Stomach Diseases Flashcards
What is the blood supply of the stomach
celiac (foregut) right gastric artery, left gastric artery, right gastro-mental artery, left gastro-mental and short gastric arteries.
What are the Gastrointestinal physiology of the stomach?
Parietal Cell - secretes HCl intrinsic factor that is stimulated by histamine, Ach and gastrin
Chief cell - secretes pepsinogen
G- cells - Gastrin
Superficial epithelial cell - Mucus, HCO3
Neuroendocrine cells - multiple ( somatostatin, inhibits cell secretion)
What is acute gastritis
it is inflammation of stomach mucosa. it involves the stomach and the small intestine.
What conditions are associated with AG?
Non-steroidal Drugs (NSAIDs) and Corticosteroids,Alcohol Abuse,Cigarette Smoking, Shock,Uremia (end of Kidney failure),Treatment with Chemotherapy Drugs,H. Pylori, Mechanical Trauma (Intubation),Burns - Curling’s Ulcer Raised Intracranial Pressure – Cushing’s Ulcers
What are the stress ulcer prophylaxis?
Mechanical ventilation, burns ( curling ulcers), head trauma ( cushing ulcer) and coagulopathy
What is Mild Acute Gastritis? Morphology?
The Surface Epithelium Is Intact, Although Scattered Neutrophils May Be Present.Lamina Propria Lymphocytes and Plasma Cells Are Not Prominent.
The Presence of Neutrophils Above the Basement Membrane—specifically, in Direct Contact with Epithelial Cells—is Abnormal in All Parts of the Gastrointestinal Tract and Signifies Active Inflammation
Severe Acute Gastritis? Morphology?
Severe Mucosal Damage, Erosion, or Loss of the Superficial Epithelium
- Leading to Formation of Mucosal Neutrophilic Infiltrates and Purulent Exudates
- Hemorrhage May Occur, Manifesting as Dark Puncta in an Otherwise Hyperemic Mucosa
Presence of Erosion and Hemorrhage Is Termed Acute Erosive Hemorrhagic Gastritis
What are the manifestations of Gastritis
Non-erosive - Painless Bleeding
Erosive - Gastritis - painful Bleeding, nausea and vomiting
What is chronic Gastritis
Nausea and upper abdominal discomfort, with or without vomiting.
What are the Causes
H. pylori infection is the MCC. Autoimmune gastritis 10% of cases of chronic gastritis and is the most common form of chronic gastritis in patients with H. pylori infection
What is H.pylori Gastritis
H. pylori organism in 90% of Antral chronic Gastritis. increased acid secretion that occurs in H. pylori gastritis may cause peptic ulcer disease. it increases the risk of gastric cancers.
What is the epidemiology of H.pylori
Associated with Poverty, Household Crowding, Limited Education, African American or Mexican American Ethnicity, Residence In Areas with Poor Sanitation, and Birth Outside of the United States
What are the 2 stains for H.pylori
Wart thin starry Silver stain and Giesma Stain
What are the 4 test of diagnosing H.pylori
Endoscopy
Serology
Urea C13 and C14 broth test
Stool sample
What are the virulence factors of H. pylori
Flagella
Urease
Adherence
Toxin
What is autoimmune gastritis
Autoantibodies to Parietal Cells and Intrinsic Factor. Loss of Parietal Cells, which Secrete Acid and Intrinsic Factor → Deficient Acid Production → Achlorhydria Stimulates Gastrin Release Resulting in Hypergastrinemia and Hyperplasia of Antral Gastrin-producing G Cells
What are the deficiencies of Autoimmune Gastritis
B12 and Megaloblastic
What are always in the histologic finding of autoimmune disorders
macrophages, lymphocytes and plasma cells
What is PUD or Peptic Ulcer Disease
a break in the lining of the stomach.
What is the major cause of PUD
H. pylori and NSAID
What is the pathogenesis of PUD
mbalances of Mucosal Defenses and Damaging Forces that Cause Chronic Gastritis
NSAIDS, Cigarette Smoking, High-Dose Corticosteroids.Hyperacidity due to Parietal Cell Hyperplasia, Impaired Inhibition of Stimulatory Mechanisms, Gastrinoma (ZES- 1st portion of duodenum).Alcoholic Cirrhosis, COPD, Chronic Renal Failure, Hyperparathyroidism (↑ Ca++ Stimulates Gastrin), Stress
What are the manifestations of PUD
it is abdominal pain That can:
Improves with eating (Duodenal Ulcer) or
Get worse with eating ( Gastric Ulcer)
What is the location of the PUD
Duodenal Ulcers Usually Occur within a Few Centimeters of the Pyloric Valve and Involve the Anterior Duodenal Wall.Gastric Peptic Ulcers Are Predominantly Located Near the Interface of the Body and Antrum.
What complication of PUD
Bleeding - iron deficiency anemia
Perforation - air under the diaphragm
obstruction
pain
What is ZES
Zollinger- elision syndrome:
60% - 90% are Malignant Pancreatic Non-β -Islet cell tumors
-Serum Gastrin >1000 pg /ml
-Parietal Cell Hyperplasia
-Peptic Ulcers May be either Single or Multiple
-May present past first portion of duodenum
What is Menetrier Disesase
Giant Rugal Folds In Gastric Fundus
- Hyperplasia of Foveolar Mucus Glands
- Protein Losing Enteropathy
- Atrophy of Parietal Cells
- Achlorhydria
- Malabsorption, Nausea, Vomiting, Abdominal -Pain, Edema,
- ↑ Risk Adenocarcinoma
MEN 1
Parathyroid
Pancreatic
Pituitary
MEN 2
Medullary thyroid
Pheochromocytoma
Parathyroid
MEN 3
Medullary Thyroid
Phenochromocytoma
Neuroma
What are the manifestation Gastric Adenocarcinoma
Early : Dyspepsia, Dysphagia and Nausea
Late: Wieght loss, Anorexia, altered Bowel Habits, Anemia and hemorrhage
What is the incidence rate of Gastric adenocarcinoma
incidence in higher (20x) in Japan, chile, Costa Rica, and Eastern Euproe than in North America, northern Europe, Africa and Southeast Asia.
What are the causes of Carcinoid tumor
Cutaneous Flushing, seating, Bronchospasm, colicky abdominal Pain, Diarrhea, Right sided Cardiac Valvular Fibrosis and due to the increase of serotonin.
What happens with Gastric Carcinoma Spread
Can Penetrate the Wall and The Serosa and Metastasize
- Frequently to Supraclavicular Node (Virchow’s Node)
- Locally to Surrounding Structures– Duodenum, Pancreas, and Retroperitoneum
- Metastasis to Ovary — Krukenberg Tumour
- Metastasis to the Skin Around Umbilicus Producing Nodules – Sister Joseph Nodules
What are causes of upper GI bleeding
Esophageal Gastritis, Ulcers Mallory weiss tear Boerhaave syndrome Erosive esophagitis Tumor Anticoagulant medication side effect
