Podcast
Questions and Answers
What does the term gastritis refer to?
What does the term gastritis refer to?
- Loss of the epithelial layer of the stomach
- Inflammation of the gastric mucosa (correct)
- Formation of an ulcer
- Breakthrough of the mucosal layer
Which type of infiltration is characteristic of acute gastritis?
Which type of infiltration is characteristic of acute gastritis?
- Neutrophilic infiltration (correct)
- Lymphocyte infiltration
- Plasma cell infiltration
- Macrophage infiltration
What distinguishes an ulcer from an erosion in the stomach?
What distinguishes an ulcer from an erosion in the stomach?
- Erosions extend deeper than ulcers
- Ulcers involve the submucosa and muscular layer (correct)
- Erosions are always localized, while ulcers are not
- Ulcers never penetrate the muscularis mucosa
Chronic gastritis can commonly result from which of the following causes?
Chronic gastritis can commonly result from which of the following causes?
What is the primary symptom associated with gastritis?
What is the primary symptom associated with gastritis?
Why might symptoms of gastritis worsen after eating?
Why might symptoms of gastritis worsen after eating?
Which type of gastritis typically has a lymphocytic infiltrate?
Which type of gastritis typically has a lymphocytic infiltrate?
What is a common misconception regarding gastritis, erosions, and ulcers?
What is a common misconception regarding gastritis, erosions, and ulcers?
What is the primary function of mucosal production in the stomach?
What is the primary function of mucosal production in the stomach?
Which of the following substances inhibits acid production in the stomach?
Which of the following substances inhibits acid production in the stomach?
How do NSAIDs contribute to acute gastritis?
How do NSAIDs contribute to acute gastritis?
What condition can cause acute gastritis due to loss of blood flow to the stomach?
What condition can cause acute gastritis due to loss of blood flow to the stomach?
What is a common cause of Cushing's ulcers?
What is a common cause of Cushing's ulcers?
What role do proton pump inhibitors play for patients at risk of gastritis?
What role do proton pump inhibitors play for patients at risk of gastritis?
Which type of gastritis is characterized by an autoimmune response?
Which type of gastritis is characterized by an autoimmune response?
How does alcohol contribute to acute gastritis?
How does alcohol contribute to acute gastritis?
What is a common characteristic of stress ulcers?
What is a common characteristic of stress ulcers?
How do stress ulcers differ from other types of ulcers?
How do stress ulcers differ from other types of ulcers?
What is a primary symptom of acute gastritis?
What is a primary symptom of acute gastritis?
Which bacterial infection is notably linked to gastritis?
Which bacterial infection is notably linked to gastritis?
What is the relationship between acetylcholine and acid production in the stomach?
What is the relationship between acetylcholine and acid production in the stomach?
What is the main feature that differentiates autoimmune gastritis from Type B chronic gastritis?
What is the main feature that differentiates autoimmune gastritis from Type B chronic gastritis?
What condition is often a result of pernicious anemia due to autoimmune gastritis?
What condition is often a result of pernicious anemia due to autoimmune gastritis?
Which enzyme produced by H.Pylori allows it to survive in acidic environments?
Which enzyme produced by H.Pylori allows it to survive in acidic environments?
What is a potential malignancy associated with H.Pylori infection?
What is a potential malignancy associated with H.Pylori infection?
What combination of drugs is commonly used in the triple therapy for H.Pylori eradication?
What combination of drugs is commonly used in the triple therapy for H.Pylori eradication?
How can the diagnosis of H.Pylori infection be confirmed non-invasively?
How can the diagnosis of H.Pylori infection be confirmed non-invasively?
What dietary element does the body release in response to the alkaline environment created by H.Pylori?
What dietary element does the body release in response to the alkaline environment created by H.Pylori?
Which part of the stomach is primarily affected by autoimmune gastritis?
Which part of the stomach is primarily affected by autoimmune gastritis?
Which test involves swallowing urea labeled with an isotope to detect H.Pylori?
Which test involves swallowing urea labeled with an isotope to detect H.Pylori?
Why is Helicobacter pylori considered the most common cause of chronic gastritis?
Why is Helicobacter pylori considered the most common cause of chronic gastritis?
What term describes the gastric cancer associated with chronic inflammation from autoimmune gastritis?
What term describes the gastric cancer associated with chronic inflammation from autoimmune gastritis?
What is the main characteristic of Type B chronic gastritis caused by H.Pylori?
What is the main characteristic of Type B chronic gastritis caused by H.Pylori?
How can eradication of H.Pylori be confirmed after treatment?
How can eradication of H.Pylori be confirmed after treatment?
What are Brunner's glands primarily responsible for in the duodenum?
What are Brunner's glands primarily responsible for in the duodenum?
Which portion of the duodenum is most commonly affected by ulcers?
Which portion of the duodenum is most commonly affected by ulcers?
What complication is more likely to occur with posterior duodenal ulcers?
What complication is more likely to occur with posterior duodenal ulcers?
What is a typical symptom of upper GI bleeding?
What is a typical symptom of upper GI bleeding?
Where do gastric ulcers most commonly occur?
Where do gastric ulcers most commonly occur?
What is the primary treatment for both gastric and duodenal ulcers when H. Pylori is identified?
What is the primary treatment for both gastric and duodenal ulcers when H. Pylori is identified?
What is a typical presentation of lower GI bleeding?
What is a typical presentation of lower GI bleeding?
How can a perforated ulcer be visually identified on an X-ray?
How can a perforated ulcer be visually identified on an X-ray?
Why are gastric ulcers often biopsied?
Why are gastric ulcers often biopsied?
What percent of duodenal ulcers are associated with H. Pylori infection?
What percent of duodenal ulcers are associated with H. Pylori infection?
What symptom is most commonly associated with gastric ulcers due to the timing of meal ingestion?
What symptom is most commonly associated with gastric ulcers due to the timing of meal ingestion?
What can be a consequence of an erosion from a posterior duodenal ulcer?
What can be a consequence of an erosion from a posterior duodenal ulcer?
What is melena a term for?
What is melena a term for?
Where does the ligament of Treitz attach?
Where does the ligament of Treitz attach?
What is the most common type of gastric cancer?
What is the most common type of gastric cancer?
Which of the following is a symptom of advanced gastric cancer?
Which of the following is a symptom of advanced gastric cancer?
What is the prognosis for noninvasive gastric cancer identified early?
What is the prognosis for noninvasive gastric cancer identified early?
Which type of gastric cancer resembles an ulcer during examination?
Which type of gastric cancer resembles an ulcer during examination?
What is considered a protective factor against gastric cancer?
What is considered a protective factor against gastric cancer?
Consumption of which substances is linked to an increased risk of gastric cancer?
Consumption of which substances is linked to an increased risk of gastric cancer?
What type of cells are typically found in diffuse gastric cancer?
What type of cells are typically found in diffuse gastric cancer?
What is a common skin finding associated with gastric cancer?
What is a common skin finding associated with gastric cancer?
Which demographic is at higher risk for gastric cancer?
Which demographic is at higher risk for gastric cancer?
What is the characteristic pathology finding in diffuse gastric cancer?
What is the characteristic pathology finding in diffuse gastric cancer?
What is the primary site of metastasis for gastric cancer?
What is the primary site of metastasis for gastric cancer?
Which factor has a very weak and inconsistent association with gastric cancer?
Which factor has a very weak and inconsistent association with gastric cancer?
What happens to the stomach in diffuse gastric cancer?
What happens to the stomach in diffuse gastric cancer?
What is one of the major risk factors for developing intestinal type gastric cancer?
What is one of the major risk factors for developing intestinal type gastric cancer?
Where does acanthosis nigricans most characteristically occur?
Where does acanthosis nigricans most characteristically occur?
What is the most common cancer associated with acanthosis nigricans when linked to malignancy?
What is the most common cancer associated with acanthosis nigricans when linked to malignancy?
What skin finding is characterized by the explosive onset of multiple itchy seborrheic keratoses?
What skin finding is characterized by the explosive onset of multiple itchy seborrheic keratoses?
An isolated enlargement of which lymph node is a concerning sign that may indicate metastatic gastric cancer?
An isolated enlargement of which lymph node is a concerning sign that may indicate metastatic gastric cancer?
What is a characteristic finding in a Sister Mary Joseph nodule?
What is a characteristic finding in a Sister Mary Joseph nodule?
What type of tumor is a Krukenberg tumor typically associated with?
What type of tumor is a Krukenberg tumor typically associated with?
What is a common cause of edema and facial swelling in patients with Menetrier's disease?
What is a common cause of edema and facial swelling in patients with Menetrier's disease?
Which symptom indicates a patient may need an endoscopy for dyspepsia?
Which symptom indicates a patient may need an endoscopy for dyspepsia?
What is the hallmark finding on a CAT scan for a patient with hypertrophic gastropathy?
What is the hallmark finding on a CAT scan for a patient with hypertrophic gastropathy?
What is the main clinical approach for a patient with dyspepsia who is younger and does not exhibit alarm symptoms?
What is the main clinical approach for a patient with dyspepsia who is younger and does not exhibit alarm symptoms?
What condition is characterized by hyperplasia of mucus cells in the stomach?
What condition is characterized by hyperplasia of mucus cells in the stomach?
What is a consequence of excessive gastric mucus secretion in Menetrier's disease?
What is a consequence of excessive gastric mucus secretion in Menetrier's disease?
What occurs when patients with dyspepsia fail to respond to initial therapy?
What occurs when patients with dyspepsia fail to respond to initial therapy?
Which lymph node drains lymph from the stomach and can be involved in metastatic cancer?
Which lymph node drains lymph from the stomach and can be involved in metastatic cancer?
What is intestinal metaplasia characterized by?
What is intestinal metaplasia characterized by?
What percentage of peptic ulcers occur in the proximal duodenum?
What percentage of peptic ulcers occur in the proximal duodenum?
Which of the following is NOT a risk factor for peptic ulcer disease?
Which of the following is NOT a risk factor for peptic ulcer disease?
What mechanism increases acid production in the presence of H.Pylori infection?
What mechanism increases acid production in the presence of H.Pylori infection?
What type of gastric cancer is associated with chronic gastritis?
What type of gastric cancer is associated with chronic gastritis?
Which symptom is typically associated with duodenal ulcers?
Which symptom is typically associated with duodenal ulcers?
What distinguishes Zollinger-Ellison Syndrome from other causes of duodenal ulcers?
What distinguishes Zollinger-Ellison Syndrome from other causes of duodenal ulcers?
What occurs during metaplastic atrophic gastritis?
What occurs during metaplastic atrophic gastritis?
What typical finding in patients with Zollinger-Ellison Syndrome differentiates them from those with regular duodenal ulcers?
What typical finding in patients with Zollinger-Ellison Syndrome differentiates them from those with regular duodenal ulcers?
What is the primary cause of pain worsening at night in duodenal ulcer patients?
What is the primary cause of pain worsening at night in duodenal ulcer patients?
Which condition can lead to an increase in gastric acid production from the stomach?
Which condition can lead to an increase in gastric acid production from the stomach?
What is a significant concern when observing ulcers during an endoscopy?
What is a significant concern when observing ulcers during an endoscopy?
What is the role of Brunner's glands in the duodenum during a meal?
What is the role of Brunner's glands in the duodenum during a meal?
Flashcards
Gastritis
Gastritis
Inflammation of the stomach lining (mucosa).
Erosion
Erosion
Loss of stomach lining, but does not go through the muscular layer.
Ulcer
Ulcer
Breakdown of stomach lining going through the muscular layer.
Acute Gastritis
Acute Gastritis
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Chronic Gastritis
Chronic Gastritis
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Dyspepsia
Dyspepsia
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Causes of Acute Gastritis
Causes of Acute Gastritis
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Chronic gastritis causes
Chronic gastritis causes
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Acute Gastritis: Causes
Acute Gastritis: Causes
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NSAID-Induced Gastritis
NSAID-Induced Gastritis
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Alcohol-Induced Gastritis
Alcohol-Induced Gastritis
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Chemotherapy-Induced Gastritis
Chemotherapy-Induced Gastritis
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H. Pylori-Induced Gastritis
H. Pylori-Induced Gastritis
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Curling's Ulcer
Curling's Ulcer
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Cushing's Ulcer
Cushing's Ulcer
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Stress Ulcers
Stress Ulcers
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Parietal Cells
Parietal Cells
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Prostaglandins (Gastritis)
Prostaglandins (Gastritis)
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Type A Chronic Gastritis
Type A Chronic Gastritis
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Type B Chronic Gastritis
Type B Chronic Gastritis
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Blood Flow & Gastritis
Blood Flow & Gastritis
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Mucus & Bicarbonate
Mucus & Bicarbonate
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Autoimmune gastritis
Autoimmune gastritis
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Parietal cells
Parietal cells
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Intrinsic factor
Intrinsic factor
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Pernicious anemia
Pernicious anemia
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H. pylori
H. pylori
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H. pylori's Survival Mechanism
H. pylori's Survival Mechanism
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Urease
Urease
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Urea Breath Test
Urea Breath Test
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MALT lymphoma
MALT lymphoma
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Stomach Antrum
Stomach Antrum
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Triple Therapy
Triple Therapy
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Gastric adenocarcinoma
Gastric adenocarcinoma
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Stool Antigen Test
Stool Antigen Test
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Chronic Gastritis (Autoimmune)
Chronic Gastritis (Autoimmune)
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Chronic inflammation
Chronic inflammation
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Triple therapy failure rate
Triple therapy failure rate
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Type A chronic gastritis
Type A chronic gastritis
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Type B chronic gastritis
Type B chronic gastritis
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Intestinal metaplasia
Intestinal metaplasia
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Metaplastic Atrophic Gastritis
Metaplastic Atrophic Gastritis
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Goblet cells in biopsies
Goblet cells in biopsies
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Peptic ulcer disease location
Peptic ulcer disease location
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H. pylori and acid secretion
H. pylori and acid secretion
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NSAID and ulcers
NSAID and ulcers
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Smoking and ulcers
Smoking and ulcers
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Duodenal ulcer cause
Duodenal ulcer cause
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Zollinger-Ellison Syndrome
Zollinger-Ellison Syndrome
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Duodenal ulcer pain relief
Duodenal ulcer pain relief
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Ulcer and cancer risk
Ulcer and cancer risk
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Duodenal Ulcers
Duodenal Ulcers
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Brunner's Glands
Brunner's Glands
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Posterior Duodenal Ulcers
Posterior Duodenal Ulcers
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Upper GI Bleeding (cause)
Upper GI Bleeding (cause)
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Upper GI Bleeding (symptom)
Upper GI Bleeding (symptom)
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Ulcer Perforation (cause)
Ulcer Perforation (cause)
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Gastric Ulcers
Gastric Ulcers
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Gastric Ulcer location
Gastric Ulcer location
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Gastric Ulcer Pain
Gastric Ulcer Pain
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Gastric Ulcer (H.Pylori)
Gastric Ulcer (H.Pylori)
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Gastric Ulcer (cancer)
Gastric Ulcer (cancer)
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Ulcer Treatment
Ulcer Treatment
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Left Gastric Artery
Left Gastric Artery
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Lower GI Bleeding (cause)
Lower GI Bleeding (cause)
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Proton Pump Inhibitors (PPI) for Dyspepsia
Proton Pump Inhibitors (PPI) for Dyspepsia
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Gastric Carcinoma (Stomach Cancer)
Gastric Carcinoma (Stomach Cancer)
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Early Stomach Cancer Survival
Early Stomach Cancer Survival
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Advanced Stomach Cancer Survival
Advanced Stomach Cancer Survival
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Intestinal Type Stomach Cancer
Intestinal Type Stomach Cancer
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Diffuse Type Stomach Cancer
Diffuse Type Stomach Cancer
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Risk Factors: Older Men
Risk Factors: Older Men
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Risk Factors: Smoking
Risk Factors: Smoking
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Risk Factors: Alcohol (Weak Association)
Risk Factors: Alcohol (Weak Association)
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Risk Factors: Nitrosamines
Risk Factors: Nitrosamines
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Risk Factors: Type A Blood
Risk Factors: Type A Blood
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Signet Ring Cells
Signet Ring Cells
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Stomach Cancer Metastasis
Stomach Cancer Metastasis
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Acanthosis Nigricans
Acanthosis Nigricans
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Acanthosis Nigricans
Acanthosis Nigricans
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Leser-Trélat Sign
Leser-Trélat Sign
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Virchow's Node
Virchow's Node
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Sister Mary Joseph Nodule
Sister Mary Joseph Nodule
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Krukenberg Tumor
Krukenberg Tumor
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Menetrier's Disease
Menetrier's Disease
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Hypertrophic Gastropathy
Hypertrophic Gastropathy
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Dyspepsia
Dyspepsia
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Alarm Symptoms (Dyspepsia)
Alarm Symptoms (Dyspepsia)
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H. Pylori
H. Pylori
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Endoscopy (EGD)
Endoscopy (EGD)
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Proton Pump Inhibitors
Proton Pump Inhibitors
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Gastric Adenocarcinoma
Gastric Adenocarcinoma
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Study Notes
Gastric Disorders - Study Notes
- Gastritis: Inflammation of the stomach mucosa; can be acute or chronic.
- Acute Gastritis: Characterized by neutrophilic infiltration; usually mucosal damage from acid or protective barrier loss. Common causes: NSAID use (inhibits prostaglandins, reducing mucus & bicarb, increasing acid), alcohol (directly damages mucosa), some chemotherapy drugs (inhibit epithelial cell replication), and H. pylori (initially).
- Chronic Gastritis: Infiltration of lymphocytes, plasma cells, and macrophages; common causes: autoimmune (Type A, destroying parietal cells and intrinsic factor [needed for B12 absorption], leading to pernicious anemia, affects fundus/body) or H. pylori infection (Type B, commonly affecting the antrum).
- Erosions & Ulcers:
- Erosion: Loss of the epithelial layer in the stomach mucosa, doesn't penetrate muscularis mucosa.
- Ulcer: Deeper erosion penetrating the muscularis mucosa; affects submucosa or muscular layer; common in stomach and duodenum.
- Symptoms: Dyspepsia (nausea, vomiting, loss of appetite, abdominal/epigastric pain). Symptoms worsened by food due to increased acid secretion and further mucosal damage.
- Acute Gastritis Mechanisms:
- Stomach epithelium produces mucus & bicarb for mucosal protection.
- Normal blood flow to stomach & mucosa essential for protection.
- Inflammation arises from either increased acid production or protective barrier loss.
Causes of Acute Gastritis
- NSAID Use: Inhibits prostaglandin production impacting mucus/bicarb, increasing acid secretion.
- Alcohol: Directly damages stomach mucosa.
- Chemotherapy Drugs: Inhibit epithelial cell replication, reducing protective layer.
- H. Pylori Infection (initially): Can lead to acute gastritis.
- Curling's Ulcer: Burn patients - fluid loss, hypotension leads to decreased mucosal perfusion & subsequent inflammation.
- Cushing's Ulcer: Increased intracranial pressure leads to vagal stimulation, increasing acetylcholine and ultimately acid production.
- Stress Ulcers: Shock, sepsis, or trauma lead to poor mucosal perfusion and lost protective barrier.
Chronic Gastritis (Type B)
- Mechanism H. Pylori: Gram-negative rod, survives in high stomach acidity due to enzyme urease which triggers alkaline environment/ammonia/ammonium formation; elevates pH, stimulating gastrin release & thus more acid.
- Location: Primarily affects the antrum (area before pylorus).
- Diagnosis: Biopsy (via endoscopy), urea breath test (patient ingests urea labeled with an isotope, detecting exhaled isotope labeled CO2), stool antigen test (detecting H. pylori antigen in stool).
- Treatment: Triple therapy (proton pump inhibitor + 2 antibiotics: clarithromycin and amoxicillin/metronidazole); confirm eradication.
Chronic Gastritis (Type A - Autoimmune)
- Mechanism: Autoimmune destruction of gastric parietal cells that secrete intrinsic factor (important for vitamin B12 absorption).
- Location: Predominantly in fundus & body of stomach.
- Consequences: Vitamin B12 deficiency, pernicious anemia
- associated condition: gastric adenocarcinoma
- Risk Factors: More common in women, associated with certain HLA-DR antigens.
Peptic Ulcer Disease
-
Causes: H. pylori infection (increase acid secretion, particularly in the antrum, leading to acid in the duodenum), NSAID use (breaks down protective lining), smoking.
-
Location: Commonly proximal duodenum (90%). Less commonly in stomach antrum (10%)
-
Zollinger-Ellison Syndrome (rare): Gastrinoma (gastrin-secreting tumor) leads to excessive acid production, multiple ulcers in duodenum.
-
Duodenal Ulcers: Often associated with H. pylori; improved by meals (bicarbonate secretion stimulated), worse at night (no buffer). Almost never cancerous; rarely biopsied.
-
Brunner's Glands (duodenum): Produce alkaline fluid, protecting duodenum from stomach acid; hypertrophy seen in peptic ulcer disease, evidenced on biopsy (increased size/thickness).
Gastric Ulcers
- Location: Often on the lesser curvature of the stomach
- Symptoms: Typically worse with meals (opposed to Duodenal ulcers) due to increased acid exposure and subsequently loss of appetite, weight loss.
- Causes: More commonly associated with H. pylori compared to duodenal ulcers (70%).
- Complications: Bleeding (left gastric artery), perforation.
- Significance: Significant association with gastric cancer (adenocarcinoma); often biopsied for malignancy exclusion.
Gastric Carcinoma (Stomach Cancer)
- Types: Intestinal type (looks like ulcer, associated with metaplasia, H. pylori, autoimmune gastritis) and diffuse type (stomach diffusely thickened, associated with signet ring cells, not associated with chronic gastritis or H. Pylori).
- Risk Factors: Age (older men), smoking, nitrosamine consumption (smoked meats, bacon, etc.), Type A blood.
- Complications: Metastasis to liver common; other potential findings: acanthosis nigricans (skin lesion), Leser-Trallet sign (Seborrheic keratoses), Virchow's node (enlarged left supraclavicular lymph node), Sister Mary Joseph nodule.
Hypertrophic Gastropathy
- Rare Disorders: Enlarged rugal folds due to cell hyperplasia. Rare disorders with enlarged rugal folds.
- Menetrier's Disease: Acquired, unknown cause, more frequent in men.
- Sign: Gastric Mucus Cell hyperplasia, leading to achlorhydria (low stomach acid), protein-losing enteropathy (hypoalbuminemia, swelling/edema), increased risk of gastric adenocarcinoma.
Clinical Approaches: Dyspepsia (Upset Stomach)
- Evaluation Algorithm: If new onset or older patient, or alarm symptoms (weight loss, early satiety), immediately refer for endoscopy (EGD). Younger patients without alarm symptoms initially tested for H. pylori.
- Treatment: Positive H. pylori test, treat with H. pylori therapy; negative test, treat empirically with proton pump inhibitor.
- Persistence: No improvement, proceed to endoscopy for further diagnosis.
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