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GI > stomach and duodenum - peptic ulcer > Flashcards

stomach and duodenum - peptic ulcer Flashcards

1
Q

what is upper area of stomach called

A

fundus

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2
Q

where is food broken up in the stomach

A

body and antrum

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3
Q

what are the 3 layer of the stomach

A
  • outer longitudinal
  • inner circular
  • innermost oblique layers
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4
Q

what is the pyloric sphincter made up of

A

thickening of the circular muscle layer

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5
Q

what does the mucosa of the upper two thirds of the stomach contain

A
  • parietal cells

- chief cells

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6
Q

what do parietal cells secrete

A

hydrochloric acid

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7
Q

what do chief cells secrete

A

pepsinogen

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8
Q

what does the antral mucosa secrete

A

bicarbonate

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9
Q

what do G cells secrete

A

gastrin

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10
Q

what is somatostatin

A

a suppressant of acid secretion

produced by D cells

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11
Q

what is the mucus made up of

A

glycoproteins called mucin

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12
Q

do prostaglandins stimulate or inhibit secretion of mucus

A

stimulate

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13
Q

what inhibit prostaglandins

A
  • aspirin

- NSAIDs

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14
Q

is acid essential for digestion

A

no

but it prevents some food-borne infections

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15
Q

what do acetylcholine and gastrin release

A

histamine via enterochromaffin cells

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16
Q

what does somatostatin inhibit

A

histamine and gastrin release

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17
Q

what are the 3 phases of acid secretion

A
  1. cephalic
  2. gastric
  3. intestinal
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18
Q

what is cephalic phase

A

thought, sight and smell of food stimulate the vagus, producing acetylcholine

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19
Q

what is gastric phase

A

distension of food directly stimulates secretory cells and gastrin release

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20
Q

what is intestinal phase

A

passage of food into duodenum stimulates GI hormone release

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21
Q

what do osmoreceptors in duodenal mucosa control

A

gastric emptying by local reflexes and release of gut hormones

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22
Q

what does intraduodenal fat do to gastric emptying

A

delays it

by negative feedback

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23
Q

what is gastritis

A

inflammation associated mucosal injury

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24
Q

what does gastropathy indicate

A

epithelial cell damage and regeneration without inflammation

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25
Q

what is most common cause of gastritis

A

H.pylori

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26
Q

what can chronic inflammation due to H.pylori lead to

A

gastric intestinal metaplasia, precursor to gastric cancer

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27
Q

where does autoimmune gastritis affect in the stomach

A

fundus and body

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28
Q

what does autoimmune cause loss of

A

parietal cells

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29
Q

what is gastropathy caused by

A
  • irritants
  • bile reflux
  • chronic congestion
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30
Q

what is helicobacter pylori

A

gram-negative

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31
Q

what does H.pylori play a major role in

A
  • gastritis

- peptic ulcers

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32
Q

where is H.pylori found

A

in gastric pits

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33
Q

when is H.pylori usually acquired

A

childhood

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34
Q

what factors increase duodenal ulceration

A
  • increased gastrin secretion
  • smoking
  • bacterial virulence
  • genetic susceptibility
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35
Q

what are gastric ulcers associated with

A

gastritis

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36
Q

what does gastritis cause loss of

A
  • parietal cells

- acid production

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37
Q

what is a peptic ulcer

A

break in the superficial epithelial cells penetrating down to the muscular mucosa

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38
Q

where can peptic ulcers occur

A

stomach or duodenum

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39
Q

what are characteristics of peptic ulcer

A
  • fibrous base

- increase in inflammatory cells

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40
Q

what are erosions

A

superficial breaks in mucosa alone

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41
Q

where are duodenal ulcers usually found

A

in duodenal cap

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42
Q

where are gastric ulcers usually found

A

lesser curve near incisura

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43
Q

what are more common duodenal ulcer or gastric ulcers

A

duodenal

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44
Q

who are common to get peptic ulcers

A

elderly

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45
Q

symptoms of peptic ulcer

A
  • recurrent, burning epigastric pain
  • nausea
  • vomiting
  • anorexia
  • weight loss
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46
Q

when does duodenal pain occur

A

at night - worse when hungry

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47
Q

how is pain for peptic ulcers relieved

A

by antacids

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48
Q

what does back pain with peptic ulcers suggest

A

penetrating posterior ulcer

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49
Q

how to diagnose H.pylori

A
  • serological tests
  • C-urea breath test
  • stool antigen
  • biopsy urease test
  • histology
  • culture
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50
Q

what does serological test for H.pylori detect

A

IgG antibodies

- can be found in saliva

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51
Q

what is the most reliable test for H.pylori

A

urea-breath test

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52
Q

what happens if H.pylori is present what happens

A

the urease enzyme that the bacteria produce splits the urea to release ammonia

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53
Q

what must you rule out first in patients with peptic ulcers in older people

A

you must exclude cancer before starting eradication therapy

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54
Q

what is the treatment for peptic ulcer

A

H.pylori eradication

55
Q

what are the H.pylori eradication medications

A
  • omeprazole + clarithromycin + amoxicillin

- omeprazole + metronidazole + clarithromycin

56
Q

how long is treatment for H.pylori eradication

A

2 weeks

57
Q

what should be used for clarithromycin resistance

A

bismuth chelate
metronidazole
tetracycline
PPI

58
Q

what should be done to check for eradication

A

breath or stool test should be performed

6 weeks after end of treatment

59
Q

what should strongly be encouraged to be stopped for a peptic ulcer

A

smoking

60
Q

how does smoking have a negative effect on peptic ulcer healing

A

it slows mucosal healing

61
Q

what perforates more duodenal or gastric ulcers

A

duodenal

62
Q

what is usually performed to close perforations

A

laparoscopic surgery

63
Q

what are 2 other H.pylori associated diseases

A
  • gastric adenocarcinoma

- gastric B-cell lymphoma

64
Q

what is another name for gastric B-cell lymphoma

A

MALT

65
Q

who is more likely to get adenocarcinoma women or men

A

men

66
Q

what is the flow chart for H.pylori infection to gastric carcinoma

A
  1. H.pylori infection
  2. acute gastritis
  3. chronic active gastritis
  4. atrophic gastritis
  5. intestinal metaplasia
  6. dysplasia
  7. advanced gastric cancer
67
Q

is smoking associated with increased stomach cancer

A

yes

68
Q

what is a risk factor for gastric carcinoma

A

anaemia

69
Q

where is early gastric cancer confined to

A

mucosa or submucosa

70
Q

what are the 2 major types of gastric cancer

A
  • intestinal

- diffuse

71
Q

is intestinal differentiated or undifferentiated

A

differentiated

  • well formed glandular structures
72
Q

what do intestinal cancer look like

A

polypoid or ulcerating lesions with heaped-up rolled edges

73
Q

what patients usually get intestinal gastric cancer

A

patents with atrophic gastritis

74
Q

is diffuse gastric cancer differentiated or undifferentiated

A

undifferentiated

75
Q

what has a worse prognosis intestinal or diffuse

A

diffuse

76
Q

symptoms of gastric cancer

A
  • epigastric pain (similar to that of a peptic ulcer)
  • nausea
  • anorexia
  • weight loss
  • vomiting
  • anaemia
77
Q

when does dysphagia occur in gastric carcinoma

A

when it involves the fundus

78
Q

where can gastric carcinoma metastases to

A
  • bone
  • brain
  • lung
79
Q

diagnosis of gastric carcinoma

A
  • gastroscopy
  • CT
  • endoscopic ultrasound
  • PET
80
Q

what does gastric carcinoma look like on gastroscopy

A
  • allows biopsies

- diffuse type gastric caner infiltrates submucosa and muscular propria so can be undetected

81
Q

CT scan of gastric carcinoma shows

A
  • gastric wall thickening
  • lymphadenopathy
  • lung and liver secondaries
82
Q

endoscopic ultrasound of gastric carcinoma

A
  • staging
  • depth of penetration of the cancer through the gastric wall
  • extension into local lymph nodes

is not needed to confirm

83
Q

what classification is used for gastric carcinoma

A

TNM staging

84
Q

what is TNM staging

A 
T = tumour 
N = nodes 
M = metastases

staged 0-4

85
Q

what kind of survival do the following have

T1N0M0, T1N1M0 or T2N0M0

A

88% 5 year

86
Q

what kind of survival do the following have:

T1N2M0, T2N1M0 or T3N0M0

A

65% 5 year

87
Q

what kind of survival do the following have:

T2N2M0, T3N1M0 or T4N0M0, T3N2M0

A

35% 5 year

88
Q

what kind of survival do the following have:

T4N1–3M0, TxN3M0 or TxNxM1

A

5% 5 year

89
Q

what is treatment for early stage gastric carcinoma

A

non-ulcerated mucosal lesions can be removed endoscopically

90
Q

what is the most effective treatment for gastric carcinoma

A

surgery

91
Q

what is given for advanced gastric carcinoma

A

surgery combined chemoradiotherapy

92
Q

what are the symptoms of GIST

A
  • usually asymptomatic

but can ulcerate and bleed

93
Q

what age does GIST usually affect

A

55-65

94
Q

where do truly benign leiomyomas occur

A

mainly oesophagus

95
Q

what kind of tumour is GIST

A

mesenchymal tumour

96
Q

what is the origin of GIST

A

stromal

97
Q

what do GIST share a common ancestor with

A

interstitial cells of Cajal

98
Q

what mutations cause GIST

A
  • proto-oncogene KIT

- platelet-derived growth factor receptor-alpha

99
Q

what is preferred treatment for GIST

A

surgery

100
Q

what drug is given for GIST

A

imatinib

101
Q

what is imatinib

A

tyrosine kinase inhibitor

102
Q

what is a primary gastric lymphoma

A

mucosa-associated lymphatic tissue (MALT)

103
Q

what type of lymphoma are MALT

A

B-cell marginal zone lymphomas

104
Q

what is primary site of MALT

A

lymph nodes

105
Q

what are MALT due to

A

H.pylori

106
Q

what age are people usually diagnosed with MALT

A

60

107
Q

symptoms of MALT

A
  • stomach pain
  • ulcers
  • localised symptoms

rarely have systemic complications

108
Q

what is first treatment for MALT

A

H.pylori eradication

109
Q

is prognosis good for MALT

A

yes

110
Q

what can large polyps result in

A

anaemia or haematemesis

111
Q

how to diagnose gastric polyps

A

endoscopic biopsies

112
Q

what is treatment for gastric polyps

A

polypectomy

113
Q

what is most common type of poly

A

hyperplastic polyp

114
Q

what do cystic gland polyps contain

A

microcysts that are lined by fundic type parietal and chief cells

115
Q

what cells secrete HCl

A

parietal cells

116
Q

what secrete alkaline fluid

A

mucosal cells

117
Q

who is most likely to get peptic ulcer men or women

A

men (middle-aged)

118
Q

risk factors of peptic ulcer

A
  • NSAIDs
  • H.pylori infection
  • smoking
  • Zollinger-Ellison syndrome
119
Q

what does dyspepsia describe

A
  • epigastric comfort
  • nausea and vomiting
  • bloating and burping
120
Q

what diseases is dyspepsia seen in

A
  • peptic ulcer
  • GORD
  • gastric cancer
121
Q

characteristics of pain in gastric ulcers

A

epigastric pain worsened by eating

122
Q

how is the pain eased in gastric ulcer

A

by antacids and lying flat

123
Q

how would rupture present in gastric ulcer

A

haematemesis

124
Q

what is gastric ulcer associated with

A

gastric malignancy

125
Q

characteristic of pain in duodenal ulcer

A

epigastric pain relieved by eating

126
Q

how would rupture present in duodenal ulcer

A

rectal bleeding / malaena

127
Q

what happens if ulcer perforates into abdomen

A

widespread peritonism (really bad)

128
Q

if patient present with dyspepsia what alarm symptoms must ask about

A
  • abdominal mass ?
  • haematemesis ?
  • rectal bleeding ?
  • weight loss ?
129
Q

what do you do if patient has alarm symptoms

A

scope and endoscopy

130
Q

what are patients tested for one month after uncomplicated dyspepsia

A

H.pylori

131
Q

how do you test for H.pylori

A
  • breath test

- stool antigen

132
Q

how is H.pylori treatment done

A

triple therapy

133
Q

management of ruptured peptic ulcer

A

ABCDE

- admit for surgical management

GI (50 decks)

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