Flashcards in 34. Gastritis Deck (37)
acute gastritis ?
aciidc damage ( erosion) to the stomach mucosa due to imbalance between mucosa defence and acidic enviroment ---> erosions or ulcers or superficial inglammation
defence of gastric mucosa
1. mucin layer
2. HCO3 trapped in mucin
3. blood supply ( provide nutrients)
acute gastritis can be caused by
1. NSAID ( esp in daily, eg RA patients )
2.Burns ( Curling ulcer)
3 Braun injury ( Cushing ulcer)
4. Heavy alcohol consuption
6. shock ( Multiple stress ulcers may be seen in ICU)
acute gastritis - NSAID
block PGE2--> decreased gastric mucosa protection
acute gastritis - Curling vs Cushing ulcer according to mechanism
Curling --->Burns ---> hypovolemia ---> mucosal ischemia
Cushing ---> brain injury ---> increased vagal stiumlation---> increased ACH --> incrased H+ production
Chronic gastritis ?
mucosal inflammation often leading to atrophy ( hypochlorhydria ---> hypergastrinemia ) and interstinal metaplasia ( --> increased risk for gastric cancer)
Chronic gastritis is mucosal inflammation often leading to
atrophy ( hypoclorhydria ---> hypergastrinemia ) and interstinal metaplasia ( ---> increased risk for gasric cancer)
Chronic gastritis - typers according to etiology ( MC)
1. chronic H.pylori infenction (MC)
2. chronic autoimmune gastritis
chronic gastritis types according to location i stomach
1. chronic H. pylori infenction ( MC) ---> first antrum and spreads to body
2. chronic autoimmune gastritis ---> affects body / fundus
chronic autoimmune gastritis - mechanism
autoantibodies to parietal cells and instrinsic factor --> increased risk for pernicious anemia
pernicious anemia --- predisposition
Helicobacter pylori - characteristics / stain
- produce usease, oxidase +, comma shape , catalase +
Helicobacter pylori is a risk factor for
1. peptic ulcer
2. gastric adenocarcinoma
3. MALT lymphoma
Helicobacter pylori - test for diagnosis
1. urea breath test
2. fecal antigen test
3. blood test - antibodies
helicobacter pylori - treatment
MC initial treatment :
PROTON PUMP INHIBITOR + CLARITHROMYCIN + AMOXICILLIN ( or metronidazole if penicilin allergy)
how to confirm erafication of H. pylori
negative urea breath and lack of stool antigen
Menetrier disease ?
gastric hyperplasia of mucosa --> hypertrophied rugae ( looking like brain gyri ), excess mucus production with resultant protein loss and parietal cell atrophy with low acid production
menetrier disease - complication
it is pecancerous
menetrier disease - looking like
brain gyri ( because of hypertrophied rugae)
• ____ (Acute/Chronic) gastritis is erosive, whereas ____ (acute/chronic) gastritis is nonerosive.
• Where does type A chronic gastritis occur? Where does type B occur?
• Name some causes of acute gastritis.
NSAIDs, alcohol, stress, uricemia, burns, brain injury
• A patient with severe burns develops which complication of acute gastritis?
Curling ulcer (burned by the Curling iron)
• A man with brain injury acutely develops raw, burning epigastric pain. He should be treated to prevent which complication?
Cushing ulcers (remember, always cushion the brain)
• In a patient with type A (fundal) gastritis, the autoantibodies are directed against what?
• Type A (fundal) gastritis is characterized by what two pathologic states?
Type A is caused by pernicious Anemia and Achlorhydria (A comes before B—pernicious Anemia is Autoimmune in first part of stomach)
• Type B (antral) gastritis is caused by infection with what organism?
Type B is caused by Helicobacter pylori (H. pylori Bacteria in second part of stomach)
• Type ____ gastritis is autoimmune related, whereas type ____ gastritis is caused by infectious diseases (e.g., H. pylori).
• ____ (Acute/Subacute/Chronic) gastritis carries an increased risk of gastric carcinoma.
• Chronic gastritis carries an increased risk of what kind of gastric carcinoma(s)?
Mucosa-associated lymphoid tissue (MALT) lymphoma and gastric adenocarcinoma
• A patient on chronic NSAID therapy complains of stomach pain and is found to be anemic. What is the pathophysiology of his condition?
NSAIDs reduce prostaglandin E2, causing erosive gastritis (this is erosive gastritis), which causes occult blood loss and mild anemia
• By what mechanism do severe burns cause acute gastritis?
Curling ulcers are caused by a decrease in plasma volume, leading to a sloughing of gastric mucosa
• How can brain injury cause acute gastritis?
Cushing ulcers are caused by increased vagal stimulation, which increases acetylcholine and, in turn, acid production by parietal cells
• A woman with Graves disease is anemic with a high MCV despite taking iron. She has bad abdominal pain. What part of her stomach is affected?
Fundus/body (this is chronic type A gastritis of the stomach, with pernicious anemia, associated with other autoimmunity such as Graves)
• In acute gastritis, there is disruption of what type of barrier?
Disruption of mucosal barrier
• What type of gastritis is an alcoholic most at risk for?