Path Peptic disease

Question 1

mucus cells

Answer 1

secrete mucus around entrance to gastric pit

Question 2

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

Triggered by what 4 things?

Answer 2

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

Question 3

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

Answer 3

Secrete histamine

chyme in duodenum -> CCK, secretin

Question 4

what protects epithelium from acid in stomach?

Answer 4

mucus-bicarb

Question 5

peptic ulcer disease (PUD)

Answer 5

defect in GI mucosa extending through muscularis mucosae.

on the decline

Question 6

symptoms of peptic ulcer

Answer 6

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

Question 7

epidemiology of PUD

Answer 7

more common in elderly & those taking nsaids

Question 8

risk factors for PUD (5)

Answer 8

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

Question 9

what must be present for PUD?

Answer 9

acid

Question 10

chronic conditions associated with PUD? (4)

Answer 10

ICU & vent
cirrhosis
organ transplants
COPD

(prophylaxis common)

Question 11

bacteria common in PUD & %

Answer 11

Helicobacter pylori in 70% of PUD

Question 12

% of helicobacter pylori inhabited pts with PUD

Answer 12

10-15%

Question 13

4 virulence factor of H. pylori

description

Answer 13

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

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

Question 14

effect of eradication of H. pylori on PUD patients?

Answer 14

reduced recurrence observed in studies

Question 15

Factors contributing to getting PUD & H pylori

Answer 15

genetic predisposition & family co-incidence

Question 16

Ulcers from NSAIDS vs H. pylori

Answer 16

increasing, decreasing

Question 17

rank of NSAIDs related death

Answer 17

15th most common cause of death in USA

Question 18

high & moderate risk factors for NSAID GI tox

Answer 18

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

Question 19

dx of PUD

Answer 19

UGI Ba X-ray of stomach (60-90% Sn)

upper endoscopy w/H pylori biopsy

Question 20

duodenal ulcer malignant?

gastric ulcer malignant?

Answer 20

never

maybe

Question 21

chance of rebleeding in duodenal ulcers

Answer 21

50%

Question 22

tx of PUD (4)

Answer 22

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

Question 23

tests for H. pylori (4)

Answer 23

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

Question 24

gastritis definition

Answer 24

gastric inflammation of mucosa

Question 25

sign in EtOH-induced gastritis

Answer 25

subepithelial hemorrages | "blood under plastic wrap"

Question 26

common associated conditions with hemorrhagic gastritis (7)

Answer 26

``` alcohol nsaids bile reflux trauma burns sepsis shock ```

Question 27

timeline for healing acute hemorrhagic gastritis

Answer 27

fast

Question 28

chronic gastritis causes (5, in a hokey way)

Answer 28

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

Question 29

possible sequelae of H pylori gastritis

Answer 29

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

Question 30

3 ways to test for H pylori

Answer 30

section, look for cell bodies in neck of gastric glands & neutrophils in center of gland test tissue soln for urease immunostain

Question 31

germinal centers in gastric wall

Answer 31

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

Question 32

another name for stomach epithelium

Answer 32

foveolar epithelium

Question 33

signs of intestinal metaplasia due to H pylori

Answer 33

inflammatory cells | intestinal metaplasia with presence of goblet cells

Question 34

What is CagA & what does it do?

Answer 34

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)

Question 35

CagPAI

Answer 35

cytotoxin-associated gene A pathogenicity island

Question 36

autoimmune gastritis

Answer 36

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

Question 37

achlorhydria

Answer 37

Ab to parietal cells, an autoimmune gastritis

Question 38

pernicious anemia

Answer 38

Ab to intrinsic factor, an autoimmune gastritis

Question 39

PUD signs of benign ulcer

Answer 39

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

Question 40

PUD signs of malignant ulcer

Answer 40

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

Question 41

Cushing ulcer

Answer 41

brain injury-related stress ulcer

Question 42

Curling ulcer

Answer 42

burn-related stress ulcer

Question 43

stress ulcer description

Answer 43

``` deep single hemorrhagic small <1 cm patechiae, hemorrages. ```

Question 44

acute hemorragic gastris associated with

Answer 44

alcohol, trauma, sepsis, shock

Question 45

chronic gastritis associated with

Answer 45

H pylori, or (uncommonly) autoimmune