stomach

Question 1

parietal cells in stomach secrete

Answer 1

intrinsic factor

gastric acid

Question 2

chief cells in stomach secrete

Answer 2

pepsinogen

activated by gastric acid to pepsin

Question 3

G cells in stomach secrete

Answer 3

gastrin

Question 4

mucosal cell cells in stomach secrete

Answer 4

HCO3

Question 5

gastrin-secreting tumor (gastrinoma) usually in pancreas → ↑ gastric acid → recurrent duodenal ulcers

Answer 5

Zollinger-Ellison syndrome

Question 6

pancreatic gastrinoma (seen in Zollinger-Ellison syndrome) is associated with

Answer 6

MEN type I

Question 7

complications of chronic gastritis due to autoimmune destruction of parietal cells (called pernicious anemia)

Answer 7

no IF → vitamin B12 deficiency:
megaloblastic anemia
peripheral neuropathy
dementia

Question 8

drugs that are potent stimulators of gastrin release from G cells of stomach → ↑gastrin → ↑H+ →GERD → ulceration

Answer 8

phenylalanine
tryptophan
hypercalcemia

Question 9

sites of HCO3 secretion to neutralize acid in GI tract

Answer 9

mucosal cells - stomach, duodenum (S cells), salivary glands, pancreatic duct
Brunner glands - duodenum

Question 10

treatment of ZE syndrome

Answer 10

PPI +/- octreotide (if tumor has octreotide R)

Question 11

↑ gastric acid production or ↓ HCO3/mucosal lining →

breakdown of mucosal lining → inflammation of stomach

Answer 11

acute gastritis

Question 12

causes of acute gastritis

Answer 12

NSAIDs and aspirin (inhibit COX - inhibit PG - ↑H, ↓PG)
alcohol
burns (curling ulcer)
brain injury (cushing ulcer)

Question 13

type of ulcer associated with burn injury

Answer 13

curling ulcer (like curling iron)
stress of burn →↓ mucosal lining production →ulcer → acute gastritis

Question 14

type of ulcer associated with brain injury

Answer 14

cushing ulcer

Question 15

causes of chronic gastritis

Answer 15

H. pylori (spiral shaped, in gastric glands)

autoimmune destruction of gastric parietal cells

Question 16

H pylori in gastric glands

neutrophils + lymphocytes invading gastric glands

Answer 16

chronic gastritis

Question 17

complication of chronic gastritis due to H.pylori

Answer 17

↑ risk of:
MALT lymphoma (due to chronic lymphocyte infiltration)
gastric cancer

Question 18

stomach biopsy shows neutrophils above BM, loss of surface epithelium, fibrin-containing purulent exudate

Answer 18

acute gastritis

Question 19

stomach biopsy reveals lymphoid aggregates in lamina propria, columnar absorptive cells, atrophy of glandular structures

Answer 19

chronic gastritis

Question 20

diffuse thickening of gastric folds, elevated serum gastrin levels, biopsy reveals glandular hyperplasia without foveolar hyperplasia

Answer 20

ZE syndrome (gastrin secreting tumor of pancreas)

Question 21

causes of gastric ulcers

Answer 21

H pylori - 70% (↓ mucosal protection)

NSAIDs (gastritis → ulceration)

Question 22

gastric acid erodes through mucosa into submucosa

Answer 22

if in stomach: peptic ulcer

in duodenum: duodenal ulcer

Question 23

upper abdominal and epigastric pain AFTER eating (↑ H production after eating)
weight loss (avoid eating)

Answer 23

gastric ulcer

Question 24

complication of gastric ulcers (due to H. pylori or NSAIDs)

Answer 24

↑ risk gastric cancer (take biopsy around ulcer to ensure no cancer)

Question 25

``` upper abdominal and epigastric pain RELIEVED by eating (HCO3 production in duodenum after eating) pain returns several hours after eating weight gain (eating makes it better) biopsy: clean, smooth borders with H.pylori in ulcer, hypertrophy of Brunner glands in duodenum (submucosal) ```

Answer 25

duodenal ulcer

Question 26

causes of duodenal ulcers

Answer 26

H. pylori (↓ mucosal protection) - 95% | ZE syndrome - rare - (secrete gastrin - ↑ gastric acid)

Question 27

complications of gastric + duodenal ulcers

Answer 27

ulcerate into vessel → hemorrhage | perforation (esp duodenal ulcers) → peritonitis

Question 28

treat actively bleeding peptic ulcer

Answer 28

somatostatin (octreotide) ↓ splanchnic blood flow

Question 29

most common cause of gastric + duodenal ulcers

Answer 29

H pylori

Question 30

treatment for irradicating H pylori

Answer 30

triple therapy: PPI + clarithromycin + amoxicillin (if pen allergy: metronidazole) quad therapy (if resistance to clarithromycin): PPI + bismuth + metronidazole + tetracycline

Question 31

treatment for neutralizing gastric acid to protect stomach + ↓ gastric acid secretion (prevent gastric ulcers, also adjuncts for H. pylori infection)

Answer 31

``` neutralize stomach acid: antacid ↓ gastric acid secretion: H2 blockers, PPIs less commonly used: bismuth + sucralfate misoprostol ```

Question 32

precursor to gastric adenocarcinoma hypertrophy of mucus producing cells → rugae look like gyri of brain atrophy of parietal cells → ↓ gastric acid production enteric protein loss → hyopalbuminemia → edema

Answer 32

Menetrier disease

Question 33

most common type of cancer in GI tract

Answer 33

``` adenocarcinoma except esophagus (can have esophageal squamous cell carcinoma in smokers too) ```

Question 34

risk factors for gastric adenocarcinoma

Answer 34

``` H pylori infection chronic gastritis nitrosamines (cured, smoked) men >50 yo japanese people in Japan ```

Question 35

weight loss + | mass in L supraclavicular node (Virchow node)

Answer 35

metastasis of GI cancer (usually gastric adenomcarcinoma)

Question 36

metastasis of gastric adenomcarcinoma

Answer 36

``` L supraclavicular node (Virchow node) periumbilical node (sister mary joseph nodule) mets to bilateral ovaries (Krukenberg tumor) ```

Question 37

>40 yo with new acanthosis nigricans (velvety darkening of skin, near neck)

Answer 37

diabetes | 50% have visceral malignancies: stomach cancer

Question 38

signet ring cells: mucous in cytoplasm pushes nucleus to periphery

Answer 38

1) gastric adenocarcinoma may be from ovary biopsy (krukenberg tumor - gastric cancer with mets) mucous in cytoplasm pushes nucleus to periphery 2) lobular carcinoma in situ (LCIS) or invasive lobular carcinoma

Question 39

pylorus hypertrophied → narrowed gastric outlet → ↓ stomach emptying nonbillious projectile vomit presents 2-6 wks of age palpable olive structure in epigastric region most common in firstborn males, most common congenital surgery in 1st mo of life

Answer 39

congenital pyloric stenosis

Question 40

diarrhea can cause

Answer 40

hypokalemia

Question 41

prolonged vomitting (days-wks) can cause

Answer 41

vomit HCl from stomach → hypochloremia metabolic alkalosis (low serum H+ concentration) → correct alkalosis in serum at K/H exchanger: cells release H+ from cells to serum, K+ from serum to cell → hypokalemia (vs acidosis: H+ out → hyperkalemia)

Question 42

treatment of Zollinger-Ellison syndrome

Answer 42

high dose PPI sporadic: surgery to resect metastatic: somatostatin analog (octreotide), IFN, chemo, radiothearpy