Stomach Flashcards
(38 cards)
foveolar cells
mucin secreting cells
How does the stomach protect itself against its acidity?
mucin
bicarbonate secreted by surface epithelium
vascular supply
Omphalocele
- persistent herniation of bowel into umbilical cord
- failure of abdominal wall to return to body cavity during development
- covered by peritoneum and amnion of cord
Gastroschisis
malformation of abdominal wall causing exposure of abdominal contents
Pyloric stenosis
congenital hypertrophy of smooth muscle of pylorus
- more common in males
- projectile vomiting in first 2-6 weeks of life
- visible peristalsis
- olive-like mass in abdomen
What are 6 general causes of abdominal pain?
- gastritis
- peptic ulcer disease
- gastroesophageal reflux disease (GERD)
- biliary colic
- irritable bowel syndrome
- pancreatitis
What are 4 symptoms of gastritis?
- nausea
- vomiting
- hematemesis-vomiting of blood
- epigastric pain
What leads to gastritis?
injury or impaired defenses
What is acute gastritis?
- transient process
- nausea, vomiting, epigastric pain
- superficial, erosive, ulcerative
- severe cases may hemorrhage
- Impairment of protective system: NSAIDs, ingestion, direct injury
-neutrophilic infiltrate
What is the treatment of acute gastritis?
removal of offending agent
pharmacologic acid blockade
tincture of time
What is chronic gastritis? What are the main causes?
more persistent
-most common cause is H pylori infection
other causes:
-autoimmune
What increases the risk for an H pylori infection? What are the 4 modes of virulence? What is the most common location of H pylori infection? What does H pylori increase the risk for?
Increased risk of infection
- poverty
- household crowding
- limited education
- AA or MA ethnicity
- Poor sanitation
- Birth outside US
Four modes of virulence:
- Flagella
- Secretion of ureases
- Adhesins
- Toxins
Antrum most common location
Increased risk of:
1. gastric adenocarcinoma due to intestinal metaplasia
- MALT
- lymphoid aggregates seen in MALT-subeptihelial plasma cells
How is the diagnosis of H pylori made?
- biopsy
- serologic testing for h pylori antibodies
- fecal detection
- urea breath test
What is the treatment of H pylori?
Triple
- PPI
- Amoxicillin
- Clarithromycin
Quadruple
- PPI
- Bismuth
- Tetracycline
- Metronidazole
Sequential therapy first
Chronic Gastritis: Autoimmune
SPARES THE ANTRUM
- antibodies to parietal cells and intrinsic factor
- vitamin b12 deficiency due to loss of IF–>pernicious anemia
- decreased pepsinogen 1 level due to loss of chief cells
- defective gastric acid secretion (achlorhydria)
- median age 60 years
- slight female>male
- increased risk of adenocarcinoma due to intestinal metaplasia
What does the decreased acid production seen in autoimmune gastritis lead to?
increase in gastrin release
and hyperplasia of antral G cells
What are symptoms of acute peptic ulcer disease? What are the causes of specific types of ulcers? What do the ulcers look like?
nausea, vomiting, coffee-ground hematemesis
stress ulcer: shock, sepsis, severe trauma
curling ulcers: severe burns, trauma
cushing ulcers: intracranial disease
ulcer are typically
What are they symptoms of chronic peptic ulcer disease?What are most often the causes?
Epigastric burning or aching pain occurring 1-3 hours after eating, worse at night, relieved by alkali or food
may also have nausea, bloating, belching
Most often due to
- H pylori
- NSAIDS
Location
- Most common in proximal duodenum and antrum (4:1)
- solitary in 80% of cases
Ulcer
-Sharply punched out defect, clean base
-perforation is complication
What is the treatment acute peptic ulcer disease?
stress ulcer prophylaxis with PPI or H2 blocker Target patients: Mechanical ventilation Severe burns Trauma Severe sepsis Intracranial injury Coagulopathy -acid blocking agents -treat underlying condition
How do you treat chronic peptic ulcer disease?
Eradication of H pylori if present
Remove offending agent
Surgery may be needed for bleeding or perforation
Zollinger Ellison Syndrome
-multiple ulcerations in GI tract due to hypersecretion of gastrin by tumor
What are risk factors for chronic peptic ulcer disease?
- NSAIDs
- Cigarette smoking
- high-dose corticosteroids
- alcoholic cirrhosis
- COPD
- Chronic renal failure
- Hyperparathyroidism
- Psychological stress
Fundic gland polyps
Sportic or associated with familial adenomatous polyposis
- -cystically dilated irregular glands lined by flattened parietal and chief cells
- well circumscribed and multiple
- located in the body and fundus
- not necessarily related to chronic gastritis
- not neoplastic
- males=females
- any age
Inflammatory and hyperplastic polyps?
50-60 years male=female -higher neoplastic risk when >1.5 cm -related to chronic gastritis -any location in stomach -multiple ovoid in shape,
