Flashcards in Clinic-Gastritis Deck (35):
1
gastritis vs gastropathy
gastritis = inflammation of gastric mucosa; gastropathy = damage without significant inflammation
2
clinical presentation for gastritis
dyspepsia ("boring" pain), N/V, do not correlate with pathology!
3
erosive gastritis is also known as?
reactive gastropathy
4
major etiologies of gastritis
DRUGS=Aspirin/NSAIDs/meds is a BIG one; INFECTION=h pylori, viral; INFLAMM="non-specific", eosinophilic
5
complications of atrophic gastritis (autoimmune)
achlorhydria leads to hypergastrinemia and gastric carcinoids; decreased IF leads to macrocytic "pernicious" anemia (impaired absorption of B12)
6
Menetrier's disease results in hypertrophy of ____, leading to increased ____ and loss of ____ from the blood
gastric folds/rugae; mucus production; protein (severe hypoproteinemia)
7
symptoms of menetrier's dz
abdominal pain, N/V, diarrhea, weight loss, anemia
8
who get's menetrier's dz
rare, more common in men
9
what is an ulcer?
a defect in mucosal surface penetrating through the muscularis mucosa
10
the number of uncomplicated gastric ulcers has ____ since 1970; the number of hemorrhagic gastric ulcers has ____ since 1970
decreased; increased (NSAID use)
11
peptic ulcer disease is due to an imbalance between?
aggressive and defensive factors in the GI tract
12
name 5 defensive factors in the stomach/duodenum
mucus barrier, bicarb secretion, prostaglandins, cellular resistance, mucosal blood flow
13
name 5 aggressive factors that degrade the stomach's defenses
H. pylori, NSAIDs, gastric acid, alcohol, smoking
14
gastroduodenal mucus is ___% water; degraded by ___; slows diffusion of ____; secretes ____
95%; pepsin; H+; bicarb
15
what do prostaglandins do?
stimulate mucus and bicarb production; reduce acid secretion
16
celebrex is selective for inhibition of?
COX-2 only (does not cause ulcers)
17
name three components of cellular defense
tight junctions, mucosal restitution (reforms barrier through small cell breakage), regeneration (larger cell breaks)
18
mucosal restitution occurs by ____, while regeneration requires _____
migration, cell division
19
more than 50% of mucosa is vulnerable when ____ in reduced
mucosal blood flow
20
uncomplicated PUD presents with?
epigastric pain, nonspecific GI issues (nausea, bloating, fullness), or asymptomatic
21
a bleeding ulcer presents with?
melena, hematemesis, hematochezia if brisk
22
a perforated ulcer presents with?
toxic appearance/shock, peritoneal signs
23
an obstruction presents with?
vomiting, succussion splash
24
dx of PUD is usually through what two tests
endoscopy, barium enema with radiography
25
tx of uncomplicated PUD (2-4 things)
acid reduction with PPI, eradication of H pylori, reduce/stop NSAIDs, stop smoking
26
tx of bleeding ulcer
endoscopic therapy (ablation?)
27
tx of perforated ulcer
surgery to px peritonitis, sepsis, shock, and death
28
tx of obstruction
nasogastric suction, dilation/surgery
29
Zollinger-Ellison occurs when there is a ____, often in the ____,____, or _____ leading to hypersecretion of _____
gastrinoma; pancreas, pituitary, or parathyroid; gastrin
30
patients with Zollinger-Ellison syndrome have what three major symptoms?
refractory peptic ulcers, GERD, and steatorrhea (inactiv of pancreatic enzymes)
31
a serum gastrin greater than ____ is diagnostic for ZES, but it can be confirmed with a _____ test
1000; secretin stimulation
32
how is a gastrinoma localized?
somatostatin receptor scintigraphy, endosonography, more than 90% in the gastrinoma triangle
33
name two causes of hypergastrinemia with high gastric acid
ZES, gastric outlet obstruction
34
name two causes of hypergastrinemia with low gastric acid
PPI use, pernicious anemia
35