Peptic Dz, gastritis: Howden

Question 1

How do you distinguish PUD from functional dyspepsia?

Answer 1

Features of PUD:
Pain is intermittent
Pain wakes pt at night
Food eases pain
Antacids usually helpful
No other symptoms

Features of functional dyspepsia:
Pain everyday over long periods
Not particularly painful at night
Food makes it worse
Antacids occasionally helpful
Other Symp: bloating, fullness, nausea

Question 2

Your pt is found to have a duodenal or gastric ulcer. What MUST be your next investigation?

Answer 2

First, ask pt if they have been tx’d in the past for H. pylori infxn. If they have, this may be a recurrence.
::If they have not, check serum for H. pylori abs (IgG).
::*Checking serology in pts prev. tx’d for H. pylori is useless because it will prob be pos. regardless of whether they are still infected or not.
Confirm absence of bact. w/ Carbon13 Urea breath test

Question 3

How do you tell a benign GI ulcer from a cancerous GI ulcer?

Answer 3

Benign: edges do not rise above level of surrounding mucosa.

Cancer: Raised margins above level of surrounding mucosa.

Question 4

You’re looking at the histology of gastric inflammation. There are neutrophils present. This is called:

Answer 4

Active gastritis

Question 5

You’re looking at the histology of gastric inflammation.

There is a lympho(plasma)cytic background. This is called:

Answer 5

Chronic gastritis

Question 6

What does H. pylori look like under the scope?

Answer 6

A flock of seagulls in a gastric pit

Question 7

How does reactive/chemical gastropathy differ from normal gastric mucosa, active gastritis, and chronic gastritis on histology?

Answer 7

Glands are more tortuous and dilated. (diff. from norm.)
No neutophils (diff. from active gastritis)
Not many lymphocytes (plasma cells) - (diff. from chronic gastritis)

Question 8

If you have a chronic duodenal/gastric H. pylori infxn, you could see these on histology that could lead to B cell lymphoma.

Answer 8

Lymphoid follicles (germinal centers). Not normally present in stomach/duodenum.

Question 9

Your pt has lymphoma secondary to a chronic H. pylori infxn. Tx with _____ often causes remission of the cancer as well as the infxn.

Answer 9

Appropriate abx.
Clarithromycin + PPI + amox -or- metronidazole
-or-
bismuth based quad. therapy
PPI + bismuth + metronidazole + tetracycline

No other long-term care needed.

Question 10

MALTomas are of B cell origin, which means their CD- markers are:

Answer 10

CD19 and CD20 (CD43 in 25% of cases, but very specific for MALToma)
Tx w/ rituximab

Question 11

The translocation associated w/ MALTomas is:

Answer 11

t(11;18) API2/MALT1

Question 12

You’ve got an older pt on aspirin with a confirmed peptic ulcer (prob. due in part to the aspirin). Why doesn’t it hurt, as most peptic ulcers do?

Answer 12

Bc the pt is on aspirin

Question 13

H. pylori is responsible for ___-___% of PUD in the US and up to ___% worldwide.
The remaining cases are mostly due to:

Answer 13

60-70% US
up to 90% worldwide
Remaining cases due to NSAIDs and cigarette smoking

Question 14

This gene is found in 90% of H. pylori isolates found in populations with elevated gastric cancer risk.
Name some other virulence factors of H. pylori.

Answer 14

CagA (toxin)
Adhesins
Urease
Flagella for motility in thick mucus