Gastritis

Question 1

Gastroduodenal Defense: Pre-epithelial

Answer 1

• Mucous
• Bicarbonate
• Surface active Phospholipids

Question 2

Gastroduodenal Defense: Epithelial

Answer 2

• Cellular resistance
• Restitution
• Growth factors, Prostaglandins
• Cell Proliferation

Question 3

Gastroduodenal Defense: Subepithelial

Answer 3

• Blood flow
• Leukocytes

Question 4

Symptoms of gastritis

Answer 4

-Epigastric abdominal pain, N/V, Anorexia/early satiety, hematemesis/ melena, anemia weight loss, symptoms of systemic disorder. Nighttime wakening *think PUD

Question 5

Gastritis: Infection

Answer 5

• H pylori
• CMV/EBV
• Candida, Anisakis

Question 6

Gastritis: Drugs

Answer 6

-NSAIDS
-Steroids
-Chemo

Question 7

Gastritis Inflammatory

Answer 7

-IBD
-Eosinophilic
-Celiac
-GVHD
-HSP

Question 8

Gastritis Hypersecretory States

Answer 8

-Zollinger Ellison
-G cell hyperplasia
-Short gut
-CF
-Renal

Question 9

Gastritis: Stress

Answer 9

-Trauma,
-Burn injury
-Head injury
-NICU

Question 10

Gastritis: Physical Agents

Answer 10

-Corrosive
-Bile Acid
-Exercise
-Radiation

Question 11

CMV Gastritis

Answer 11

• Increased in immune compromised, can also be in normal immune patients.
  -Menetrier’s: abdominal pain, vomiting, edema (2/2 PLE). EGD: enlarged folds +/- erosions/ulcers.
  Histology: enlarged torturous glands, CMV+ inclusion bodies, PCR
  Management: usually self limited, supportive, +/- antiviral

Question 12

NSAIDS

Answer 12

Topical damage from pill.
Pharmacological effects (COX inhibition reduce prostaglandins).
NSAIDS can cause ulceration or reactive gastropathy: epithelial hyperplasia, mucin depletion, fibromuscular hyperplasia, vascular ectasia.
May occur after one dose or chronic dosing.
Gastroprotection with PPI may prevent lesions

Question 13

IBD Gastritis

Answer 13

Upper GI tract (macro and micro) involvement is commonly found, rarely in isolation
Focal gastritis more common in Crohn’s disease, +granuloma can distinguish Crohn’s disease from UC.

Question 14

Celiac disease

Answer 14

lymphocytic gastritis or chronic superficial gastritis may be present in up to 1/3 of children with celiac disease.

Question 15

Acute GVHD

Answer 15

Nausea, vomiting, anorexia +/- skin, lower GI, and liver findings.
21-100 days after BMT.
Apoptotic cells are hallmark.
Need to rule out CMV infection.

Question 16

Zollinger Ellison syndrome symptoms

Answer 16

• Abdominal pain, +/- diarrhea (due to hypergastrinemia).
• Prolonged PUD despite treatment.
• Recurrent PUD, complicated PUD,
• MEN1

Question 17

Zollinger Ellison Syndrome Lab findings

Answer 17

• Elevated fasting gastrin, positive secretin test (provocative test), low gastric pH.
  Endoscopic findings: multiple ulcers in different locations.

Question 18

Zollinger Ellison Syndrome Management

Answer 18

• Identify tumor: gastrinoma triangle.
• PPI, surgical removal of tumor.

Question 19

Stress related mucosal disease

Answer 19

Critically ill patients under physiological stress.
RF: ventilation, major surgery, head injury, multi-organ failure, hemodynamic instability, anti-coagulation.
Data on prevention with acid suppression limited in pediatrics: may decrease UGIB but no change in mortality

Question 20

Corrosive Gastritis

Answer 20

Alkali: Liquefactive necrosis. Transmural, esophageal>gastric injury.
Acidic: Coagulative necrosis: more severe gastric injury.
EGD: grade of injury/stricture risk, early therapy.