34. Gastritis Flashcards Preview

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Flashcards in 34. Gastritis Deck (37):
1

acute gastritis ?

aciidc damage ( erosion) to the stomach mucosa due to imbalance between mucosa defence and acidic enviroment ---> erosions or ulcers or superficial inglammation

2

defence of gastric mucosa

1. mucin layer
2. HCO3 trapped in mucin
3. blood supply ( provide nutrients)

3

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
5. chemotherpay
6. shock ( Multiple stress ulcers may be seen in ICU)

4

acute gastritis - NSAID

block PGE2--> decreased gastric mucosa protection

5

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

6

Chronic gastritis ?

mucosal inflammation often leading to atrophy ( hypochlorhydria ---> hypergastrinemia ) and interstinal metaplasia ( --> increased risk for gastric cancer)

7

Chronic gastritis is mucosal inflammation often leading to

atrophy ( hypoclorhydria ---> hypergastrinemia ) and interstinal metaplasia ( ---> increased risk for gasric cancer)

8

Chronic gastritis - typers according to etiology ( MC)

1. chronic H.pylori infenction (MC)
2. chronic autoimmune gastritis

9

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

10

chronic autoimmune gastritis - mechanism

autoantibodies to parietal cells and instrinsic factor --> increased risk for pernicious anemia

11

pernicious anemia --- predisposition

HLA-DR5

12

Helicobacter pylori - characteristics / stain

- produce usease, oxidase +, comma shape , catalase +
-silver

13

Helicobacter pylori is a risk factor for

1. peptic ulcer
2. gastric adenocarcinoma
3. MALT lymphoma

14

Helicobacter pylori - test for diagnosis

1. urea breath test
2. fecal antigen test
3. blood test - antibodies
4. biopsy

15

helicobacter pylori - treatment

MC initial treatment :
PROTON PUMP INHIBITOR + CLARITHROMYCIN + AMOXICILLIN ( or metronidazole if penicilin allergy)

16

how to confirm erafication of H. pylori

negative urea breath and lack of stool antigen

17

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

18

menetrier disease - complication

it is pecancerous

19

menetrier disease - looking like

brain gyri ( because of hypertrophied rugae)

20

• ____ (Acute/Chronic) gastritis is erosive, whereas ____ (acute/chronic) gastritis is nonerosive.

Acute; chronic

21

• Where does type A chronic gastritis occur? Where does type B occur?

Fundus/body; antrum

22

• Name some causes of acute gastritis.

NSAIDs, alcohol, stress, uricemia, burns, brain injury

23

• A patient with severe burns develops which complication of acute gastritis?

Curling ulcer (burned by the Curling iron)

24

• 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)

25

• In a patient with type A (fundal) gastritis, the autoantibodies are directed against what?

Parietal cells

26

• 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)

27

• 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)

28

• Type ____ gastritis is autoimmune related, whereas type ____ gastritis is caused by infectious diseases (e.g., H. pylori).

A; B

29

• ____ (Acute/Subacute/Chronic) gastritis carries an increased risk of gastric carcinoma.

Chronic

30


• Chronic gastritis carries an increased risk of what kind of gastric carcinoma(s)?

Mucosa-associated lymphoid tissue (MALT) lymphoma and gastric adenocarcinoma

31

• 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

32

• 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

33

• 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

34

• 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)

35

• In acute gastritis, there is disruption of what type of barrier?

Disruption of mucosal barrier

36

• What type of gastritis is an alcoholic most at risk for?

Acute gastritis

37

• A patient with rheumatoid arthritis, adherent to his medications, has nausea and abdominal pain. What type of gastritis are you considering?

Acute gastritis (the patient is likely taking NSAIDs daily)

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