Flashcards in Diseases of the Upper GI: Stomach Deck (30):
Solid emptying is mediated by ____________.
vagal nerve stimulation
The ___________ glands are in the _________ and secrete gastrin.
What three pathways stimulate acid secretion?
- Neural pathway (acetylcholine on M3 receptors)
- Gastrin pathway (hormonal secretion from gastric cells landing on CCK2 receptors)
- Histamine from ECL cells on H2 receptors
The cardinal finding of Menetrier's disease is _____________.
What is Zollinger-Ellison syndrome?
- Neuroendocrine tumor in pancreas or duodenum
- The excess gastrin secretion (from the neuroendocrine tumor) leads to increased acid secretion and many ulcers
The stomach of someone with ______________ will lack rugae. What causes this?
autoimmune atrophic gastritis (AAG); attack on parietal cells – leading to pernicious anemia and increased risk of cancer
Infection with Helicobacter pylori tend to have what chronological presentation?
What are some features of H. pylori?
- Suited to live in acidic environment
- Spiral shape with multiple flagella
- Produces urease with breaks down urea to ammonia (which neutralizes pH)
- CagA injected into epithelium to adhere
- VacA to inhibit T cells
Antibiotics prevent _____________ in those with H. pylori infection.
Most H. pylori infection leads to ______ gastritis.
pan (80%); about 15% only have antral inflammation
In whom should you consider testing for H. pylori infection?
- Active PUD
- History of PUD without treatment
- Gastric neoplasia
By what non-endoscopic tests can you test for H. pylori? (Endoscopic tests use a small histologic sample – high sensitivity/specificity.)
- Blood antibody tests
- Stool sample
- Urea breath test
Consider treating even if the patient is ____________.
What are treatment guidelines for H. pylori?
- PPI, clarithromycin, and amoxicillin (14 days)
- PPI, bismuth, metronidazole, and tetracycline (14 days)
- Sequential therapy
What are gastropathies?
Injury in the absence of inflammation
Can be caused by ethanol, NSAIDs, stress, cocaine, or bile reflux
How does alcohol injure the stomach?
It disrupts the mucosa and increases acid secretion. This only occurs with high concentrations of alcohol.
Why do NSAIDs injure the stomach?
Because the production of mucus and bicarb (both of which are protective) depend on prostaglandins
True or false: most people with peptic ulcers are asymptomatic.
The lifetime prevalence of peptic ulcer disease is _______.
5% - 10%
How is PUD treated?
- PPI therapy (allowing the ulcer to heal)
- H. pylori test and treat (preventing recurrence)
- Risk-factor avoidance (e.g., smoking, NSAIDs)
Gastrointestinal stomal tumors originate from which cell type? (This is the most common mesenchymal stomach cancer.)
Interstitial cells of Cajal (pacemaker cells)
Cardiac glands contain _______________.
mucus-secreting cells that also produce some pepsinogen
Oxyntic glands are found in the ____________ and contain the following cell types: ____________.
fundus and body; mucous cells, parietal cells, chief cells, endocrine cells, and enterochromaffin cells
The pyloric glands contain which cell types?
Mucous and endocrine
Activation of receptors in the proximal small intestine does what to gastric emptying?
Slows it (so that the small intestines don't become overwhelmed with contents)
The disease that presents with mucous-cell hyperplasia has what presenting signs/symptoms?
Which type of polyp can result from long-term PPI use?
True or false: fundic polyps are associated with a high risk of malignancy.
False. No risk.
From what cells do carcinoid tumors generally arise?
Enterochromaffin or enterochromaffin-like cells