stomach and duodenum - peptic ulcer Flashcards
1
Q
what is upper area of stomach called
A
fundus
2
Q
where is food broken up in the stomach
A
body and antrum
3
Q
what are the 3 layer of the stomach
A
- outer longitudinal
- inner circular
- innermost oblique layers
4
Q
what is the pyloric sphincter made up of
A
thickening of the circular muscle layer
5
Q
what does the mucosa of the upper two thirds of the stomach contain
A
- parietal cells
- chief cells
6
Q
what do parietal cells secrete
A
hydrochloric acid
7
Q
what do chief cells secrete
A
pepsinogen
8
Q
what does the antral mucosa secrete
A
bicarbonate
9
Q
what do G cells secrete
A
gastrin
10
Q
what is somatostatin
A
a suppressant of acid secretion
produced by D cells
11
Q
what is the mucus made up of
A
glycoproteins called mucin
12
Q
do prostaglandins stimulate or inhibit secretion of mucus
A
stimulate
13
Q
what inhibit prostaglandins
A
- aspirin
- NSAIDs
14
Q
is acid essential for digestion
A
no
but it prevents some food-borne infections
15
Q
what do acetylcholine and gastrin release
A
histamine via enterochromaffin cells
16
Q
what does somatostatin inhibit
A
histamine and gastrin release
17
Q
what are the 3 phases of acid secretion
A
- cephalic
- gastric
- intestinal
18
Q
what is cephalic phase
A
thought, sight and smell of food stimulate the vagus, producing acetylcholine
19
Q
what is gastric phase
A
distension of food directly stimulates secretory cells and gastrin release
20
Q
what is intestinal phase
A
passage of food into duodenum stimulates GI hormone release
21
Q
what do osmoreceptors in duodenal mucosa control
A
gastric emptying by local reflexes and release of gut hormones
22
Q
what does intraduodenal fat do to gastric emptying
A
delays it
by negative feedback
23
Q
what is gastritis
A
inflammation associated mucosal injury
24
Q
what does gastropathy indicate
A
epithelial cell damage and regeneration without inflammation
25
what is most common cause of gastritis
H.pylori
26
what can chronic inflammation due to H.pylori lead to
gastric intestinal metaplasia, precursor to gastric cancer
27
where does autoimmune gastritis affect in the stomach
fundus and body
28
what does autoimmune cause loss of
parietal cells
29
what is gastropathy caused by
- irritants
- bile reflux
- chronic congestion
30
what is helicobacter pylori
gram-negative
31
what does H.pylori play a major role in
- gastritis
| - peptic ulcers
32
where is H.pylori found
in gastric pits
33
when is H.pylori usually acquired
childhood
34
what factors increase duodenal ulceration
- increased gastrin secretion
- smoking
- bacterial virulence
- genetic susceptibility
35
what are gastric ulcers associated with
gastritis
36
what does gastritis cause loss of
- parietal cells
| - acid production
37
what is a peptic ulcer
break in the superficial epithelial cells penetrating down to the muscular mucosa
38
where can peptic ulcers occur
stomach or duodenum
39
what are characteristics of peptic ulcer
- fibrous base
| - increase in inflammatory cells
40
what are erosions
superficial breaks in mucosa alone
41
where are duodenal ulcers usually found
in duodenal cap
42
where are gastric ulcers usually found
lesser curve near incisura
43
what are more common duodenal ulcer or gastric ulcers
duodenal
44
who are common to get peptic ulcers
elderly
45
symptoms of peptic ulcer
- recurrent, burning epigastric pain
- nausea
- vomiting
- anorexia
- weight loss
46
when does duodenal pain occur
at night - worse when hungry
47
how is pain for peptic ulcers relieved
by antacids
48
what does back pain with peptic ulcers suggest
penetrating posterior ulcer
49
how to diagnose H.pylori
- serological tests
- C-urea breath test
- stool antigen
- biopsy urease test
- histology
- culture
50
what does serological test for H.pylori detect
IgG antibodies
| - can be found in saliva
51
what is the most reliable test for H.pylori
urea-breath test
52
what happens if H.pylori is present what happens
the urease enzyme that the bacteria produce splits the urea to release ammonia
53
what must you rule out first in patients with peptic ulcers in older people
you must exclude cancer before starting eradication therapy
54
what is the treatment for peptic ulcer
H.pylori eradication
55
what are the H.pylori eradication medications
- omeprazole + clarithromycin + amoxicillin
| - omeprazole + metronidazole + clarithromycin
56
how long is treatment for H.pylori eradication
2 weeks
57
what should be used for clarithromycin resistance
bismuth chelate
metronidazole
tetracycline
PPI
58
what should be done to check for eradication
breath or stool test should be performed
6 weeks after end of treatment
59
what should strongly be encouraged to be stopped for a peptic ulcer
smoking
60
how does smoking have a negative effect on peptic ulcer healing
it slows mucosal healing
61
what perforates more duodenal or gastric ulcers
duodenal
62
what is usually performed to close perforations
laparoscopic surgery
63
what are 2 other H.pylori associated diseases
- gastric adenocarcinoma
| - gastric B-cell lymphoma
64
what is another name for gastric B-cell lymphoma
MALT
65
who is more likely to get adenocarcinoma women or men
men
66
what is the flow chart for H.pylori infection to gastric carcinoma
1. H.pylori infection
2. acute gastritis
3. chronic active gastritis
4. atrophic gastritis
5. intestinal metaplasia
6. dysplasia
7. advanced gastric cancer
67
is smoking associated with increased stomach cancer
yes
68
what is a risk factor for gastric carcinoma
anaemia
69
where is early gastric cancer confined to
mucosa or submucosa
70
what are the 2 major types of gastric cancer
- intestinal
| - diffuse
71
is intestinal differentiated or undifferentiated
differentiated
- well formed glandular structures
72
what do intestinal cancer look like
polypoid or ulcerating lesions with heaped-up rolled edges
73
what patients usually get intestinal gastric cancer
patents with atrophic gastritis
74
is diffuse gastric cancer differentiated or undifferentiated
undifferentiated
75
what has a worse prognosis intestinal or diffuse
diffuse
76
symptoms of gastric cancer
- epigastric pain (similar to that of a peptic ulcer)
- nausea
- anorexia
- weight loss
- vomiting
- anaemia
77
when does dysphagia occur in gastric carcinoma
when it involves the fundus
78
where can gastric carcinoma metastases to
- bone
- brain
- lung
79
diagnosis of gastric carcinoma
- gastroscopy
- CT
- endoscopic ultrasound
- PET
80
what does gastric carcinoma look like on gastroscopy
- allows biopsies
| - diffuse type gastric caner infiltrates submucosa and muscular propria so can be undetected
81
CT scan of gastric carcinoma shows
- gastric wall thickening
- lymphadenopathy
- lung and liver secondaries
82
endoscopic ultrasound of gastric carcinoma
- staging
- depth of penetration of the cancer through the gastric wall
- extension into local lymph nodes
is not needed to confirm
83
what classification is used for gastric carcinoma
TNM staging
84
what is TNM staging
```
T = tumour
N = nodes
M = metastases
```
staged 0-4
85
what kind of survival do the following have
T1N0M0, T1N1M0 or T2N0M0
88% 5 year
86
what kind of survival do the following have:
T1N2M0, T2N1M0 or T3N0M0
65% 5 year
87
what kind of survival do the following have:
T2N2M0, T3N1M0 or T4N0M0, T3N2M0
35% 5 year
88
what kind of survival do the following have:
T4N1–3M0, TxN3M0 or TxNxM1
5% 5 year
89
what is treatment for early stage gastric carcinoma
non-ulcerated mucosal lesions can be removed endoscopically
90
what is the most effective treatment for gastric carcinoma
surgery
91
what is given for advanced gastric carcinoma
surgery combined chemoradiotherapy
92
what are the symptoms of GIST
- usually asymptomatic
| but can ulcerate and bleed
93
what age does GIST usually affect
55-65
94
where do truly benign leiomyomas occur
mainly oesophagus
95
what kind of tumour is GIST
mesenchymal tumour
96
what is the origin of GIST
stromal
97
what do GIST share a common ancestor with
interstitial cells of Cajal
98
what mutations cause GIST
- proto-oncogene KIT
| - platelet-derived growth factor receptor-alpha
99
what is preferred treatment for GIST
surgery
100
what drug is given for GIST
imatinib
101
what is imatinib
tyrosine kinase inhibitor
102
what is a primary gastric lymphoma
mucosa-associated lymphatic tissue (MALT)
103
what type of lymphoma are MALT
B-cell marginal zone lymphomas
104
what is primary site of MALT
lymph nodes
105
what are MALT due to
H.pylori
106
what age are people usually diagnosed with MALT
60
107
symptoms of MALT
- stomach pain
- ulcers
- localised symptoms
rarely have systemic complications
108
what is first treatment for MALT
H.pylori eradication
109
is prognosis good for MALT
yes
110
what can large polyps result in
anaemia or haematemesis
111
how to diagnose gastric polyps
endoscopic biopsies
112
what is treatment for gastric polyps
polypectomy
113
what is most common type of poly
hyperplastic polyp
114
what do cystic gland polyps contain
microcysts that are lined by fundic type parietal and chief cells
115
what cells secrete HCl
parietal cells
116
what secrete alkaline fluid
mucosal cells
117
who is most likely to get peptic ulcer men or women
men (middle-aged)
118
risk factors of peptic ulcer
- NSAIDs
- H.pylori infection
- smoking
- Zollinger-Ellison syndrome
119
what does dyspepsia describe
- epigastric comfort
- nausea and vomiting
- bloating and burping
120
what diseases is dyspepsia seen in
- peptic ulcer
- GORD
- gastric cancer
121
characteristics of pain in gastric ulcers
epigastric pain worsened by eating
122
how is the pain eased in gastric ulcer
by antacids and lying flat
123
how would rupture present in gastric ulcer
haematemesis
124
what is gastric ulcer associated with
gastric malignancy
125
characteristic of pain in duodenal ulcer
epigastric pain relieved by eating
126
how would rupture present in duodenal ulcer
rectal bleeding / malaena
127
what happens if ulcer perforates into abdomen
widespread peritonism (really bad)
128
if patient present with dyspepsia what alarm symptoms must ask about
- abdominal mass ?
- haematemesis ?
- rectal bleeding ?
- weight loss ?
129
what do you do if patient has alarm symptoms
scope and endoscopy
130
what are patients tested for one month after uncomplicated dyspepsia
H.pylori
131
how do you test for H.pylori
- breath test
| - stool antigen
132
how is H.pylori treatment done
triple therapy
133
management of ruptured peptic ulcer
ABCDE
| - admit for surgical management
