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What are the main diseases of the stomach and duodenum?
- Gastritis
- Peptic ulcer disease
- Zollinger Ellison Syndrome
- Malignant tumors of the stomach
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What are the four layers throughout the GI Tract?
- Mucosa
- Submucosa
- Muscularis (stomach has a third, oblique layer)
- Serosa
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What are the four main zones of the stomach?
- Cardia (proximal)
- Fundus: That part of the stomach that is above the gastroesophageal junction (GEJ)
- Body (corpus)
- Antrum (distal)
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Which zones of the stomach share histological traits?
- Cardia and antrum share histological traits
- Fundus and body share histological traits
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Which zones of the stomach make the acids and enzymes?
The fundus and the body
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Which zones of the stomach have the job of protecting the esophagus and the duodenum from the acids and the enzymes?
The cardia and antrum
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What are gastric juices made up of?
Combined secretions of mucous cells, parietal cells and chief cells
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What do mucous cells, parietal cells, and chief cells produce?
- Mucous cells produce mucous (lol)
- Parietal cells produce HCl and intrinsic factor
- Chief cells produce pepsinogen I and II
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What are the 3 types of gastritis?
- Erosive and hemorrhagic "gastritis"
- Nonerosive, nonspecific
- Specific types of gastritis
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What are the common causes of "gastritis?"
- NSAIDs
- ETOH
- Stress (medical/surgical, not emotional)
- Portal HTN
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What is the main sign of "gastritis?" Also, what is the main tool of diagnosis?
- Main sign -> Hematemesis
- Diagnosis is by endoscopy, which also rules out other causes of bleeding (PUD, varices)
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What are the types of endoscopic findings you can get while diagnosing Erosive and Hemorrhagic Gastritis?
- Subepithelial hemorrhages
- Petechiae
- Erosions
- Usually there is no significant inflammation on histologic examination
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Stress-related mucosal erosions and subepithelial hemorrhages develop within ___ hours in the majority of critically ill patients.
72 hours
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Stress Gastritis:
_____ is associated with the high mortality, however this is seldom the cause of death.
Bleeding
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What are the specific causes of stress gastritis?
- Mechanical ventilation
- Coagulopathy
- Trauma
- Burns
- Shock
- Sepsis
- Central nervous system injury
- Hepatic or renal failure
- Multi-organ failure
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The incidence of bleeding can be reduced by 50% in critically ill patients with stress gastritis prophylaxis by using what?
- Continuous IV H2 antagonists
- OR Proton pump inhibitors
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What is used for stress gastritis treatment?
- Continuous infusion IV Proton pump inhibitors
- Endoscopy is performed as needed to ensure there are no other treatable causes.
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What % of patients receiving chronic NSAIDs develop gastritis?
25-50%
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What % of NSAID Gastritis patients have ulcers at endoscopy?
10-20%
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Only NSAID Gastritis patients with ________ should undergo diagnostic endoscopy.
alarm symptoms
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NSAID Gastritis: Those without significant NSAID ulceration should be treated _____________
symptomatically with PPIs
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True or false: Upper GI bleeding due to NSAID gastritis is generally severe.
False. It is generally not severe.
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What kind of treatment is utilized for alcoholic gastritis?
Therapy with PPIs or H2 receptor antagonists for 2-4 weeks.
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Nonerosive, Nonspecific Gastritis is caused by Helicobacter pylori. What are the defining characteristics of Helicobacter pylori?
- Spiral, gram-negative rod
- Chronic, diffuse mucosal inflammation
- Present in 30-50% of the population -> Most are asymptomatic -> 15% of those infected develop PUD -> Chronic infection associated with increased risk of adenocarcinoma and B cell gastric lymphoma
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Describe the testing standards for Helicobacter pylori.
- Serologic tests NOT recommended due to low sensitivity and low specificity
- Fecal antigen immunoassay (>95% sensitivity and specificity)
- Urea breath test (>95% sensitivity and specificity)
- Discontinue PPIs 7-14 days prior to testing
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Describe the defining features of Pernicious Anemia Gastritis
- Autoimmune disorder
- Parietal cell antibodies -> Destroy the H+-K+-ATPase pump -> Loss of intrinsic factor -> Achlorhydria and vitamin B12 malabsorbtion
- Risk of adenocarcinoma increased 3x
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What causes infectious gastritis?
- Bacterial (necrotizing gastritis)
- Viral (CMV with AIDS and organ transplantation)
- Fungal (Candida)
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What causes Granulomtous gastritis?
Crohn's, H. pylori, TB, syphilis, sarcoid (may be symptomatic or asymptomatic)
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What are the three rare causes of gastritis?
- Eosinophilic
- Lymphocytic
- Menetrier's disease (giant thickened gastric folds, cause is unknown, treated with cetuximab)
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Definition: Break in the mucosa
Caused when normal mucosal defenses are impaired or overwhelmed by acid or pepsin
Extend through the muscularis mucosa
Peptic Ulcer Disease (PUD)
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What % is the lifetime risk of Peptic Ulcer Disease?
10%
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Duodenal ulcers are _x as common as gastric ulcers.
5x
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What are the risk factors for Peptic Ulcer Disease?
Risk factors are smoking and NSAID use (diet, ETOH, emotional stress are not risk factors)
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What are the three causes for Peptic Ulcer Disease (PUD)?
- H. pylori
- NSAID use -> 1-2% of long-term NSAID users have major complications (bleeding, perforation) within 1 year -> Cox 2 inhibitors reduce major complications by 50%
- Acid hypersecretory states (Z-E syndrome)
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What are the signs and symptoms of Peptic Ulcer Disease?
- Dyspepsia -> 80-90% of patients -> less than 25% of patients with dyspepsia will have PUD
- Relieved by food (50%)
- Physical exam: mild epigastric pain
- Labs: -> Anemia if bleeding -> Leukocytosis if perforation -> Increased amylase if penetration into pancreas
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What is used to diagnose Peptic Ulcer Disease?
- Endoscopy -> Procedure of choice -> Best diagnostic accuracy and can take biopsies -> ALL gastric ulcers need to be biopsied
- Barium Upper GI -> Acceptable alternative to endoscopy -> Not capable of biopsy
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