h.pylori and NSAIDS

Question 1

risk factor of serious GI events with NSAIDS?

Answer 1

aprior bleeding or ulcer
anticoagulants
corticosteroids
dose 
age
(from most to least)

Question 2

NSAIDS targets?

Answer 2

cox1 (hematosis, gastric PG)

cox2 (peripheral inflammation)

Question 3

what does cox 1 produce?

Answer 3

tranexamic acid

gastric PG

Question 4

cox 1+2 inhibition results in

Answer 4

inhibition of PG synthesis which relives inflammation

removal of gastric mucosal protection

Question 5

selective cox 2 inhibitors effect?

Answer 5

less gastric mucus disturbance

Question 6

NSAIDS toxic effects on small intestine?

Answer 6

ulcers
strictures
excerbation of IBD

Question 7

NSAIDS toxic effects on large intestine?

Answer 7

ulcers 
strictures
excerbation of IBD
diverticular bleading 
colitis

Question 8

Traditional NSAIDS?

Answer 8

iboprofen
naxil
indomethacine

Question 9

zollinger ellison (ZES) definition?

Answer 9

gastrinoma- gastric producing tumor

Question 10

gastrin target site?

Answer 10

colecytokinin B receptors on ECL cells which secrete histamine in response

Question 11

gastrin morphological outcomes?

Answer 11

trophic influence on gastric epithel

substential rugea

Question 12

ZES location?

Answer 12

gastrinoma tringle (90%)
junction of 1+2 deudoneum
junction of neck and body of pancreas
junction of cystic and common bile ducts

Question 13

ZES phathology?

Answer 13

tumors are malignant 60%
liver as primary metastatic site
multiple lession on first onset in 30-50%

Question 14

when to think about gastrinoma?

Answer 14

PUD + diarrhea
PUD in unusual location or multiple location
PUD refractory to treatment
PUD with prominat gastric folds
MEN-1 suggestive findings
ulcerative complications (perforation, stricturs)

Question 15

gastrinoma diagnosis?

Answer 15

fasting gastrin

gastrin with low PH

Question 16

gastrinoma treatment ?

Answer 16

PPI
somatostatin analogues (D-cell)
resection

Question 17

non H.pylori / NSAIDS / gastrinoma ulcers?

Answer 17

Infection (cmv, hepes a bit)
drugs (bisphosphonate, causties)
heterogenic (basophilia in myeloproliferative disease)

Question 18

PUD symptoms

Answer 18

most are asymptomatic
burning epigastric pain with worsen by fasting
90% of dyspeptic patients have no PUD
complications without antecedant symptoms

Question 19

dyspepsia?

Answer 19

upper abdominal discomfort

Question 20

dyspepsia DD?

Answer 20

PUD 
NUD
proximal GI tumors
reflux
billiary disease
ischemic heart disease (usually caudal wall)

Question 21

PUD physical exam?

Answer 21

epigastric tenderness- low predictor

rull-out complications:
tachycardia
lymphoadenopathy

Question 22

PUD diagnosis tests?

Answer 22

endoscopy
Bx histopathology
Bx rapid urease test (H.pylori)

Question 23

forrest classification for PU bleeding?

Answer 23

1a- arterial jet
1b- oozing
2a- visible vessle
2b- adherent clot
2c- black spot
3- clean base

Question 24

follow up of PU?

Answer 24

DU- none usually

GU- bening and malignant look alike, thus check up till complete healing +Bx

Question 25

PUD bleeding prognosis?

Answer 25

mortality (5-10)% mostly due to non bleding cause 50% bleed without preceding symptoms melena (dark stool due bleeding) hematochezia (passage of fresh blood per anus, usually in or with stools) hypotension and tachycardia syncope ICU

Question 26

bubble in right diaphragm?

Answer 26

probably a perforation of air feeld organ in peritoneal sack

Question 27

Ringle's sing?

Answer 27

intestinal walls are seen in x-ray due to air in abdomen

Question 28

penetration?

Answer 28

perforation of ulcer bed tunnels into adjacent organ DU- pancrease GU- slpeen gastrocolic

Question 29

fistula?

Answer 29

connection of two empty vessles

Question 30

PUD complications?

Answer 30

bleeding > prforation > obstruction

Question 31

PUD associated obstruction symptoms?

Answer 31

``` vomitting bloating early sateity weight loss dehydration ```

Question 32

PUD assiciated obstruction pathogenesis?

Answer 32

edema or scar of ulcer deminishing space, | usually in deudoneum

Question 33

stress related mucosal injury pathopysiology?

Answer 33

``` HCL up mucosal ischemia systemic cytokins oxidative stress poor GI motility ```

Question 34

stress related mucosal injury risk factors?

Answer 34

ICU: coagulopathy mechanical ventillation

Question 35

stress related mucosal injury treatment?

Answer 35

PPI | ivesive- inefficient (due to it being diffusic problem)

Question 36

Menertier disease morphology?

Answer 36

tortous gastric folds massive foveolar hyperplasia reduction of oxyntic glands, cheif @ parietal cells

Question 37

Menetrier disease DD?

Answer 37

ZES malignancy infection- CMV, syphilis, H.pylori

Question 38

Menetrier pathopysiology?

Answer 38

``` TGF-a production is up EGFR signaling is up intensive mucus secretion malabsorption protien losing gastropathy hypoalbuminemia edema ```

Question 39

Menetrier treatment?

Answer 39

``` PPI CMV treatment H.pylori eradication centuximab when all fails gastrectomy ```

Question 40

chronic gastritis A?

Answer 40

``` body of stomach secondary to : autoimmune -pernicious anemia (B12, intrinsic factor antigens) H.pylori ```

Question 41

chronic gastritis B?

Answer 41

``` antral H.pylori gastric atrophy intestinal metaplasia Adenoca ```

Question 42

gastroparesis?

Answer 42

delayed gastric emptying of soilds without obstruction

Question 43

gastroparesis etiology?

Answer 43

``` idiopathic 50% diabities meds viral autoimmune paraneoplastic (scc in lungs) ```

Question 44

gastroparesis treatment?

Answer 44

``` lifestyle meds gastric pacing botox- dialition pylorus gastrostomy jejunostomy ```