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MHD > Stomach > Flashcards

Stomach Flashcards

1
Q

foveolar cells

A

mucin secreting cells

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2
Q

How does the stomach protect itself against its acidity?

A

mucin
bicarbonate secreted by surface epithelium
vascular supply

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3
Q

Omphalocele

A
  • persistent herniation of bowel into umbilical cord
  • failure of abdominal wall to return to body cavity during development
  • covered by peritoneum and amnion of cord
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4
Q

Gastroschisis

A

malformation of abdominal wall causing exposure of abdominal contents

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5
Q

Pyloric stenosis

A

congenital hypertrophy of smooth muscle of pylorus

  • more common in males
  • projectile vomiting in first 2-6 weeks of life
  • visible peristalsis
  • olive-like mass in abdomen
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6
Q

What are 6 general causes of abdominal pain?

A
  1. gastritis
  2. peptic ulcer disease
  3. gastroesophageal reflux disease (GERD)
  4. biliary colic
  5. irritable bowel syndrome
  6. pancreatitis
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7
Q

What are 4 symptoms of gastritis?

A
  1. nausea
  2. vomiting
  3. hematemesis-vomiting of blood
  4. epigastric pain
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8
Q

What leads to gastritis?

A

injury or impaired defenses

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9
Q

What is acute gastritis?

A
  1. transient process
  2. nausea, vomiting, epigastric pain
  3. superficial, erosive, ulcerative
  4. severe cases may hemorrhage
  5. Impairment of protective system: NSAIDs, ingestion, direct injury

-neutrophilic infiltrate

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10
Q

What is the treatment of acute gastritis?

A

removal of offending agent
pharmacologic acid blockade
tincture of time

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11
Q

What is chronic gastritis? What are the main causes?

A

more persistent
-most common cause is H pylori infection
other causes:
-autoimmune

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12
Q

What increases the risk for an H pylori infection? What are the 4 modes of virulence? What is the most common location of H pylori infection? What does H pylori increase the risk for?

A

Increased risk of infection

  • poverty
  • household crowding
  • limited education
  • AA or MA ethnicity
  • Poor sanitation
  • Birth outside US

Four modes of virulence:

  1. Flagella
  2. Secretion of ureases
  3. Adhesins
  4. Toxins

Antrum most common location

Increased risk of:
1. gastric adenocarcinoma due to intestinal metaplasia

  1. MALT
    - lymphoid aggregates seen in MALT-subeptihelial plasma cells
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13
Q

How is the diagnosis of H pylori made?

A
  1. biopsy
  2. serologic testing for h pylori antibodies
  3. fecal detection
  4. urea breath test
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14
Q

What is the treatment of H pylori?

A

Triple

  1. PPI
  2. Amoxicillin
  3. Clarithromycin

Quadruple

  1. PPI
  2. Bismuth
  3. Tetracycline
  4. Metronidazole

Sequential therapy first

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15
Q

Chronic Gastritis: Autoimmune

A

SPARES THE ANTRUM

  • antibodies to parietal cells and intrinsic factor
  • vitamin b12 deficiency due to loss of IF–>pernicious anemia
  • decreased pepsinogen 1 level due to loss of chief cells
  • defective gastric acid secretion (achlorhydria)
  • median age 60 years
  • slight female>male
  • increased risk of adenocarcinoma due to intestinal metaplasia
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16
Q

What does the decreased acid production seen in autoimmune gastritis lead to?

A

increase in gastrin release

and hyperplasia of antral G cells

17
Q

What are symptoms of acute peptic ulcer disease? What are the causes of specific types of ulcers? What do the ulcers look like?

A

nausea, vomiting, coffee-ground hematemesis

stress ulcer: shock, sepsis, severe trauma
curling ulcers: severe burns, trauma
cushing ulcers: intracranial disease

ulcer are typically

18
Q

What are they symptoms of chronic peptic ulcer disease?What are most often the causes?

A

Epigastric burning or aching pain occurring 1-3 hours after eating, worse at night, relieved by alkali or food
may also have nausea, bloating, belching

Most often due to

  1. H pylori
  2. NSAIDS

Location

  • Most common in proximal duodenum and antrum (4:1)
  • solitary in 80% of cases

Ulcer
-Sharply punched out defect, clean base

-perforation is complication

19
Q

What is the treatment acute peptic ulcer disease?

A 
stress ulcer prophylaxis with PPI or H2 blocker
Target patients:
Mechanical ventilation 
Severe burns 
Trauma
Severe sepsis
Intracranial injury 
Coagulopathy 
-acid blocking agents
-treat underlying condition
20
Q

How do you treat chronic peptic ulcer disease?

A

Eradication of H pylori if present
Remove offending agent
Surgery may be needed for bleeding or perforation

21
Q

Zollinger Ellison Syndrome

A

-multiple ulcerations in GI tract due to hypersecretion of gastrin by tumor

22
Q

What are risk factors for chronic peptic ulcer disease?

A
  1. NSAIDs
  2. Cigarette smoking
  3. high-dose corticosteroids
  4. alcoholic cirrhosis
  5. COPD
  6. Chronic renal failure
  7. Hyperparathyroidism
  8. Psychological stress
23
Q

Fundic gland polyps

A

Sportic or associated with familial adenomatous polyposis

  • -cystically dilated irregular glands lined by flattened parietal and chief cells
  • well circumscribed and multiple
  • located in the body and fundus
  • not necessarily related to chronic gastritis
  • not neoplastic
  • males=females
  • any age
24
Q

Inflammatory and hyperplastic polyps?

A 
50-60 years 
male=female
-higher neoplastic risk when >1.5 cm
-related to chronic gastritis
-any location in stomach
-multiple ovoid in shape,
25
Q

Gastric adenoma polyp?

A

50-60 years

  • male 3x more
  • risk higher when >2 cm
  • related to chronic gastritis
  • ANTRUM
  • intestinal type epithelium with variable degrees of dysplasia
  • carcinoma can be present in up to 30% of adenomas
26
Q

Extranodal lymphomas occur commonly in the GI tract especially the stomach what is a type of lymphoma that occurs?

A

Mucosa-associated lymphoid tissue (MALT)

-marginal zone b cell lymphomas

27
Q

Carcinoid tumor arise from what? Where do they occur? What location is the most aggressive?
When is the peak incidence? What does carcinoid syndrome indicate?

A
  • arise from neuroendocrine cells (G cells in the stomach)
  • 40% occur in small intestine
  • most agressive in midgut
  • 60s
  • carcinoid syndrome indicate metastasis
28
Q

GIST: gastrointestinal stromal tumor

neoplasm of what?

A

Mesenchymal neoplasm of interstitial cells of Cajal: pacemaker cells for the cut
>50% in stomach

29
Q

What do GIST look like?

A

solitary, well circumscribed fleshy, submucosal mass
Males>females
60s
75-80% gain of function mutation in gene encoding tyrosine kinase c-KIT
-symptoms related to mass effect or mucosal ulceration

30
Q

What is the treatment of GIST?

A

Surgical resection if possible

Imatinib-inhibits tyrosine kinase activity of c-KIT and PDGRFA

31
Q

Gastric Adenocarcinoma causes:

A
  1. H pylori infection
    - chronic gastritis–>proinflammatory proteins
  2. Epstein Barr virus
    - 10% of cases; unclear mechanism
    - proximal stomach, marked lymphocytic infiltrate
  3. Mutations
    - Germline mutation of CHD1 causing loss of E cadherin function (diffuse type)
    - Familial adenomatous polyposis coli: mutations in APC genes (intestinal type)
32
Q

Intestinal Gastric Adenocarcinoma

A 
Bulky
Glandular structures, exophytic mass or ulcerated tumor 
55 yrs old
Male X2
Incidence higher in high-risk areas
33
Q

Diffuse Adenocarcinoma

A

-infiltrative growth, discohesive cells with large mucin vacuoles
-signet ring cells
-linitis plastica caused by desmoplastic reaction
-incidence same regardless of geography
males=females

34
Q

What is the treatment for gastric adenocarcinoma?

A

surgical resection when possible; chemo minimally effective

-prognosis based on extent of nodal involvement whether metastasis is present at diagnosis

35
Q

Metastatic gastric adenocarcinoma spread to the left supraclavicular node is called?

A

virchow node

36
Q

Metastatic gastric adenocarcinoma often has distant metastases where?

A

liver

37
Q

Metastatic gastric adenocarcinoma spread to periumbilical region it’s called?

A

sister mary joseph nodule (intestinal type)

38
Q

Metastatic gastric adenocarcinoma spread to bilateral ovaries it’s called?

A

krukenberg tumor (diffuse type)

MHD (81 decks)

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