Peptic Diseases and Gastritis (Jackson/Nichols) Flashcards Preview

Gastro > Peptic Diseases and Gastritis (Jackson/Nichols) > Flashcards

Flashcards in Peptic Diseases and Gastritis (Jackson/Nichols) Deck (48):
1

gastric cells that make HCl

parietal

2

gastric cells that make pepsinogen

chief

3

gastric cells that make bicarbinate rich mucos

mucous cells

4

gastric cells that make gastrin

g cells

5

what intracellular processes drigger H/K ATPase activity

↑ Ca (thru IP3) and ↑ cAMP (thru AC)

6

exert a negative feedback on acid secretion in partial cells?

distention, low pH, somatostatin, and prostaglandins inhibit parietal cell H+ secretion

CCK and secretin inhibit action of gastrin

7

what is the cephalic phase of acid secretion

Taste, smell, and chewing food stimulates acetylcholine release via the vagal nerve → partial cells secrete HCl (30% of total secretion)

8

What is the gastric phase of acid secretion?

Chemical effects of food and distension of stomach causes:
-release of gastrin by the G cells (indirect stim of parietal cells)
-release of Ach from vagal N to directly act on parietal cells

9

how does gastric acid secretion in pts with DUODENAL ulcers compare to secretion in normal patients? GASTRIC ulcers?

Duodenal: ↑H+ (2x nml) and ↑gastrin

Gastric: ↓H+ and ↑gastrin (H+ leaks out due to damage to the mucosa and gastin ↑ to compensate)

10

what prevents auto digestion?

mucos-bicarb layer in stomach

11

how does duodenal bicarb secretion in pts with DUODENAL ulcers compare to secretion in normal patients

↓ basal [bicarb] and ↓ acid stimulated secretion of bicarb

12

definition of PUD

defect in GI mucose extending THROUGH THE MUSCULARIS MUCOSA

13

Risk factors for PUD

PUD HANGS around with H pyloir:

H pylori
ASA
NSAIDs
Genetics
Smoking

14

What chronic diseases is PUD assc with? how is it prevented in these conditions (i.e. what is the prophylactic treatment?)

Stress
Transplanted organs
Cirrhosis
COPD

prophylactic PPIs

15

symptoms of PUD

abd pain (nocturnal or with food)
nausea
anorexia
**may be asympomatic and present with complication = bleeding or perforation

16

morphology of H pylori

gram - spiral shaped with 4-6 flagella

17

pts infected with h pylori will have ↑ or ↓ response to gastrin/acid production. why?

↑ due to ↓somatostatin release

18

Since H pylori colonize gastric mucosa, how do they cause a duodenal ulcer?

1. inhibit somatostatin secretion → gastrin → ↑H+ secretion
2. inhibits duodenal HCO3- secretion → duodenal contents become abnormally acidic → mucosa eroded
3. ↑ gastrin has trophic effect on parietal cells →↑H
4. increased inflammatory cells and cytokines

19

top 2 causes of PUD

H pylori and NSAIDs

20

How does H pylori elicit an inflammatory response

secretes LPS and peptides that will cross gastric epithelium and are then chemotactic for neutrophils and monocytes in the lamina propria → monocytes secrete TNF< IL-1, O2-, Prostaglandins

21

how does NSAID use leas to PUD

NSAIDS
▪︎ ↑HCl
▪︎ ↓bicarb
▪︎ ↓glutathione → ↑ROS

22

pareital cell hyperplasia occurs as a result of

↑ vagal stimulation and gastrin

23

how is the diagnosis of PUD made

UGI barium X ray
upper endoscopy **also allows for biopsy

24

What are the complications of PUD?

bleeding → hematemesis, melana, anemi
perforation
penetration into adj organs (pancreas, liver, colon)
obstruction (due to edema or fibrosis)

25

perforated duodenal ulcers are assc with

ZES, NSAIDs, cocaine

26

Acute PUD → obstruction due to ____.
Chronic PUD → obstruction due to _____.

Acute PUD → obstruction due to edema.
Chronic PUD → obstruction due to fibrosis.

27

Obstruction causes pt to _____ several hours after they eat

vomit

28

Treatment of PUP

H2 blockers or PPIs
Abx

29

can you assume a pt with a + serological test for H pyloru has an active H pylori infection

no, they may have cleared it but they still have Abs made to it

30

defn of gastritis. How is this diff than the defn of PUD?

gastritis = infalmmation of mucosa
PUD = inflammation and damage extends thru the muscularis mucosa

31

common causes of gastritis:

H pylori
NSAIDs
alcohol
extreme stress (ICU

(less common: chemo, bile reflux, truama, burns, sepsis, shock)

32

“blood under plastic wrap” on endoscopy indicates

multiple subepi hemorrhages without any breaks in mucosa = assc with alcohol use

33

numerous petechiae and erosions of on gastric mucosa

acute hemorrhagic gastritis

34

causes of chronic gastritis

H pylori > autoimmune and bile reflux

35

chronic gastritis can lead to

atrophy, intestinal metaplasia/dysplasia/neoplasia

36

WHere is the stomach is chronic gastritis due to H pylori likely to affect? autoimmune?

ABBA
Bacteria = Antrum
Autoimmune = Body

37

what type of cells will predominate in chronic active gastritis

neutrophils = ACTIVE!!

38

chronic gastritis due to (autoimmune or H pylori) commonly displays lymphoid follicles/germinal centers

H pylori

39

where will the H pylori organisms be found in chronic gastritis

superficial MUCOUS layer (above the epi)

40

most important virulence factors for H pylori

CagA protien **degrades p53**

also, T4SS (found in CagPAI)

41

characteristics of autoimmune chronic gastritis

4 A's
Abs to parietal cells
Achlorhydria
pernicious Anemia (Abs to intrinsic factor)
Atrophy*all chronic gastritis cuases atrophy, so maybe only 3 A's?

42

↑ risk for MALT lymphoma

H pylori chronic gastritis

43

assc with G cell and partial cell hyperplasia
assc with parietal cell hyperplasia (No G cell)

BOTH: autoimmune chronic gastritis
**loss of parietal cells at the same time since there are Abs made against it

Parietal only: PUD (due to ↑Ach/vagal stim and gastrin)

44

seen in histo of chronic PUD

NIGS
necrosis, inflammation, granulation tissue, scar

45

bigger or smaller ulcers are signs of benignity

smaller

46

deeper or shallow ulcers are signs of benignity

deeper

47

stress ulcers occur with

Brain injury = Cushing ulcer (↑vagal stim → inc Ach and H+ secretion)
**C(r)ush the brain and you may get stress ulcer**

Burns = Curling ulcer (↓plasma volume → sloughing of gastric mucosa)
**burned by a curling iron**

48

describe appearance of stress ulcer

deep, single, small (<1 cm) penis to DEEPly penetrate Katniss which makes her BLEED

You are welcome.