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DIT topics > stomach > Flashcards

stomach Flashcards

1
Q

parietal cells in stomach secrete

A

intrinsic factor

gastric acid

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2
Q

chief cells in stomach secrete

A

pepsinogen

activated by gastric acid to pepsin

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3
Q

G cells in stomach secrete

A

gastrin

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4
Q

mucosal cell cells in stomach secrete

A

HCO3

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5
Q

gastrin-secreting tumor (gastrinoma) usually in pancreas → ↑ gastric acid → recurrent duodenal ulcers

A

Zollinger-Ellison syndrome

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6
Q

pancreatic gastrinoma (seen in Zollinger-Ellison syndrome) is associated with

A

MEN type I

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7
Q

complications of chronic gastritis due to autoimmune destruction of parietal cells (called pernicious anemia)

A

no IF → vitamin B12 deficiency:
megaloblastic anemia
peripheral neuropathy
dementia

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8
Q

drugs that are potent stimulators of gastrin release from G cells of stomach → ↑gastrin → ↑H+ →GERD → ulceration

A

phenylalanine
tryptophan
hypercalcemia

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9
Q

sites of HCO3 secretion to neutralize acid in GI tract

A

mucosal cells - stomach, duodenum (S cells), salivary glands, pancreatic duct
Brunner glands - duodenum

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10
Q

treatment of ZE syndrome

A

PPI +/- octreotide (if tumor has octreotide R)

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11
Q

↑ gastric acid production or ↓ HCO3/mucosal lining →

breakdown of mucosal lining → inflammation of stomach

A

acute gastritis

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12
Q

causes of acute gastritis

A

NSAIDs and aspirin (inhibit COX - inhibit PG - ↑H, ↓PG)
alcohol
burns (curling ulcer)
brain injury (cushing ulcer)

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13
Q

type of ulcer associated with burn injury

A 
curling ulcer (like curling iron)
stress of burn →↓ mucosal lining production →ulcer → acute gastritis
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14
Q

type of ulcer associated with brain injury

A

cushing ulcer

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15
Q

causes of chronic gastritis

A

H. pylori (spiral shaped, in gastric glands)

autoimmune destruction of gastric parietal cells

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16
Q

H pylori in gastric glands

neutrophils + lymphocytes invading gastric glands

A

chronic gastritis

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17
Q

complication of chronic gastritis due to H.pylori

A

↑ risk of:
MALT lymphoma (due to chronic lymphocyte infiltration)
gastric cancer

18
Q

stomach biopsy shows neutrophils above BM, loss of surface epithelium, fibrin-containing purulent exudate

A

acute gastritis

19
Q

stomach biopsy reveals lymphoid aggregates in lamina propria, columnar absorptive cells, atrophy of glandular structures

A

chronic gastritis

20
Q

diffuse thickening of gastric folds, elevated serum gastrin levels, biopsy reveals glandular hyperplasia without foveolar hyperplasia

A

ZE syndrome (gastrin secreting tumor of pancreas)

21
Q

causes of gastric ulcers

A

H pylori - 70% (↓ mucosal protection)

NSAIDs (gastritis → ulceration)

22
Q

gastric acid erodes through mucosa into submucosa

A

if in stomach: peptic ulcer

in duodenum: duodenal ulcer

23
Q 
upper abdominal and epigastric pain AFTER eating (↑ H production after eating)
weight loss (avoid eating)
A

gastric ulcer

24
Q

complication of gastric ulcers (due to H. pylori or NSAIDs)

A

↑ risk gastric cancer (take biopsy around ulcer to ensure no cancer)

25
Q 
upper abdominal and epigastric pain RELIEVED by eating (HCO3 production in duodenum after eating)
pain returns several hours after eating
weight gain (eating makes it better)
biopsy: clean, smooth borders with H.pylori in ulcer, hypertrophy of Brunner glands in duodenum (submucosal)
A

duodenal ulcer

26
Q

causes of duodenal ulcers

A

H. pylori (↓ mucosal protection) - 95%

ZE syndrome - rare - (secrete gastrin - ↑ gastric acid)

27
Q

complications of gastric + duodenal ulcers

A

ulcerate into vessel → hemorrhage

perforation (esp duodenal ulcers) → peritonitis

28
Q

treat actively bleeding peptic ulcer

A

somatostatin (octreotide) ↓ splanchnic blood flow

29
Q

most common cause of gastric + duodenal ulcers

A

H pylori

30
Q

treatment for irradicating H pylori

A

triple therapy:
PPI + clarithromycin + amoxicillin (if pen allergy: metronidazole)
quad therapy (if resistance to clarithromycin):
PPI + bismuth + metronidazole + tetracycline

31
Q

treatment for neutralizing gastric acid to protect stomach + ↓ gastric acid secretion (prevent gastric ulcers, also adjuncts for H. pylori infection)

A 
neutralize stomach acid: antacid
↓ gastric acid secretion: H2 blockers, PPIs
less commonly used: 
bismuth + sucralfate
misoprostol
32
Q

precursor to gastric adenocarcinoma
hypertrophy of mucus producing cells → rugae look like gyri of brain
atrophy of parietal cells → ↓ gastric acid production
enteric protein loss → hyopalbuminemia → edema

A

Menetrier disease

33
Q

most common type of cancer in GI tract

A 
adenocarcinoma
except esophagus (can have esophageal squamous cell carcinoma in smokers too)
34
Q

risk factors for gastric adenocarcinoma

A 
H pylori infection
chronic gastritis
nitrosamines (cured, smoked)
men >50 yo
japanese people in Japan
35
Q

weight loss +

mass in L supraclavicular node (Virchow node)

A

metastasis of GI cancer (usually gastric adenomcarcinoma)

36
Q

metastasis of gastric adenomcarcinoma

A 
L supraclavicular node (Virchow node)
periumbilical node (sister mary joseph nodule)
mets to bilateral ovaries (Krukenberg tumor)
37
Q

> 40 yo with new acanthosis nigricans (velvety darkening of skin, near neck)

A

diabetes

50% have visceral malignancies: stomach cancer

38
Q

signet ring cells: mucous in cytoplasm pushes nucleus to periphery

A

1) gastric adenocarcinoma
may be from ovary biopsy (krukenberg tumor - gastric cancer with mets)
mucous in cytoplasm pushes nucleus to periphery
2) lobular carcinoma in situ (LCIS) or invasive lobular carcinoma

39
Q

pylorus hypertrophied → narrowed gastric outlet → ↓ stomach emptying
nonbillious projectile vomit
presents 2-6 wks of age
palpable olive structure in epigastric region
most common in firstborn males, most common congenital surgery in 1st mo of life

A

congenital pyloric stenosis

40
Q

diarrhea can cause

A

hypokalemia

41
Q

prolonged vomitting (days-wks) can cause

A

vomit HCl from stomach →
hypochloremia
metabolic alkalosis (low serum H+ concentration) → correct alkalosis in serum at K/H exchanger: cells release H+ from cells to serum, K+ from serum to cell → hypokalemia (vs acidosis: H+ out → hyperkalemia)

42
Q

treatment of Zollinger-Ellison syndrome

A

high dose PPI

sporadic: surgery to resect
metastatic: somatostatin analog (octreotide), IFN, chemo, radiothearpy

DIT topics (115 decks)

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