Stomach Path I

Question 1

parietal cells

Answer 1

HCl and IF

Question 2

chief cells

Answer 2

protelytic enzymes

Question 3

stomach ulceration

Answer 3

smooth border - better

rough border - likely malignant

Question 4

acute gastritis

Answer 4

acute mucosa inflammation

-neutros present - w/ or w/out ulceration

Question 5

acute hemorrhagic gastritis

Answer 5

erosive with bleeding

• with NSAIDs, aspirin
• alcoholic
• heavy smoker
• stress

Question 6

stress ulcer

Answer 6

tx with PPIs
-pt with shock, burns, sepsis, trauma, critically ill

curling - burns/trauma
cushings - intracranial bleed

Question 7

erosion

Answer 7

stressed situation

-not an ulcer

Question 8

h. pyloric

Answer 8

inhibition of gastric bicarb transporters

Question 9

curling ulcer

Answer 9

severe stress situations

-burns, trauma, sepsis, etc.

Question 10

cushing ulcer

Answer 10

intracranial injury - disrupted vagal activity

Question 11

chronic gastritis

Answer 11

presence of chronic mucosal inflammatory changes
-atrophy and metaplasia

majority - h. pylori infection

autoimmune - pernicious anemia - < 10%

also with drugs, alcoholi, toxins

Question 12

giemsa and steiner silver stain

Answer 12

h. pylori

Question 13

CagA

Answer 13

toxin of h. pyloric - may be involved in ulcer or cancer development

Question 14

chronic inflammation of antrum

Answer 14

almost always h. pylori

increased acid production

Question 15

entire stomach chronic inflammation

Answer 15

alcohol, smoking, etc.

Question 16

h. pylori virulence

Answer 16

1 flagella
2 urease
3 adhesins
4 toxins - CagA

Question 17

duodenal ulcers

Answer 17

increased risk with h pylori chronic gastritis

Question 18

active chronic gastritis

Answer 18

PMNs

-hallmark of ongoing h. pylori infection

Question 19

swallow urea with carbon-14 tag - do breath test

Answer 19

if positive - h. pylori

-takes up C-14 and CO2 given off has this tagged carbon

Question 20

mucosal atrophy in chronic gastritis

Answer 20

marker for increased cancer risk

Question 21

tx h pylori

Answer 21

PPIs and antibiotics

Question 22

h pylori diagnosis

Answer 22

detection of organism in biopsy

often in antrum

Question 23

autoimmune gastritis

Answer 23

spares antrum

• includes hypergastrinemia - achlorydia
• defective gastric acid secretion

aka atrophic

Question 24

autoimmune gastritis path

Answer 24

Abs to parietal cells and IF - detected in serum and gastric secretions

CD4 T cells against parietal cell components** - H/K ATPase

chief cells also get destroyed

Question 25

pernicious anemia

Answer 25

with autoimmune gastritis if severe

Question 26

oxyntic mucosa

Answer 26

acid producing

Question 27

autoimmune gastritis histo

Answer 27

glandular atrophy and inflammatory infiltrates destroys acid producing mucosa in body nd fundus may see intestinal metaplasia

Question 28

autoimmune gastritis

Answer 28

60yo female often with other autoimmune disease - hashimotos, DM, addison, graves, etc.

Question 29

atrophic glossitis

Answer 29

smooth beefy tongue | -with B12 deficiency

Question 30

reactive gastropathy

Answer 30

chemical injury NSAID use bile reflux trauma

Question 31

eosinophilic gastritis

Answer 31

allergy, parasites, h. pylori

Question 32

lymphocytic gastritic

Answer 32

celiac

Question 33

granulomatous gastritis

Answer 33

crohn, mycobacteria, fungi, CMV, h. pylori

Question 34

trichobezoar

Answer 34

hair ball in stomach

Question 35

peptic ulcer

Answer 35

chronic solitary lesions in part of GI tract exposed to lots of acid usually with chronic gastritis - association with h. pylori and NSAID use

Question 36

ulcer

Answer 36

by definition through the muscularis mucosa

Question 37

erosion

Answer 37

limited to mucosa

Question 38

PUD clinical

Answer 38

duodenal, male, h. pylori related also esophagus with GERD or meckel diverticulum with gastric mucosa pretty common

Question 39

zollinger ellison syndrome

Answer 39

uncontrolled release of gastrin by tumor get lots of acid - can cause ulcers

Question 40

hypercalcemia

Answer 40

stimulate gastrin production and increased acid secretion

Question 41

classic peptic ulcer

Answer 41

sharply punched out defect heaped up margins - in cancer

Question 42

pneumoperitoneum

Answer 42

air within abdominal cavity

Question 43

tx of PUD

Answer 43

antibiotics - h pylori PPI surgery if severe bleeding/perforation

Question 44

melena

Answer 44

black tarry stools stool in contact with acid - in upper GI bleeds

Question 45

hematochezia

Answer 45

bright red blood in stool | -lower GI bleed

Question 46

coffee grounds

Answer 46

slow bleeding/oozing

Question 47

red blood/clots

Answer 47

active ongoing bleeding

Question 48

bile stained

Answer 48

no bleeding above treitz ligament

Question 49

clear

Answer 49

competent pylorus - but bleeding could still be occuring

Question 50

confirmation of bleeding location

Answer 50

upper GI endoscopy - EGD - diagnostic and therapeutic - inject epi or electro coag techniques can biopsy with EGD - determine h. pylori infection