Week 8: Peptic Ulcers

Question 1

What is peptic ulcer disease?

Answer 1

Involves ulcers primarily in the stomach and duodenum.

Question 2

What is central to the development of peptic ulcer disease?

Answer 2

Gastritis, or inflammation of the gastric mucosa

Question 3

What is gastritis?

Answer 3

Inflammation of the stomach’s mucosa

Question 4

What does normal stomach mucosa look like?

Answer 4

Pink, with folds that help it expand when full.

Question 5

What happens to the mucosa in the stomach in gastritis?

Answer 5

Becomes flat, swollen (edema), red (inflammation), makes less mucus.

Question 6

What protects the stomach from its own acid?

Answer 6

Mucus

Question 7

What happens when the mucosa makes less mucus?

Answer 7

It becomes vulnerable to acid damage.

Question 8

What is acute gastritis and what causes it?

Answer 8

Sudden inflammation, caused by Alcohol binge, aspirin use.

Question 9

What’s chronic gastritis?

Answer 9

Long-term mucosa damage (e.g., stress, alcohol, chronic aspirin).

Question 10

Why worry about chronic gastritis?

Answer 10

Leads to mucosal atrophy(Thinning of the mucosa) → ulcers → possible cancer.

Question 11

What is H. Pylori?

Answer 11

Bacteria that survives in stomach mucus and causes gastritis.

Question 12

Who discovered H. Pylori?

Answer 12

Australian pathologist drank it himself and got gastritis!

Question 13

What diseases are linked to H. Pylori?

Answer 13

Gastritis, peptic ulcers, gastric cancer.

Question 14

How do we treat H. Pylori infections?

Answer 14

Antibiotics.

Question 15

What is mucosal atrophy?

Answer 15

Thinning of the gastric mucosa due to chronic inflammation, reducing mucus production and increasing vulnerability to gastric juice

Question 16

What is metaplasia?

Answer 16

One type of cell changes into another (gastric cells → intestinal cells).

Question 17

Why is intestinal metaplasia bad?

Answer 17

It’s pre-cancer! Increases risk for gastric cancer.

Question 18

What does the stomach make to help absorb B12?

Answer 18

Intrinsic factor (IF).

Question 19

What happens to IF in chronic gastritis?

Answer 19

Reduced production of intrinsic factor (IF) by the stomach, less B12 absorbed and less B12 deficiency anemia.

Question 20

What should you ask if someone has anemia?

Answer 20

Do they have gastritis? If yes, check B12 levels as well

Question 21

What is an ulcer?

Answer 21

consequence of chronic gastritis, deep erosion of the mucosa, goes beyond the surface.

Question 22

What comes before an ulcer?

Answer 22

Erosion (shallow mucosal damage).

Question 23

Why are ulcers dangerous?

Answer 23

Can bleed (hematemesis), cause perforation, lead to shock.

Question 24

What is perforation?

Answer 24

Ulcer punches a hole in the stomach and its contents leak into peritoneal cavity.

Question 25

Why is perforation deadly?

Answer 25

Causes chemical peritonitis → inflammation → shock → emergency!

Question 26

How do ulcers look?

Answer 26

Flat areas around them, deep crater (hole), possible bleeding.

Question 27

Where are gastric ulcers?

Answer 27

In the stomach, can bleed and require surgery.

Question 28

Where are duodenal ulcers?

Answer 28

In the duodenum (1st part of small intestine). Less likely to cause peritonitis but can bleed.

Question 29

Duodenal ulcers location?

Answer 29

Duodenum wall, retroperitoneal space.

Question 30

What is the best way to find ulcers?

Answer 30

Endoscopy.

Question 31

What can you do during an endoscopy?

Answer 31

See ulcers, take biopsies, cauterize (burn) bleeding vessels.

Question 32

Why biopsy ulcers?

Answer 32

To check if it’s cancer or chronic gastritis.

Question 33

Which ulcers are linked to cancer?

Answer 33

Gastric ulcers (duodenal ulcers usually are not cancer).

Question 34

Main complications of ulcers?

Answer 34

Bleeding, perforation, cancer.

Question 35

What’s hematemesis?

Answer 35

Vomiting blood due to ulcer bleeding.

Question 36

What is peritonitis?

Answer 36

Infection/inflammation of the peritoneum → caused by perforation.

Question 37

What are stress ulcers?

Answer 37

Ulcers caused by severe stress (ICU patients, shock, burns).

Question 38

Why do ICU patients get stress ulcers?

Answer 38

Stress → cortisol surge → less mucus + more acid → ulcers.

Question 39

What are 7 things that damages the stomach lining?

Answer 39

H. Pylori Alcohol Aspirin/NSAIDs Stress Smoking Bile salts Ischemia (low blood flow)

Question 40

What does pepsin do?

Answer 40

Digests proteins.

Question 41

When is pepsin activated?

Answer 41

By the gastric acid

Question 42

What happens if acid and pepsin are out of control?

Answer 42

further damages the mucosa, leading to ulcerations.

Question 43

Is H. Pylori enough to cause cancer?

Answer 43

No, you also need environmental factors (diet, smoking).

Question 44

What else increases gastric cancer risk?

Answer 44

Nitrates in food and smoking

Question 45

What's the incidence of stomach cancer?

Answer 45

Higher rates in East Asia and parts of South America

Question 46

What has reduced rates of stomach cancer in North America?

Answer 46

Refrigeration and better food preservation

Question 47

What is intestinal metaplasia linked to?

Answer 47

H. Pylori → chronic gastritis → metaplasia → gastric cancer.

Question 48

Most common gastric cancer type?

Answer 48

Adenocarcinoma.

Question 49

Where in the stomach, where in gastric cancer?

Answer 49

In the lower third (antrum).

Question 50

What are 2 types of gastric cancer?

Answer 50

1. Intestinal type → linked to metaplasia & H. Pylori 2. Diffuse type → less linked to H. Pylori

Question 51

What is gastric cancer?

Answer 51

Typically evolves from gastritis, leading to atrophy and intestinal metaplasia.

Question 52

What is a significant step towards in development in gastric cancer?

Answer 52

Intestinal metaplasia

Question 53

Which type of cancer is most common?

Answer 53

Intestinal type

Question 54

What age group is most common in the intestinal type of gastric cancer?

Answer 54

Older individuals

Question 55

What are the lifestyle risks for ulcers/gastritis?

Answer 55

Smoking Drinking alcohol Stress NSAIDs (aspirin, ibuprofen)