser curvature

Question 21

Gastric ulcer or duodenal ulcers are more likely to cause bleeding?

Answer 21

Gastric Ulcers are more likely to bleed from the left gastric artery
(Pipe with blood from the gastric ulcer is much larger than that of the duodenal

Question 22

Gastric ulcer or duodenal ulcer is more likely to perforate?

Answer 22

Anterior Duodenal Ulcer

Pipe with air coming out of it is much larger in the duodenal ulcer

Question 23

Melena occurs in what type of GI bleed?

Answer 23

Upper- before ligament of Tritz

Tarry substance coming from the truck

Question 24

Inflammation of the pylorus during PUD can lead to what?

Answer 24

Gastric Outlet obstruction

Path obstructed sign near pylorus

Question 25

Perforation of ulcer causes what type of pain?

Answer 25

Refereed pain to the shoulder due to the phrenic nerve

Suspenders pops off shoulder in worker inside the duodenal ulcer

Question 26

Ulcer perforation shows what on Xray?

Answer 26

Radiolucency (dark) between the hemidiaphragm and the liver on the right side
(Construction workers belt)

Question 27

Why is a biopsy done on those with PUD?

Answer 27

Rule out malignancy

guy holder crab on the border of the PUD ulcer