22 Questions
What percentage of duodenal ulcers are due to H. pylori?
95%
What is the typical location of a gastric ulcer?
Lesser curvature of the antrum
What is a common cause of gastric ulcers besides H. pylori infection?
All of the above
What is a characteristic feature of benign peptic ulcers?
Small, sharply demarcated, and surrounded by radiating folds of mucosa
What is the main difference between duodenal and gastric ulcers?
Pain pattern
What is the risk of bleeding from a ruptured gastric ulcer?
Bleeding from the left gastric artery
What is the role of biopsy in peptic ulcer diagnosis?
To exclude gastric carcinoma
What is the typical location of a duodenal ulcer?
Proximal duodenum
What is a risk factor for the intestinal type of gastric carcinoma?
H pylori infection
Which of the following is NOT associated with diffuse type of gastric carcinoma?
Signet ring cells
What is a common site of distant metastasis in gastric carcinoma?
Liver
What is a risk factor for acute gastritis?
Severe burn
Which of the following is a rare presentation of gastric carcinoma?
Acanthosis nigricans
What is the term for the thickening of the stomach wall seen in diffuse type of gastric carcinoma?
Linitis plastica
What is a defense mechanism of the gastric mucosa?
Bicarbonate secretion by surface epithelium
What is a clinical feature of chronic gastritis?
Chronic inflammation of the stomach mucosa
Which of the following nodes can be involved in lymph node spread of gastric carcinoma?
Left supraclavicular node
What is a consequence of acid damage to the gastric mucosa?
Superficial inflammation and ulceration
What is a risk factor for gastric mucosal damage?
Long-term use of NSAIDs
What is a complication of chronic gastritis?
All of the above
What is a defense mechanism of the gastric mucosa against H. pylori infection?
Increased mucus production by foveolar cells
What is a characteristic of chronic autoimmune gastritis?
Autoimmune response against parietal cells
Study Notes
Gastric Carcinoma
- Intestinal type: large, irregular ulcer with heaped up margins, commonly involves the lesser curvature of the antrum
- Risk factors: intestinal metaplasia (e.g., due to H pylori and autoimmune gastritis), nitrosamines in smoked foods (Japan), and blood type A
- Diffuse type: characterized by signet ring cells that diffusely infiltrate the gastric wall, resulting in thickening of the stomach wall (linitis plastica)
- Not associated with H pylori, intestinal metaplasia, or nitrosamines
- Presents late with weight loss, abdominal pain, anemia, and early satiety; rarely presents as acanthosis nigricans or Leser-Trelat sign
- Spread to lymph nodes can involve the left supraclavicular node (Virchow node)
- Distant metastasis most commonly involves the liver; other sites include the periumbilical region (Sister Mary Joseph nodule)
Peptic Ulcer Disease
- Solitary mucosal ulcer involving the proximal duodenum (90%) or distal stomach (10%)
- Duodenal ulcer: almost always due to H pylori (> 95%); rarely due to ZE syndrome
- Presents with epigastric pain that improves with meals
- Diagnostic endoscopic biopsy shows ulcer with hypertrophy of Brunner glands
- Usually arises in the anterior duodenum; when present in the posterior duodenum, rupture may lead to bleeding from the gastroduodenal artery or acute pancreatitis
- Gastric ulcer: usually due to H pylori (75%); other causes include NSAIDs and bile reflux
- Presents with epigastric pain that worsens with meals
- Ulcer is usually located on the lesser curvature of the antrum
- Rupture carries risk of bleeding from the left gastric artery
- Differential diagnosis of ulcers includes carcinoma
- Benign peptic ulcers are usually small (< 3 cm), sharply demarcated ("punched-out"), and surrounded by radiating folds of mucosa
- Malignant ulcers are large and irregular with heaped up margins
- Biopsy is required for definitive diagnosis
Acute Gastritis
- Acidic damage to the stomach mucosa
- Due to imbalance between mucosal defenses and acidic environment
- Defenses include mucin layer produced by foveolar cells, bicarbonate secretion by surface epithelium, and normal blood supply
- Risk factors: severe burn (Curling ulcer), NSAIDs, heavy alcohol consumption, chemotherapy, increased intracranial pressure (Cushing ulcer), and shock
- Acid damage results in superficial inflammation, erosion (loss of superficial epithelium), or ulcer (loss of mucosal layer)
Chronic Gastritis
- Chronic inflammation of the stomach mucosa
This quiz covers the two main types of gastric cancer, intestinal and diffuse, including their characteristics and risk factors.
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