Gastroduodenal disorders Flashcards Preview

GI_EB > Gastroduodenal disorders > Flashcards

Flashcards in Gastroduodenal disorders Deck (37):
1

List the five basic functions of the stomach

1. storage
2. mixing and mechanical breakdown
3. proteolytic digestion
4. absorp water, salts, alcohol, some drugs
5. secretion of digestive hormones.

2

Which portions of the stomach perform exocrine functions?

Body and fundus

3

Which portions of the stomach largely function as adaptive storage regions?

Body and fundus

4

Which regions of the stomach perform endocrine functions?

Antrum (and pylorus)

5

Which regions of the stomach function in propulsion?

Antrum (and pylorus)

6

Describe normal gastric motility

controlled by the gastric pacemaker, and modified by the vagus nerve, and the rest of the enteric nervous system

7

What are the consequences of diabetic gastroparesis?

delayed gastric emptying, early satiety, post-prandial abdominal pain, nausea and vomiting

8

List the cell types in the stomach that have exocrine roles and their functions

- Mucus cells line the superior surface of the gland and produce mucus and bicarbonate.

- Parietal cells secrete HCl and intrinsic factor.

- Chief cells produce pepsinogen, primarily in the fundus.

- Enterochromaffin–like cells secrete histamine; primarily in the body.

9

List the cell types in the stomach that have endocrine roles and their products

- G cells: produce gastrin which stimulates gastric acid production/ release
- D cells: produce somatostati which inhibits acid production/ release

10

List the phases of gastric acid secretion

- basal rate of gastric acid secretion, diurnal, greatest in the evening and least in the early morning.
- cephalic phase, eating or thinking about food, stimulates gastric acid production via the vagus nerve.
- gastric phase, acid production is stimulated (via gastrin) by antral distention and presence of protein.
- intestinal phase modulates acid secretion via endocrine pathways as food is digested and absorbed in the intestine

11

________ is the final common pathway to gastric mucosal injury

Prostaglandin deficiency

12

_______ are the most potent acid suppressing medications available

PPIs

13

What conditions are PPIs used to treat?

Peptic ulcer disease, GERD, H pylori eradication

14

List examples of PPIs

Omeprazole, pantoprazole, lansoprazole, esomeprazole, rabeprazole, dexlansoprazole

15

Why are H2 antagonists less potent at suppressing acid than PPIs?

Suppress histamine, just one of the pathways to increase acid secretion

16

What conditions can H2 antagonists be used to treat?

Peptic ulcer disease, GERD

17

List the alarm symptoms seen with dyspepsia in peptic ulcer disease. What must be done when alarm symptoms are present?

Bleeding
Anemia
Age>50
Early satiety
Unexplained weight loss
Dysphagia or Odynophagia
Recurrent vomiting
Family hx of GI cancer

Requires urgent endoscopy

18

Describe how NSAIDs, hypersecretory states, and H pylori contribute to peptic ulceration

- NSAIDs decrease mucosal defenses, causes mainly gastric ulcers
- Hypersecretory states increase acid and pepsin, causes mainly duodenal ulcers
- H pylori does both

19

List complications of ulcer disease

- bleeding (10-20%)
- gastric outlet obstruction (2%)
- perforation (2%)

20

Duodenal ulcers are almost always in the _____, almost always benign, and often overly the _________ artery

bulb
gastroduodenal artery

21

Ulcers in the 2nd or 3rd duodenum are suspicious for hypersecretory states such as hypergastrinemia due to __________

Zollinger-Ellision Syndrome
A gastrinoma produces unregulated acid production

22

Gastric ulcers have ______ potential and should be examined with repeat endoscopy after a regimen of acid suppression

Malignant
May biopsy at follow up endoscopy if no active bleed

23

What might explain the decrease in hospitalizations and surgeries related to peptic ulcer disease?

More effective acid suppression- PPIs
Recognition and treatment of H pylori

24

List aggressive factors contributing to ulcer production

H. pylori
NSAIDs inhibit PGE production, local irritant
Acid
Pepsin
Bile acids
Pancreatic enzymes
Tobacco, caffeine, alcohol
Heredity
Delayed emptying
Stress, steroids

25

List factors that are protective against ulcer formation

Mucus
Bicarbonate
Mucosal blood flow
Prostaglandins

26

________ is a preferred method of peptic ulcer disease diagnosis, because biopsies can be performed at the same time

Upper endoscopy (as compared to upper GI X ray)

27

List complications of H pylori infection

Chronic active gastritis
Duodenal OR gastric ulcers
Gastric adenocarcinoma
MALToma

28

The local host response to H pylori infection is ____ biased, which usually occurs in response to intracellular pathogens

Th1- paradoxical because H pylori is not intracellular

29

H pylori causes _______ of epithelial cells and increases ______ release

apoptosis
gastrin

30

Increased ______ in response to H pylori infection activates neutrophils

IL-8

31

List methods that can be used to diagnose H pylori

Biopsy by upper endoscopy for histopathology/ microscopic examination or urease testing
Urea breath test
Stool antigen
Serology

32

List situations in which it is appropriate to test for H pylori

Dyspepsia without “alarm” signs
Peptic ulcer disease
Gastric cancer
Gastric lymphoma

33

The urea breath test and H pylori stool antigen test sensitivity is reduced by:

PPIs, antibiotics, bismuth
Patients must be off for two weeks before test of cure by these methods

34

Describe therapy of ulcer disease

6-8 weeks of PPI (or H2 blocker)
Discontinue aspirin and NSAIDs

35

Describe treatment of H pylori infection

First line:
PPI for 8 weeks + clarithromycin and amoxicillin (or metronidazole) for 10-14 days

Alternate:
PPI, bisuth, metronidazole, tetracycline

36

_______for treatment and diagnosis of bleeding has greatly reduced number of PUD patients needing surgery

Endoscopy

37

What are indications for ulcer surgery?

Refractory outlet obstruction
Unresponsive GI bleeding
Perforation
Malignancy
Recurrent ulcers