Peptic Diseases and Gastritis (Jackson/Nichols) Flashcards Preview

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