stomach patho

Question 1

gastritis

Answer 1

inflammation of gastric mucosa resulting from exposure to acid and other agents, can be a acute or chronic

Question 2

acute gastritis

Answer 2

could be asymptomatic up to epigastric pain, N/V, ulceration, hemorrhage, hematemesis

stomach is usually shielded from acid by mucin (secretes bicarb to neutralize) and blood supply that buffers and removes caustic agents

injury can cause this problem and you will see presence of neutrophils in endothelial layer

Question 3

common causes of chemical gastritis

Answer 3

NSAIDs (inhibit prostaglandins), uremia and infection by h pylori (inhibit bicarb), chemical exposure (direct injury)

Question 4

stress gastritis

Answer 4

patients with severe trauma, burns, critical illness probe to developing stress ulcers
local ischemia d/t systemic hypotension, reduced blood flow, SNS vasoconstriction causes increased acid production

for ICU patients, prevent with PPIs

Question 5

H pylori gastritis

Answer 5

spiral shaped bacillus detectable in gastric mucosal biopsies from many patients with duodenal ulcer and chronic gastritis

• bacteria invade the gastric mucosa and can persist for life
• associated with increased risk of gastric carcinoma

bacterial enzymes and other toxic products directly damage endothelial cells, increased production of gastric acid, production of protease that degrade normally protective glycoproteins in the mucous layer, exposing epithelial cells to harsh gastric contents

stimulation of acute and chronic inflammation and cytokine release

Question 6

diagnosis of h pylori

Answer 6

symptoms will be like gastritis

diagnosis will be with biopsy to ID h pylori via stain/culture
breath test (looking for ammonia)
stool test (presence of h pylori)

Question 7

peptic ulcer disease

Answer 7

benign ulcer composed of granulation tissue and necrotic cell debris and inflammatory cells resting on fibrous scar
results from excess gastric acid and impaired mucosal defense
more frequent in duodenum and stomach and seen in middle to older age adults

Question 8

gastritis treatments

Answer 8

antacid (relief of dyspepsia), H 2 receptor antagonists (inhibits gastric acid secretion), PPIs (covalently bind/inhibit HK pump), prostaglandin analogues (enhance bicarb secretion, stimulate mucosal blood flow, decrease mucosal cell turnover)

Question 9

polyp

Answer 9

inflammatory abnormal tissue when cells grow and divide more they should or do not die when they should

Question 10

adenoma

Answer 10

abnormal tissue that may serve as precursor for cancer
most common malignancy of stomach
can spread to involve duodenum, pancreas, retroperitoneum

Question 11

neuroendocrine tumors

Answer 11

grows from neuroendocrine cells (found throughout body)
carcinoid - often grow slowly

most 75% found in GI tract (small intestine) - 25% found in lungs
foregut (stomach, duodenum, esophagus) tumors rarely spread
midgut (small intestine) are aggressive
hindgut (appendix, colon) benign

Question 12

Zollinger Ellison Syndrome

Answer 12

gastrinoma - gastrin secreting tumor which increases HCL via gastrin and histamine stimulation

leads to peptic ulcer disease, erosive esophagitis, and diarrhea

multiple endocrine neoplasi type 1 - hereditary, neoplasia of parathyroid glands, pancreatic islet cell tumors, pituitary gland tumors

Question 13

anesthetic considerations of zollinger ellison

Answer 13

GERD, large gastric fluid volume, IV volume depletion, hypokalemia, maintain PPI, assess for liver metastases

Question 14

carcinoid syndrome

Answer 14

tumors secrete vasoactive and other hormone like stubstances

when tumor is intestinal, vasoactive mediators are metabolized in liver - symptoms then reflect metastatic disease

two factor release

• direct physical
• beta adrenergic

carcinoid syndrome symptoms = flush, sweat, bronchospasm, abd pain, diarrhea, cardiac valve abnormalities

Question 15

carcinoid heart disease

Answer 15

seen in up to 60% of patient with carcinoid syndrome

triad = cardiac involvement, flushing, diarrhea

right sided failure from valvular and myocardial plaque formation, left side protected by lung metabolism of serotonin

50% of carcinoid death results from heart failure

Question 16

anesthetic considerations and carcinoid syndrome

Answer 16

avoid trigger for mediator release

• histamine (morphine, atracurium, succ)
• catecholamine (epi, NE, dopa, ketamine, ephedrine)

asses for flushing, wheezing, labile HR and BP

treat hypotention with alpha

continue somatostatin (blunts vasoactive bronchoconstrictive effects)