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Diseases Of The Stomach Flashcards

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1
Q

What is the definition of acute gastritis?

A

Short term inflammatory process that involves walls of stomach, especially mucosa

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2
Q

What is the aetiology of acute gastritis?

A

Exogenous factors - alcohol
Ingestion of corrosive substances eg acetone
Drugs such as NSAID’s, antibiotics or corticosteroids
Diet of spicy food, coffee,

Endogenous factors - urea
Infectious diseases
Allergies
Ischaemia

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3
Q

What is the morphopathology of acute gastritis>

A

Edematous mucosa
Erosions
Purulent exudates
Necrotic epithelium

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4
Q

What are the different anatomo-pathological forms of acute gastritis?

A

Cathatral acute gastritis - endoscopy reveals intense red mucosa, oedema and little bleeding

Erosive acute gastritis (ulcerative acute gastritis) - more severe than first form

Phlegmonous acute gastritis - discovered beside gastric cancer or at alcohol abusers

Emphysematous acute gastritis - produced by infection of gastric wall with anaerobic bacteria

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5
Q

What are the clinical symptoms of acute gastritis?

A

Epigastric pain that is increased by ingesting food
NBA’s yea
Vomiting which relieves the pain
Anorexia
Headache
Diarrhoea

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6
Q

What are the clinical for a self acute gastritis?

A

Alcoholic acute gastritis
Corrosive acute gastritis
Medicamentous acute gastritis
Infectious acute gastritis
Allergic acute gastritis

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7
Q

What are the symptoms of alcoholic acute gastritis

A

Epigastralgia
Vomiting containing large amounts of mucous and bile
Anorexia
Digestive intolerance
Altered general status

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8
Q

what is the treatment for alcoholic acute gastritis?

A

Stopping alcohol intake and following same dietary and medical recommendations as for all gastritis

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9
Q

What are the symptoms of corrosive acute gastritis?

A

Dysphagia
Sialorrhea (drooling or excessive salivation)
Retrosternal pain
Epigastric pain
Vomiting with haemorrhaging aspect
Altered general status

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10
Q

what is the treatment for corrosive acute gastritis?

A

Gastric and oesophageal mucosal lovage
Parenteral nutrition for 3-4 weeks

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11
Q

What causes medicamentous acute gastritis?

A

Produced by any kind of drug which ingested in large quantities produces gastric irritation

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12
Q

What is infectious acute gastritis associated with?

A

Pneumonia
Flyer
Typhoid fever
Dysentery

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13
Q

What is characteristic of allergic acute gastritis?

A

Lesions appearing and disappearing

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14
Q

How do you diagnose allergic acute gastritis?

A

Skin test and specific serological tests

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15
Q

What is found at the physical examination for acute gastritis?

A

Sensibility at palpation of Epigastrium
Dry, red tongue
Tachycardia
Oliguria (low urine output)

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16
Q

What is the paraclinical investigation for acute gastritis?

A

Gastric X-ray
Endoscopy
Biopsy

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17
Q

How do you determine a positive diagnosis for acute gastritis?

A

Anamnesis, physical examination and paraclinical examination

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18
Q

what is the treatment plan for acute gastritis?

A

Dietary management
Rich in soft liquids for 1-2 days (1-2 litres of tea a day)
Next 3-5 days eat vegetable soups, boiled rice, potatoes, cow cheese and finally boiled meat

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19
Q

What is the medical treatment for acute gastritis?

A

Gastric protective (sucralfate, sodium bicarbonate)
Anticholinergics (atropine derivatives)
Sedative solutions (codeine phosphate)
Correction of hydroelectrolythic and protein imbalance

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20
Q

What is the definition of chronic non erosive gastritis?

A

Refers to inflammatory changes in the mucosa or submucosa leading to atrophy of glands that are replaced by metaplasia

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21
Q

what is chronic non erosive gastritis characterised by?

A

Grossly visible erosions

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22
Q

What are the underlying aetiological agents that can cause chronic gastritis?

A

Helicobacter pylori
Bile reflux
NSAID’s
Autoimmunity
Allergic response

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23
Q

What is a complication of h pylori gastritis?

A

Peptic ulcer
Gastric malignancy

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24
Q

What is a complication of chronic strophic gastritis?

A

Gastric carcinoma

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25
What is a complication of autoimmune gastritis?
Achlorhydria (absence of HCL in secretion) Hypergastrinemia Loss of pepsin and pepsinoegn Anemia Increased risk of gastric neoplasm
26
Which race is h pylori gastritis more common in?
Asians Hispanics
27
high race is autoimmune gastritis more common in?
Northern Europe and black people Less common in south Europe and Asian people
28
Which sex is chronic h pylori gastritis common in?
Both sexes with similar frequency
29
which sex is affected more by autoimmune gastritis?
Females 3:1 male
30
Which age group is more likely to suffer from all forms of chronic gastritis?
People aged 40-60 years of age
31
What is the classification order chronic gastritis?
Sydney system, updated to Houston system Alphabetical classification Aetiological classification
32
What is the Sydney system based on?
Aetiology Pathogenical mechanisms Location of lesions Severityt of inflammatory process Atrophy or metaplasia degree
33
Wha is needed for classification ion the Sydney’s system?
2 biopsies from each gastric area, gastric corpus or antropyloric area, from anterior band posterior gastric wall
34
What does inflammation mean for the Sydney system?
Increase in the number of lymphocytes and plasmocytes in the lamina propria
35
What does atrophy mean in the Sydney classification?
Decreased number off specialised glands Fromm the gastric corpus and from the antropyloric area
36
What does h pylori bacteria do to lesions of the gastric mucosa?
Colonises the lesions
37
What is the alphabetical classification of chronic gastritis?
Type A - autoimmune Type B - bacterial Type C - chemical (duodenal or biliary reflux)
38
What are the etiological classifications for chronic gastritis?
Infectious chronic gastritis Non infectious chronic gastritis
39
Which infections can cause infectious chronic gastritis?
H pylori (most common) Mycobacteriosis Parasitic infections Viral infections
40
What can cause non infectious gastritis?
Autoimmune gastritis Chemical gastropathy - related to chronic bile reflux or NSAID Uraemia gastropathy Lymphocytic gastritis Eosinophilia gastritis Radiation injury to the stomach Ischemic gastritis
41
Which infection of h pylori is more likely to develop peptic ulcer?
H pylori strain that secretes vacuolating toxin A
42
Which h pylori strain has a higher risk of developing gastric carcinoma?
Strains that produce CagA protein
43
What are the 2 common progressions of hpylori associated chronic gastritis?
Antral inflammation predominant gastritis - usually in patients with peptic ulcers Multi focal astrophic gastritis involves corpus and gastric antrum with progressive development of gastric atrophy (usually leads to gastric carcinoma)
44
Wheat are the clinical features of h pylori associated chronic gastritis?
Typically asymptomatic but can manifest - Gastric pain Nausea Vomiting Anorexia Significant weight loss
45
What are the complications of h pylori associated gastritis?
Peptic ulcers Gastric adenocarcinoma MALT lymphoma
46
What is found on the physical examination for h pylori associated chronic gastritis?
In uncomplicated h pylori - epigastric tenderness may exist If gastric ulcers coexist - guaiac positive stool may result from occult blood loss (hidden blood loss) Halitosis and abdominal pain or discomfort may occur with bloating associated with bacterial overgrowth syndrome
47
How do you diagnose h pylori associated chronic gastritis?
Upper GI endoscopy essential to establish diagnosis of gastritis Endoscopy for chronic h pylori infection may show areas of intestinal metaplasia Tissue sampling from gastric antrum, incisura and corpus is essential to establish topography of gastritis and to identify atrophy and intestinal metaplasia Can do specific stain tests (giemsa) to identify h pylori infection Late stages can do urea breath test and serological tests for evidence of infection Bacterial culture of gastric biopsy
48
What histological findings are present in h pylori associated chronic gastritis?
Polymorphonuclear leukocytes present in lamina propria, glands, surface epithelium and foveolar cells Lymphoid aggregates expanding the lamina propria of the mucosa Significant loss of gastric glands produces gastric atrophy
49
What is the treatment for h pylori associated chronic gastritis?
Eliminate the h pylori infection - first line triple therapies Quadruple therapies are recommended as second line treatment when triple therapies fail to eradicate h pylori Administered for 10-14 days
50
What is triple therapy for h pylori infection?
PPI - Lansoprazole ATB - clarithromycin ATB - amoxicillin
51
What is involved in quadruple therapy for h pylori infection?
PPI twice daily - lansoprazole Tetracycline Bismuth sucralfate Metronidazole
52
What are some other causes of infectious gastritis?
Tuberculosis Fungi Both Cavan cause caseating granulomas
53
Which diseases can cause gastritis in immunosuppressed patients?
Cytomegalovirus - infection of stomach observed in immunosuppressed patients Herpes simplex causes basophil infection intranuclear inclusions in epithelial cells Mycobacterium avium can infiltrate lamina propria by histocytes (type of immune cell that destroys foreign substances)
54
What are the clinical features form infectious granulomatous gastritis?
Caseating granulomasd secondary to TB may be found in the absence of lung disease in patients who are malnourished, immunosuppressed or alcoholic Patients may report gastric pain, nausea and vomiting
55
What are the histological findings for infectious granulomatous gastritis?
Early stages - isolated granulomas in the mucosa and submucosa Later stages - inflammation extends too muscularis propria and fibrosis may be prominent Granuloma normally caseating if associated with TB If syphilis is involved can show poorly formed granulomas CMV shows - intranuclear eosinophilic inclusions. Patchy mild inflammatory infiltrate is observed in lamina propria. Herpes simplex causes basophil infection intranuclear inclusions in epithelial cells
56
What is autoimmune gastritis typically associated with?
Antiparietal and anti intrinsic factor antibodies
57
what may patients develop in autoimmune gastritis if deficiency occurs?
Pernicious anemia
58
What characterises autoimmune gastritis?
Atrophic gastritis limited to corpus fundus mucosa and marked diffuse atrophy of parietal and chief cells
59
Which vitamin deficiency can autoimmune gastritis lead to?
Vitamin b12 deficiency (Cobalamin)
60
What causes Cobalamin deficiency in autoimmune gastritis?
Due to intrinsic factor deficiency leading to inadequate absorption of B12
61
What are the clinical features of Cobalamin deficiency?
Haematological manifestations - Megalobastic anaemia Purpura (rare) due to thrombocytopenia Symptoms of anemia eg weakness, light headedness, vertigo, tinnitus, palpitations, angina GI manifestations - megaloblastosis - sore tongue. Anorexia with moderate weight loss and diarrhoea due to malabsorption Neurological manifestations - due to demyelination and thus atonal degeneration and neuronal death. Affected nerves are the peripheral nerves, posterior and lateral columns of spinal cord and cerebrum. Signs and symptoms include numbness and parasthesias in the extremities, weakness and ataxia lack of coordination)
62
How do you diagnose autoimmune gastritis?
Antiparietal and anti IF antibodies in the serum Achlorhydria, both basal and stimulated and hypergastrinema Low serum cobalamin (<100pg/ml)
63
what are the early histological findings for autoimmune gastritis?
Early phase - multifocal diffuse infiltration of lamina propria by mononuclear cells and eosinophils and focal T cell infiltration of oxyntic glands with glandular destruction occur. Focal mucous neck cell hyperplasia and hypertonic changes of parietal cells are also observed
64
what are the florid histological findings for autoimmune gastritis?
Increased lymphocytic inflammation, oxyntic gland atrophy and focal intestinal metaplasia occur
65
what are the end histological findings for autoimmune gastritis?
Diffuse involvement of gastric corpus and fundus by chronic atrophic gastritis associated with little intestinal metaplasia
66
What is the treatment for autoimmune gastritis?
No specific treatment, just b12 supplement for pernicious anaemia Elated gastric emptying treated with metoclopramide
67
What is chronic reactive chemical gastropathy associated with?
Long term intake of aspirin or NSAID’s
68
What is another cause of chronic reactive chemical gastropathy
Bile containing intestinal contents reflux into the stomach
69
What are the histological findings associated with chronic bile reflux and long term NSAID use?
Mucosal oedema Congestion Fibromuscular hyperplasia in the lamina propria Pit or foveolar hyperplasia
70
What are the clinical manifestations in reflux gastritis?
Epigastralgia is the most important one (epigastric pain) that occurs after food ingestion, not relieved by anti ulcerous drugs and is increased by alkaline substances
71
How do you diagnose reflux gastritis?
Physical examination Endoscopy Gastric X-ray Values of biliary acids (should be high)
72
What does endoscopy shoes for reflux gastritis?
Distribution of lesions - most frequent in antrum
73
What are the main causes of chronic non infectious granulomatous gastritis?
Chron disease Sarcoidosis Isolated granulomatous gastritis
74
What are the clinical features of chron disease and gastric involvement?
Gastric pain Nausea Vomiting
75
What is sarcoidosis off the stomach usually associated with?
Granulomatous inflammation in other locations, especially the lungs, hilar nodes or salivary glands
76
What are the symptoms of sarcoid involvement in gastritis?
Gastric ulcers Haemorrhage Pyloric stricture Gastric outlet obstruction
77
What are the clinical manifestations of lymphocytic gastritis?
Non specific dyspepsia Epigastralgia Heartburn Nausea Anorexia Anemia Weight loss
78
What is the diagnosis for lymphocytic gastritis?
Biopsy and counting number of lymphocytes from gastric corpus (diagnosis can be made when 30 or more lymphocytes per 100 consecutive epithelial cells are observed)
79
What normally accompanies eosinophilic gastritis?
Parasitic infection (gastro enteritis)
80
What doe patients normally have in peripheral blood?
Eosinophilia
81
What can cause eosinophilic gastroenteritis in some cases?
Foods allergy, usually milk or soy
82
Which connective tissue disorders can also cause eosinophilic gastritis?
Scleroderma Polymyositis Dermamysoitis
83
What are the clinical features for eosinophilic gastritis with predominant mucosal involvement?
Nausea Vomiting Abdominal pain related to ingestion of specific foods
84
What are the clinical features for eosinophilic gastritis with predominant muscularis propria involvement?
Outlet obstruction symptoms
85
What is the treatment for eosinophilic gastritis?
Removal of certain foods and steroid therapy
86
What are the histological findings in eosinophilic gastritis?
Patchy infiltration by numerous eosinophils (typically contain 10-50 eosinophils per high power field and plasma cells) Mucosal oedema Congestion Necrosis of the surface epithelium
87
What does radiation lead to in radiation gastritis?
Degenerative changes in epithelial cells and a no specific chronic inflammatory infiltrate in the lamina propria
88
What will higher levels of radiation lead to?
Permanent mucosal damage Atrophy of fundus glands Mucosal erosions Capillary hemorrhage
89
What causes ischemic gastritis?
Atherosclerotic thrombi arising from the celiac and superior mesenteric arteries
90
What can chronic ischemia in ischemic gastritis lead to?
Superficial erosions and rarely deep ulcers
91
What are the clinical features of menetrier’s gastritis?
Epigastralgia Nausea Vomit Oedema of lower extremities due to hypoproteinemia
92
What are the lab findings for menetrier’s gastritis?
Decreased HCL secretion Increased mucous secretion Hypoproteinemia
93
What is the treatment for menetrier’s gastritis?
Protective alimentary diet Correction of protein imbalance by parenteral adminstration of aminofusin aminosteril Cytoprotective drugs Surgery - vagotomised combined with partial gastrectomy
94
What is found is 25-74% of patients with liver cirrhosis?
Congestive gastropathy
95
Heart is the pasthology congestive gastropathy?
Gastric mucosa congestion is produced due to portal hypertension
96
What are the clinical findings of congestive gastropathy?
Nausea Vomiting Anorexia Clinical manifestations of liver cirrhosis
97
What are the lab findings for congestive gastropathy?
Endoscopy - hyperaemia, erosions, oedema, microhaemorrhages (located at cardial angle and fundus)
98
What is the treatment for congestive gastropathy?
Treatment of portal hypertension

Gastroenterology (28 decks)

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