where in the stomach does chronic autoimmune gastritis occur?
body & fundus
are there antibodies seen in chronic autoimmune gastritis? is this what causes damage?
there can be antibodies against parietal cells and or intrinsic factor which can be used for diagnosis but this is NOT what causes the damage- damage is type IV hypersensitivity that is cell mediated
what are some clinical features in chronic autoimmune gastritis
- atrophy of mucosa
- knocking out ability to produce acid-achlorhydria
- increased gastrin levels and antral G cell hyperplasia (because of loss of negative feedback)
- megaloblastic anemia (lack of IF)
what is the more common type of chronic gastritis
chronic H pylori gastritis
how does H pylori weaken mucosal defenses?
secretes ureases and proteases and cause inflammation
where in the stomach is the most common site of chronic H pylori gastritis
antrum
what is the treatment for chronic H pylori gastritis
triple therapy
will resolve gastritis, ulcer and will reverse the intestinal metaplasia
where is peptic ulcer disease usually
90% in the proximal duodenum or distal stomach (10%)
what is the usual cause of a duodenal ulcer
H pylori (rarely ZE syndrome)
you have epigastric pain that IMPROVES with meals, where is the ulcer?
duodenum
how does a duodenal ulcer appear on endoscopy?
ulcer with hypertrophy of brunner glands
what are some causes of a gastric ulcer
H pylori (70%) NSAIDs (20%)
do gastric ulcers get better or worse with food
WORSE
where are the gastric ulcers usually located? what is a risk that is associated with this?
on lesser curvature of antrum. associated with rise of bleeding from left gastric artery if the ulcer ruptures
you have an ulcer than is PUNCHED OUT
benign or malignant
benign
what are some other features of a benign gastric ulcer
small, punched out, margins next to it are NOT piling up, flat and normal
what are some features of a malignant ulcer?
irregularly shaped (NOT punched out), much larger, and there will be piling up of the mucosa at the edge of ulcer
what are the 2 types of gastric carcinoma
intestinal and diffuse type
how does the intestinal type of gastric carcinoma appear?
large, irregular ulcer with heaped up margins
usually involves the lesser curvature of the antrum
how does the diffuse type of gastric carcinoma appear?
signet ring cells that diffusely infiltrate the gastric wall
results in the cancer PLUS a reaction to the cancer (desmoplasia)
what type of cell is the following describing:
“nucleus is pushed off the to the edge due to mucus production”
when are these cells seen?
signet ring cell
see in diffuse type gastric carcinoma
what is desmoplasia (seen in diffuse type gastric carcinoma)
reactive response of the stroma (mainly just fibrosis and blood vessels). appears white
results in the thickening of the stomach wall
diffuse or intestinal type, which is associated with H pylori infection?
intestinal type
where does gastric carcinoma like to spread (which node)?
virchow’s nodes (left supraclavicular)
what are 2 skin manifestations that can be seen with gastric carcinoma
acanthosis nigricans
lesser trelet sign
what gastric carcinoma likes to go to the periumbilical region (sister mary joseph nodule)?
intestinal type
what gastric carcinoma is associated with krukenburg tumors?
diffuse type
will see signet cells in the ovaries
what disorder is duodenal atresia associated with?
down syndrome
how does duodenal atresia appear on barium swallow?
double bubble sign (2 separate areas of distension)
is the vomiting in duodenal atresia billous or non billous
billous
is meckel diverticulum true or false diverticulum?
true (outpouching of all 3 layers of wall)
why does meckel diverticulum arise?
due to failure of vitelline duct to involute
you see meconium coming out of the baby’s umbilicus? whats up
meckel diverticulum
what is the most common congenital anomaly of the GI tract?
meckel diverticulum
what condition?
“twisting of bowel on its mesentery”
volvulus
what is the most common location of a volvus in the elderly? the young?
elderly- sigmoid colon
young adults- cecum
what condition
“telescoping of proximal segment of bowel into the distal segment”
intussusception
person presents with current jelly stools
intussusception
intussusception usually needs a “leading edge” to drag the bowel on, in adults what usually is in? children?
children-lymphoid hyperplasia
adults-tumor
what is usually the cause of a transmural infarction in the bowel?
embolism/thrombosis of SMA or thrombosis of mesenteric vein
what are the 2 acquired pathways to lactose intolerance
- as you age you become intolerant and once you are intolerant you are for the rest of your life
- after an infection that destroys the enzyme you are temporarily intolerant until the bowel is repaired
