stomach Flashcards by jouna alsaif

what is h pylori infection

gram negative urease producing spiral shaped bacterium found in gastric antrum and areas of gastric metaplasia in duodenum.

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h pylori infection is associated with what

chronic active gastritis
PUD
gastric cancer
gastric b cell lymphoma

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are most pts with h pylori infection symptomatic?

no most are asymptomatic aquire in childhood fecal oral route persist for life unless treated.

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patients with h pylori infection present with gastritis where are most located

1)ANTRUM
2)body of stomach ( atrophic gastritis)
3) some intestinal metaplasia (premalignant condition)

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gastric acid secretion in h pylori is increased by what

increased gastrin secretion
increased parietal cell mass
decrease somatostatin production due to antral gastritis

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what are non-invasive tests to diagnose h pylori

serology( serum antibody detection)
urea breath test
stool antigen

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invasive tests to diagnose h pylori

histology with direct visualization of h pylori (silver stain)
rapid urease test (CLO)

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eradication of h pylori indicated for who

all patients with
PUD
atrophic gastritis
gastric b cell lymphoma
gastric cancer resection
dyspepsia
first degree relative w gastric cancer

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what is treatment of H pylori

14 day regimen ppi triple therapy OMC
omeprazole
metronidazole
clarithromyocin

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quadruple therapy in H pylori

using bismuth chelate, omeprazole, metronidazole, tetracycline

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where does PUD mostly occur in

stomach or proximal duodenum

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what are more common duodenal or gastric ulcers

duodenal

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what is PUD

loss of mucosa and exposure of submucosa in or adjacent to acud bearing area

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causes of peptic ulcer disease

PEPTIC
pylori (h pylori infection)
excess NSAIDs (aspirin, ibuprofen)
Pain relief misuse ( chronic analgesic use)
tobacco and alcohol use
increased stress ( physiologic stress)
corticosteroids and Cushings (hypersecretion of acid)

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what are symptoms aggravating and releiving of peptic ulcer disease

burning epigastric pain
releived by antacids
associated with food : duodenal ulcers worse when hungry and at night
gastric ulcers worse with food
nausea
heartburn

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complications of h pylori

perforation (ant wall of duodenum)
painless hemorrhage (UGIB) -gastroduodenal artery involved
gastric outlet obstruction: from edema /scarring –> copious projectile vomitting

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endoscopy in h pylori is done for what

follow up endoscopy plus biopsy is performed for all GUs to demonstrate healing and exclude malignancy

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gastropathy symptoms

indigestion, vomiting, hemorrhage

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what is mucosal damage from use of aspirin or other NSAIDs and infections CMV and HSV

gastropathy

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what is the most commonn cause of gastritis

h pylori infection

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symptoms of gastritis

usually asymptomatic or functional dyspepsia

what is usually discovered incidentally

gastritis
when a gastric mucosal biopsy is taken at endoscopy .
mucosa may appear reddened or normal

in gastritis acute inflam is associated with what type of infiltration

neutrophilic infiltration

what are gastric polyps

growths that form in inner lining of stomach

what are types of polyps

1)hyperplastic polyps : associated w chronic gastritis minor risk of Ca 2)fundic gland polyps: found in upper stomach associated w PPI or FAP 3)adenomatous polpys: pre cancerous high risk of gastric cancer (usually in antrum) 4)Hamartomatous polyp: associated w genetic syndromes like peutz jeghers syndrome or juvenile polyposis

what are causes of gastric cancer

unknown h pylori and pernicious anemia->chronic gastritis-> atrophic gastritis --> premalignant intestinal metaplasia

gastric cancer tumors are most commonly where

in the antrum and almost always adenocarcinomas

what are two types of tumors

intestinal type 1: localized ulcerated lesions with rolled edges diffuse type 2 : diffuse with extensive submucosal spread, giving a picture of linitis plastica on histology: signet ring cells

what are symptoms of gastric cancer

pain simiar to PUD symptoms related to location of tumor tumor near pylorus present w outflow obstruction: vomitting tumors near cardia: vomitting and dysphagia

what is a sister mary joseph nodule

palpable epigastric mass , palpable nodule protruding from umbilicus

what is virchows node

lymph node is sometimes felt in supraclavicular fossa

where do gastrointestinal stromal tumor occur in

stomach and proximal small intestine

are GIST benign

previously considered benign but on follow up most have malignant potentials, slow growing tumors

histologically there are 3 subtypes of GIST

spindle epitheloid mixed/ pleomorphic

what is a pneumonic for GIST

G: gastric genes cKIT (CD117) , PDGFRA I: interstitial cells of cajal S: spindle cells, submucosal mass T: tyrosine kinase receptor

tx of gist

imatinib - Tyrosine kinase inhibitor used in advanced stages

gastric lymphomas mostly arise from what

MALToma

how is gastric lymphoma treated

usually by underlying cause mostly associated with h pylori so removing that would treat it

where is gluten found

wheat rye barely

what is a gluten sensitive enteropathy an autoimmune condition characterized by abnormal jejunal mucosa and distal duodenal mucosa

celiac disease

celiac disease is less likely to affect what part of the colon

the illeum

celiac disease has a strong association with which type of class

HLA class 11 ( HLA-DQ2 - HLA DQ8)

what are typical histological features seen in celiac disease

1)villous atrophy 2)crypt hyperplasia 3) increased number of lymphocytes in epithelial cells and lamina propria

what is the toxic portion in gluten

alpha- gliadin

explain what happens in celiac disease

1️⃣Gluten Enters the Gut • When a person with celiac disease eats gluten, it reaches the small intestine. 2️⃣ Gluten Triggers an Immune Response • A specific part of gluten called gliadin gets modified by an enzyme called tissue transglutaminase (tTG). • The immune system mistakenly sees gliadin as harmful and starts attacking it. 3️⃣ Immune System Attacks the Small Intestine • gliadin interacts with APC in LP via hladq2 and dq8 then Special immune cells (T-cells) get activated and cause inflammation • Autoantibodies (Anti-tTG, Anti-EMA, Anti-DGP) are produced, further damaging the intestine. 4️⃣ Damage to the Intestinal Villi

what are the two peaks of celiac disease

infancy (when they start eating gluten containing food) adults ( fifth decade)

during investigations what deficency do patients w celiac disease most likely have?

mild anemia 50% folate defecient Iron deficient

what are serum antibodies in celiac disease

1) BEST: IgA tissue transglutaminase antibodies (high sensitivity and specificity) 2) antiglandin 3) IgA endomyisial antibodies

untreated celiac disease can lead to what

hyposplenism pnemoccocal vaccine given to all patients

what is dermatitis herpetiformis

deposition of IgA at dermo-epidermal junction of skin including areas not involved in rash

how does dermatitis herpetiformis looks like

itchy symmetrical eruption of vesicles and crusts over extensor surfaces