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