Stress Related Mucosal Injury Flashcards
What conditions can lead to stress-related mucosal injury?
Shock, sepsis, massive burns, severe trauma, head injury
These conditions can result in acute erosive gastric mucosal changes or frank ulceration with bleeding.
What is the most common presentation of stress-induced gastritis or ulcers?
GI bleeding
This bleeding is usually minimal but can occasionally be life-threatening.
When does bleeding tend to occur after an acute injury or insult?
48–72 hours
Bleeding is associated with risk factors such as respiratory failure and underlying coagulopathy.
What histological features are associated with stress injury?
No inflammation or H. pylori
Therefore, ‘gastritis’ is considered a misnomer in this context.
What factors play a role in the pathogenesis of stress-related mucosal injury?
Mucosal ischemia, breakdown of protective barriers, systemic cytokine release, poor GI motility, oxidative stress
Elevated gastric acid secretion may also be noted in specific cases.
Which medications have shown superiority in preventing stress-associated GI bleeding?
PPIs over H2 blockers
PPIs do not increase the risk of nosocomial infections, mortality, or prolonged ICU stay.
What is the treatment of choice for stress prophylaxis?
PPIs
Oral PPI is preferred if the patient can tolerate enteral administration.
What should be considered if bleeding occurs despite prophylactic measures?
Endoscopy, intraarterial vasopressin, embolization, surgery
Surgery is a last resort, with total gastrectomy having a high mortality rate.
What concerns have arisen regarding the use of PPIs?
Effects on the immune system, high cost
These concerns have led to studies comparing PPIs and H2 receptor antagonists.
What did the PEPTIC trial demonstrate?
Comparative efficacy between PPIs and H2 blockers regarding mortality
However, technical aspects of the study limited the interpretation of results.
