6 - Stomach Pathology

Question 1

Acid output of gastric fluid collected via NG tube over a 1 hour period on an empty stomach

Answer 1

Basal acid output (BAO)

Question 2

Acid output of gastric fluid collected over 1 hour following administration of pentagastrin

Answer 2

Maximal acid output (MAO)

Question 3

Increased BAO and MAO will occur with ___. Normal/decreased BAO and MAO will occur with ___.

Answer 3

Increased: Duodenal ulcers; ZE syndrome Normal/decreased: Gastric ulcers

Question 4

• 2-6 weeks old
• Projectile nonbilious vomiting
• Visible hyperperistalsis
• Palpable abdominal mass (“olive mass”)

Answer 4

Infantile hypertrophic pyloric stenosis

Question 5

Dx of infantile hypertrophic pyloric stenosis

Answer 5

Abdominal US

Question 6

Tx of infantile hypertrophic pyloric stenosis

Answer 6

Pyloromyotomy

Question 7

4 MCC of gastroparesis

Answer 7

1. Idiopathic (MCC)
2. Autonomic neuropathy (DM)
3. Post-vagotomy
4. Anticholinergic medications
5. Systemic sclerosis

Question 8

Direct toxicity and/or mucosal ischemia → mucosal injury → allows gastric acid and other substances (e.g. pepsin) to penetrate into the mucosa → damage to the gastric mucosa with erosion and subsequent hemorrhage

Answer 8

Acute hemorrhagic erosive gastropathy

Question 9

Etiologic agents for acute hemorrhagic erosive gastropathy (5)

Answer 9

1. Alcohol → direct toxic effect
2. Cancer chemotherapy → multifactorial
3. Caustic ingestions → acid/alkali
4. Iron pills → can cause mucosal necrosis, erosions, and ulcers
5. Cocaine → vasoconstriction of mesenteric vasculature → subsequent ischemic injury (alpha-receptor stimulation)

Question 10

Ulcers associated with severe physiologic stress. Etiology:

• Severe trauma
• Extensive burns
• Major surgery
• Intracranial disease (CNS injury causing increased intracranial pressure)

Answer 10

Stress-related mucosal injury