Path Peptic disease Flashcards Preview

GI & Liver Fall 2013 CBD > Path Peptic disease > Flashcards

Flashcards in Path Peptic disease Deck (45):
1

mucus cells

secrete mucus around entrance to gastric pit

2

parietal cells: what they produce
how do they produce it?

Triggered by what 4 things?

secretes HCl across H-K-ATPase
adenyl cyclase, cAMP pathway

triggered by ACh (vagal)
gastrin (from G cells)
Histamine (from ECL cells)
prostaglandin I/E

3

what causes ECL cells to secrete and what do they secrete?

Secrete histamine
chyme in duodenum -> CCK, secretin

4

what protects epithelium from acid in stomach?

mucus-bicarb

5

peptic ulcer disease (PUD)

defect in GI mucosa extending through muscularis mucosae.

on the decline

6

symptoms of peptic ulcer

abdominal pain (80%, may be nocturnal or relieved with food)
nausea, anorexia

7

epidemiology of PUD

more common in elderly & those taking nsaids

8

risk factors for PUD (5)

Helicobacter pylori gastritis
ASA, NSAIDS, clopidogrel
smoking
genetics
acid must be present

9

what must be present for PUD?

acid

10

chronic conditions associated with PUD? (4)

ICU & vent
cirrhosis
organ transplants
COPD

(prophylaxis common)

11

bacteria common in PUD & %

Helicobacter pylori in 70% of PUD

12

% of helicobacter pylori inhabited pts with PUD

10-15%

13

4 virulence factor of H. pylori

description

urease (resistance to HCl)
LPS (inflammation)
CagA (cytotoxin-associated gene A, -> p53)
T4SS pilus (syringe-like structure)

4-6 flagella. gram-negative, spiral-shaped

14

effect of eradication of H. pylori on PUD patients?

reduced recurrence observed in studies

15

Factors contributing to getting PUD & H pylori

genetic predisposition & family co-incidence

16

Ulcers from NSAIDS vs H. pylori

increasing, decreasing

17

rank of NSAIDs related death

15th most common cause of death in USA

18

high & moderate risk factors for NSAID GI tox

High risk factors:
Hx of complicated ulcer, >2 risk factors

moderate risk factors:
Age >65, high dose NSAIDs, hx of uncomplicated ulcer, aspirin (any dose), glucocorticoids, anticoagulants

19

dx of PUD

UGI Ba X-ray of stomach (60-90% Sn)
upper endoscopy w/H pylori biopsy

20

duodenal ulcer malignant?
gastric ulcer malignant?

never
maybe

21

chance of rebleeding in duodenal ulcers

50%

22

tx of PUD (4)

H2 blockers or PPIs 6-8 wks
kill H pylori
avoid smoking, NSAIDS, ASA
surg

23

tests for H. pylori (4)

urea breath test
fecal antigen test
serological test (no good for tx evaluation)
biopsy of antrum

24

gastritis definition

gastric inflammation of mucosa

25

sign in EtOH-induced gastritis

subepithelial hemorrages
"blood under plastic wrap"

26

common associated conditions with hemorrhagic gastritis (7)

alcohol
nsaids
bile reflux
trauma
burns
sepsis
shock

27

timeline for healing acute hemorrhagic gastritis

fast

28

chronic gastritis causes (5, in a hokey way)

h pylori, h pylori, h pylori, autoimmune, bile reflux

29

possible sequelae of H pylori gastritis

gastric adenocarcinoma (1-3%)
low grade lymphoma/galtoma (0.1%)

30

3 ways to test for H pylori

section, look for cell bodies in neck of gastric glands & neutrophils in center of gland

test tissue soln for urease

immunostain

31

germinal centers in gastric wall

chronic follicular gastritis due to H pylori. also seen with immunostain for h. pylori

32

another name for stomach epithelium

foveolar epithelium

33

signs of intestinal metaplasia due to H pylori

inflammatory cells
intestinal metaplasia with presence of goblet cells

34

What is CagA & what does it do?

virulence factor for H pylori that causes degradation of p53. Messes up cell polarization.

injected with T4SS (type IV secretion system) pilus structure in CagA pathogenicity island (CagPAI)

35

CagPAI

cytotoxin-associated gene A pathogenicity island

36

autoimmune gastritis

<10% of chronic gastritis
Ab to parietal cells (achlorhydria)
Ab to intrinsic factor (pernicious anemia)

37

achlorhydria

Ab to parietal cells, an autoimmune gastritis

38

pernicious anemia

Ab to intrinsic factor, an autoimmune gastritis

39

PUD signs of benign ulcer

punched out
deep
flat or overhanging margins
round
small <2 cm
solitary
radiating rugal folds

40

PUD signs of malignant ulcer

nonradiating folds
irregular shape
nodular
shallower
sloping
shaggy base
bigger >3cm

41

Cushing ulcer

brain injury-related stress ulcer

42

Curling ulcer

burn-related stress ulcer

43

stress ulcer description

deep
single
hemorrhagic
small <1 cm
patechiae, hemorrages.

44

acute hemorragic gastris associated with

alcohol, trauma, sepsis, shock

45

chronic gastritis associated with

H pylori, or (uncommonly) autoimmune