Stomach Flashcards by k k

HCl secretion importance

denatures proteins, protect from infection, absorption of Fe/B12

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What triggers slowing in gastric emptying

decreased pH (acid), fatty acids and caloric density, increase in osmolality

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Types of Gastritis

infectious, lymphocytic, Eosinophilic, gastritis associated with systemic disease

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Autoimmune Atrophic Gastritis

autoimmune attack against parietal cells, IF

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Causes of Infectious gastritis

Bacterial (H pylori, syphilis, TB)
Fungal (candidiasis, aspergillosis, histoplasmosis, mucormycosis)
Parasitic (giardia, cryptospyridia, etc)
Viral (CMV)

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Peptic ulcer disease original hypothesis

thought to be all from stress-lifestyle –>increased acid

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Helicobacter pylori

most common human bacterial infection, which is life-long for most–most asymptomatic
- makes urease enzyme to neutralyze stomach acid by creating ammonia from urea

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Strain of H pylori associated with pathogenicity

CagA
- associated with duodenal and gastric ulcers

VacA– exotoxin, pores in membrane, inhibit T cells

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H pylori risks

Gastric cancer
gastic lymphoma
atrophic gastritis
Peptic ulcer

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Chronic gastritis

presence of mononuclear inflammatory (lymphocytes and plasma cells) cells within lamina propria

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Progression of gastritis

Colonized mucosa –> superficial gastritis – gastric atrophy– intestinal metaplasia – dysplasia – gastric adenocarcinoma

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Antral predominant infection associated with

acid secretion adn duodenal ulcer (DU)

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Duodenal ulcer (DU)

gastric metaplasia in duodenum (H pylori colonize –>inflammation –> cell damage –>ulcer)

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what is severity of body gastritis correlated with

acid secretion inversely correlates with severity of gastric body gastritis

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Diagnosis of H pylori

Endoscopy Mucosal biopsy
- Histology, Rapid urease test

No mucosal biopsy required
- Blood antibody test, stool antigen test, urea breath test (not as common)

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Treat H pylori infection

triple therapy (PPI + clarithromycin + amoxicilin 10-14 days)
Rescue quadruple therapy (PPI + metronidazole + tetracycline + bismuth)
Sequential therapy

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when to treat H pylori

Peptic ulcer disease, gastric lymphoma, fam hx of gastric carcinoma, whenever diagnosed??

Other causes of gastritis

Non H pylori infection – uncommon (CMV, Candidiasis, Aspergillosis, etc)

Eosinophilic (

- can have ulceration
- early satiety, nausea, vomiting
- increased eos in blood    - rare, cause unknown

Thickened folds

H. pylori, neoplasia, Menetrier’s disease, lymphocytic infiltration, acid hypersecretory states

Menetrier’s Disease

very very rare; increased mucous secretion, decreased acid; abdominal pain, weight loss, bleeding, hypoalbuminemia

Non-inflammatory Epithelial cell injury also called…

Gastropathies

Gastropathy

gastroduodenal injury in absence of significant inflammation

NSAIDs
Ethanol
Stress ulceration
Cocaine
Bile reflux

ethanol gastropathy

similar to NSAID type injury; disrupts mucosa and increased acid secretion
- PUD with high concentration (>10%), high amounts of use, NSAID use

GI side effets of NSAID use

heartburn, nausea, vomiting, abdominal pain; mucosal lesions - 20% in 3 months

GI complications– perforated ulcers or GI bleeding

Gastric protective mechanisms

ALL PG dependent - mucous layer thickness - cell membrane hydrophobicity - bicarb secretion - mucosal blood flow - epithelial cell migration/proliferation

Stress ulcers

ICU patients - CNS injury (cushing's ulcer), Burns (Curling's ulcer), prolonged mechanical ventilation > 48 hours, coagulopathy - fundus and body, impaired mucosal protection, incerased acid secretion

Peptic ulcer complications

abdominal pain, anemia, bleeding, acute bleed (hematemesis melena--black tarry smelly stool), perforation (5% lifetime), Gastric outlet obstruction-duodenal ulcer

Treatment of Severe PUD -acute bleeding

- IV resuscitation -->restore IV volume - acid suppression - PPI drip (improves clotting) - Endoscopy - Angiography- coils Surgery

Treatment of severe PUD with perforation

Surgery

Treat PUD

PPI therapy, H pylori test and treat, risk factor avoidance (NSAIDs, smoking, chronic PPI if NSAID needed for cardiac disease)

Types of gastric neoplasms

polyps, adenocarcinoma, stromal tumors, neuro-endocrine tumors, lymphoma

Gastric polyps

Hyperplastic, adenomia, fundic gland polyps (common-benign and unrelated o H pylori)

Hyperplastic gastric polyps

found near gastritis ulcer; rare,malignant potential (>1 cm)

Adenoma (gastric polyp)

Premalignant, FAP

Fundic gland polyps

type of gastric polyp associated with chronic PPI use; benign and unrelated to H pylori

2nd most common cancer world-wide

gastric Adenocarcinoma

2nd most common cause of death from cancer world-wide

gastric adenocarcinoma

Gastric cancer treatment

Surgery (endoscopic removal for stage 0), Chemo, Radiation

GIST

distinct stromal tumor ---most common in mesenchymal tumor of stomach (60%) - Leiomyomas NOT GISTs

Treatment of GIST

Gleevec

Prognosis of GIST compared to other stromal tumors

WORSE

GISTs

cell of origin = interstitial cell of Cajal (pacemaker) + for c-kit (CD117) mutation in transmembrane receptor tyrosine kinase (RTK)