Clinic-Gastritis

Question 1

gastritis vs gastropathy

Answer 1

gastritis = inflammation of gastric mucosa; gastropathy = damage without significant inflammation

Question 2

clinical presentation for gastritis

Answer 2

dyspepsia (“boring” pain), N/V, do not correlate with pathology!

Question 3

erosive gastritis is also known as?

Answer 3

reactive gastropathy

Question 4

major etiologies of gastritis

Answer 4

DRUGS=Aspirin/NSAIDs/meds is a BIG one; INFECTION=h pylori, viral; INFLAMM=”non-specific”, eosinophilic

Question 5

complications of atrophic gastritis (autoimmune)

Answer 5

achlorhydria leads to hypergastrinemia and gastric carcinoids; decreased IF leads to macrocytic “pernicious” anemia (impaired absorption of B12)

Question 6

Menetrier’s disease results in hypertrophy of ____, leading to increased ____ and loss of ____ from the blood

Answer 6

gastric folds/rugae; mucus production; protein (severe hypoproteinemia)

Question 7

symptoms of menetrier’s dz

Answer 7

abdominal pain, N/V, diarrhea, weight loss, anemia

Question 8

who get’s menetrier’s dz

Answer 8

rare, more common in men

Question 9

what is an ulcer?

Answer 9

a defect in mucosal surface penetrating through the muscularis mucosa

Question 10

the number of uncomplicated gastric ulcers has ____ since 1970; the number of hemorrhagic gastric ulcers has ____ since 1970

Answer 10

decreased; increased (NSAID use)

Question 11

peptic ulcer disease is due to an imbalance between?

Answer 11

aggressive and defensive factors in the GI tract

Question 12

name 5 defensive factors in the stomach/duodenum

Answer 12

mucus barrier, bicarb secretion, prostaglandins, cellular resistance, mucosal blood flow

Question 13

name 5 aggressive factors that degrade the stomach’s defenses

Answer 13

H. pylori, NSAIDs, gastric acid, alcohol, smoking

Question 14

gastroduodenal mucus is ___% water; degraded by ___; slows diffusion of ____; secretes ____

Answer 14

95%; pepsin; H+; bicarb

Question 15

what do prostaglandins do?

Answer 15

stimulate mucus and bicarb production; reduce acid secretion

Question 16

celebrex is selective for inhibition of?

Answer 16

COX-2 only (does not cause ulcers)

Question 17

name three components of cellular defense

Answer 17

tight junctions, mucosal restitution (reforms barrier through small cell breakage), regeneration (larger cell breaks)

Question 18

mucosal restitution occurs by ____, while regeneration requires _____

Answer 18

migration, cell division

Question 19

more than 50% of mucosa is vulnerable when ____ in reduced

Answer 19

mucosal blood flow

Question 20

uncomplicated PUD presents with?

Answer 20

epigastric pain, nonspecific GI issues (nausea, bloating, fullness), or asymptomatic

Question 21

a bleeding ulcer presents with?

Answer 21

melena, hematemesis, hematochezia if brisk

Question 22

a perforated ulcer presents with?

Answer 22

toxic appearance/shock, peritoneal signs

Question 23

an obstruction presents with?

Answer 23

vomiting, succussion splash

Question 24

dx of PUD is usually through what two tests

Answer 24

endoscopy, barium enema with radiography

Question 25

tx of uncomplicated PUD (2-4 things)

Answer 25

acid reduction with PPI, eradication of H pylori, reduce/stop NSAIDs, stop smoking

Question 26

tx of bleeding ulcer

Answer 26

endoscopic therapy (ablation?)

Question 27

tx of perforated ulcer

Answer 27

surgery to px peritonitis, sepsis, shock, and death

Question 28

tx of obstruction

Answer 28

nasogastric suction, dilation/surgery

Question 29

Zollinger-Ellison occurs when there is a ____, often in the ____,____, or _____ leading to hypersecretion of _____

Answer 29

gastrinoma; pancreas, pituitary, or parathyroid; gastrin

Question 30

patients with Zollinger-Ellison syndrome have what three major symptoms?

Answer 30

refractory peptic ulcers, GERD, and steatorrhea (inactiv of pancreatic enzymes)

Question 31

a serum gastrin greater than ____ is diagnostic for ZES, but it can be confirmed with a _____ test

Answer 31

1000; secretin stimulation

Question 32

how is a gastrinoma localized?

Answer 32

somatostatin receptor scintigraphy, endosonography, more than 90% in the gastrinoma triangle

Question 33

name two causes of hypergastrinemia with high gastric acid

Answer 33

ZES, gastric outlet obstruction

Question 34

name two causes of hypergastrinemia with low gastric acid

Answer 34

PPI use, pernicious anemia

Question 35

where does ZES usually metastasize?

Answer 35

LN, liver