Peptic Disease

Question 1

How do prostaglandins inhibit acid secretion?

Answer 1

they target a receptor on the serosal surface of the parietal ell. Throuh a G protein on adenylate cyclase, causing a decrease in cAMP.

Question 2

What chemical induces acid secretion in the cephalic phase?

Answer 2

acetylcholine

Question 3

The arrival of food and acid in the small bowel trigger the release of what two chemicals? What do they do together?

Answer 3

CCK and Secretin are secreted upon arrival of food in the small bowel, and they feedback to inhibit acid secretion in the stomach.

Question 4

What prevents the stomach from being degraded and destroyed by it’s own acidity and enzymes?

Answer 4

the mucous-bicarbonate layer which causes a ph gradient on the surface.

Question 5

What is Peptic Ulcer Disease?

Answer 5

a defect in GI mucosa extending through muscularis mucosae

Question 6

What are symptoms of peptic ulcers?

Answer 6

epigastric burning, may be nocturnal or relieved with food.
Nausea/anorexia
May be asx (common with NSAIDS and elderly)

Question 7

What are risk factors for PUD

Answer 7

h pylori
medicines (nsaids, asa, clopidogrel)
smoking
genetic factors
acid increase

Question 8

What chronic dz have ulcers associated with them?

Answer 8

icu pts on ventilators
cirrhosis
organ transplat
copd

Question 9

What does h pylori produce?

Answer 9

urease - making it resistant to gastric acid

Question 10

What is the morphology of h pylori

Answer 10

spiral-shaped, gram- bacteria with four to six unipolar sheathed flagella.

Question 11

What is the mechanism of h pylori?

Answer 11

secretes factors, a peptide, and LPS, which are cehmotactic for neutrophils and monocytes. heat, acid and alkali stable. the inflammatory cells, once recruited, will then release oxygen radicals, prostaglandins, interleukin, and tumor necrosis factor that will fruther promote additional inflammation.

Question 12

What are high risk factors for nsaid gi toxicity?

Answer 12

history of a previously complicated ulcer,
over 65 yo
high-dose nsaid therapy
previous history of uncomplicated ulcerconcurrent use of aspirin, glucocorticoids or anticoagulants

Question 13

What are some causes of pud

Answer 13

increased vagal activity
parietal cell hyperplasia
acid erosive injury

Question 14

what are complicatoins of pud

Answer 14

bleeding - hematemesis, melena, anemia
perforation
penetration
gastric outlet obtruction (vomiting 3-4 hrs post eating)

Question 15

What is a dz that causes pud?

Answer 15

ZE dz

Question 16

how can we tx pud?

Answer 16

anti-secretory agents-h2 blockers ppis
eradicate h pylori
avoid smoking, nsaids and asa

Question 17

What are tests for h pylori?

Answer 17

urea breath test. (no bismuth, ppi or abs)
fecal antigen test using mab
serological test
biopsy

Question 18

is pud or erosive gastritis more superficial

Answer 18

erosive gastritis

Question 19

what does the “blood under plastic wrap” refer to?

Answer 19

hemorrhagic gastritis with multiple subepithelial hemorrhages without any visible breaks in mucosa.

Question 20

what is associated with acute hemorrhagic gastritis

Answer 20

alcohol, non-steroidal, anti-inflammatory agents, bile reflux, trauma, burns, sepsis, shock

Question 21

how do you present with acute hemorrhagic gastritis

Answer 21

abd discomfort, pain heartburn n/v hematemesis (can be massive)

Question 22

What is the main cause of chronic gastritis?

Answer 22

h pylori

Question 23

what does nichols say about h pylori gastritis?

Answer 23

common, increasing with age, severe in antrum, lymphocytic infiltration, with germinal centers and neutrophils (which make it active). leads to gastric adenocarcinoma

Question 24

What stain detects h pylori?

Answer 24

giemsa stain

Question 25

What is the most important toxin assocaited with h pylori?

Answer 25

cytotoxin-associated gene A - CagA protein

Question 26

what does CagA protein do?

Answer 26

It’s the h pylori toxin that degreades p53. Activates pathways to cell proliferatoin and messes up cell polarization.

Question 27

How does CagA get into cells?

Answer 27

It’s injected by type IV secretion sytem t4ss pilus structure

Question 28

If you have g-cell hyperplasia, do you have AI gastritis or h pylori?

Answer 28

AI

Question 29

Describe the gross appearance of ulcers

Answer 29

round, deep, punched out

Question 30

What did NIGS mean?

Answer 30

necrosis, inflammation, granulation tissue,scar

Question 31

What are characteristics of a malignant gastric ulcer?

Answer 31

irregular shape, heaped up or nodular margins, shallower, sloping ulcerate mass or bowl shape, necrotic shaggy base, bigger than 3cm

Question 32

what are characteristics of benign gastric ulcers

Answer 32

round-oval, flat or overhaning margins, deeper, punched out, perpendicular walls or flask shape, smooth clean base smaller than 2 cm radiating rugal folds

Question 33

Describe a stress ulcer

Answer 33

frequently small hemorrhagic spots, multiple

Question 34

When do you get stress ulcers?

Answer 34

brain injury (cushing ulcer) burn (curling ulcer)
3-7 days post event

Question 35

what is acute hemoorrhagic gastritis associate dwith ? take home point

Answer 35

alcohol, nsaids, trauma, sepsis shock.

Question 36

what is chronic gastritis associated with

Answer 36

h pylori

Question 37

benign ulcers tend to be ??

Answer 37

small round deep and punched out