Gastric Disorders Study

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Questions and Answers

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?

  • Neutrophilic infiltration (correct)
  • Lymphocyte infiltration
  • Plasma cell infiltration
  • Macrophage infiltration

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?

<p>H.Pylori infection and autoimmune disorders (D)</p> Signup and view all the answers

What is the primary symptom associated with gastritis?

<p>Dyspepsia (B)</p> Signup and view all the answers

Why might symptoms of gastritis worsen after eating?

<p>More acid is secreted, worsening mucosal damage (B)</p> Signup and view all the answers

Which type of gastritis typically has a lymphocytic infiltrate?

<p>Chronic gastritis (C)</p> Signup and view all the answers

What is a common misconception regarding gastritis, erosions, and ulcers?

<p>They all have the same treatment (A)</p> Signup and view all the answers

What is the primary function of mucosal production in the stomach?

<p>To protect the mucosa (C)</p> Signup and view all the answers

Which of the following substances inhibits acid production in the stomach?

<p>Prostaglandins (B)</p> Signup and view all the answers

How do NSAIDs contribute to acute gastritis?

<p>By inhibiting prostaglandin production (A)</p> Signup and view all the answers

What condition can cause acute gastritis due to loss of blood flow to the stomach?

<p>Burns (B)</p> Signup and view all the answers

What is a common cause of Cushing's ulcers?

<p>Increased intracranial pressure (B)</p> Signup and view all the answers

What role do proton pump inhibitors play for patients at risk of gastritis?

<p>Reduce the risk of ulcer formation (D)</p> Signup and view all the answers

Which type of gastritis is characterized by an autoimmune response?

<p>Type A chronic gastritis (A)</p> Signup and view all the answers

How does alcohol contribute to acute gastritis?

<p>By irritating the mucosal layer (B)</p> Signup and view all the answers

What is a common characteristic of stress ulcers?

<p>Common in ICU patients (D)</p> Signup and view all the answers

How do stress ulcers differ from other types of ulcers?

<p>They result primarily from poor mucosal perfusion (C)</p> Signup and view all the answers

What is a primary symptom of acute gastritis?

<p>Dyspepsia (C)</p> Signup and view all the answers

Which bacterial infection is notably linked to gastritis?

<p>Helicobacter pylori (B)</p> Signup and view all the answers

What is the relationship between acetylcholine and acid production in the stomach?

<p>Acetylcholine promotes acid production (A)</p> Signup and view all the answers

What is the main feature that differentiates autoimmune gastritis from Type B chronic gastritis?

<p>Type B occurs in the antrum of the stomach (C)</p> Signup and view all the answers

What condition is often a result of pernicious anemia due to autoimmune gastritis?

<p>Vitamin B12 deficiency (B)</p> Signup and view all the answers

Which enzyme produced by H.Pylori allows it to survive in acidic environments?

<p>Urease (B)</p> Signup and view all the answers

What is a potential malignancy associated with H.Pylori infection?

<p>B-cell lymphoma (A)</p> Signup and view all the answers

What combination of drugs is commonly used in the triple therapy for H.Pylori eradication?

<p>Omeprazole, Amoxicillin, Metronidazole (D)</p> Signup and view all the answers

How can the diagnosis of H.Pylori infection be confirmed non-invasively?

<p>Stool antigen test (D)</p> Signup and view all the answers

What dietary element does the body release in response to the alkaline environment created by H.Pylori?

<p>Gastrin (D)</p> Signup and view all the answers

Which part of the stomach is primarily affected by autoimmune gastritis?

<p>Body and fundus (C)</p> Signup and view all the answers

Which test involves swallowing urea labeled with an isotope to detect H.Pylori?

<p>Urea breath test (D)</p> Signup and view all the answers

Why is Helicobacter pylori considered the most common cause of chronic gastritis?

<p>It can cause both acute and chronic gastritis (D)</p> Signup and view all the answers

What term describes the gastric cancer associated with chronic inflammation from autoimmune gastritis?

<p>Gastric adenocarcinoma (A)</p> Signup and view all the answers

What is the main characteristic of Type B chronic gastritis caused by H.Pylori?

<p>Occurs in the antrum and can cause ulcers (A)</p> Signup and view all the answers

How can eradication of H.Pylori be confirmed after treatment?

<p>Urea breath test (D)</p> Signup and view all the answers

What are Brunner's glands primarily responsible for in the duodenum?

<p>Producing alkaline fluid (B)</p> Signup and view all the answers

Which portion of the duodenum is most commonly affected by ulcers?

<p>Anterior portion (B)</p> Signup and view all the answers

What complication is more likely to occur with posterior duodenal ulcers?

<p>Pancreatitis (A)</p> Signup and view all the answers

What is a typical symptom of upper GI bleeding?

<p>Coffee ground vomit (B)</p> Signup and view all the answers

Where do gastric ulcers most commonly occur?

<p>Lesser curvature of the stomach (D)</p> Signup and view all the answers

What is the primary treatment for both gastric and duodenal ulcers when H. Pylori is identified?

<p>Proton pump inhibitors (C)</p> Signup and view all the answers

What is a typical presentation of lower GI bleeding?

<p>Bright red blood per rectum (C)</p> Signup and view all the answers

How can a perforated ulcer be visually identified on an X-ray?

<p>Free air under the diaphragm (A)</p> Signup and view all the answers

Why are gastric ulcers often biopsied?

<p>To rule out adenocarcinoma (B)</p> Signup and view all the answers

What percent of duodenal ulcers are associated with H. Pylori infection?

<p>Nearly 100% (C)</p> Signup and view all the answers

What symptom is most commonly associated with gastric ulcers due to the timing of meal ingestion?

<p>Pain worse with meals (D)</p> Signup and view all the answers

What can be a consequence of an erosion from a posterior duodenal ulcer?

<p>Upper GI tract hemorrhage (D)</p> Signup and view all the answers

What is melena a term for?

<p>Dark, tarry stools (B)</p> Signup and view all the answers

Where does the ligament of Treitz attach?

<p>To the duodenum (C)</p> Signup and view all the answers

What is the most common type of gastric cancer?

<p>Adenocarcinoma (A)</p> Signup and view all the answers

Which of the following is a symptom of advanced gastric cancer?

<p>Weight loss (D)</p> Signup and view all the answers

What is the prognosis for noninvasive gastric cancer identified early?

<p>95% five-year survival (B)</p> Signup and view all the answers

Which type of gastric cancer resembles an ulcer during examination?

<p>Intestinal type (B)</p> Signup and view all the answers

What is considered a protective factor against gastric cancer?

<p>Use of NSAIDs (A)</p> Signup and view all the answers

Consumption of which substances is linked to an increased risk of gastric cancer?

<p>Nitrosamines (C)</p> Signup and view all the answers

What type of cells are typically found in diffuse gastric cancer?

<p>Signet ring cells (C)</p> Signup and view all the answers

What is a common skin finding associated with gastric cancer?

<p>Acanthosis nigricans (D)</p> Signup and view all the answers

Which demographic is at higher risk for gastric cancer?

<p>Older men (D)</p> Signup and view all the answers

What is the characteristic pathology finding in diffuse gastric cancer?

<p>Linitis plastica (D)</p> Signup and view all the answers

What is the primary site of metastasis for gastric cancer?

<p>Liver (D)</p> Signup and view all the answers

Which factor has a very weak and inconsistent association with gastric cancer?

<p>Alcohol consumption (D)</p> Signup and view all the answers

What happens to the stomach in diffuse gastric cancer?

<p>It thickens diffusely (C)</p> Signup and view all the answers

What is one of the major risk factors for developing intestinal type gastric cancer?

<p>H.Pylori infection (D)</p> Signup and view all the answers

Where does acanthosis nigricans most characteristically occur?

<p>Intertriginous sites (D)</p> Signup and view all the answers

What is the most common cancer associated with acanthosis nigricans when linked to malignancy?

<p>Gastric adenocarcinoma (D)</p> Signup and view all the answers

What skin finding is characterized by the explosive onset of multiple itchy seborrheic keratoses?

<p>Leser-Trélat sign (C)</p> Signup and view all the answers

An isolated enlargement of which lymph node is a concerning sign that may indicate metastatic gastric cancer?

<p>Left supraclavicular lymph node (A)</p> Signup and view all the answers

What is a characteristic finding in a Sister Mary Joseph nodule?

<p>A palpable nodule around the umbilicus (D)</p> Signup and view all the answers

What type of tumor is a Krukenberg tumor typically associated with?

<p>Metastasis from the stomach (C)</p> Signup and view all the answers

What is a common cause of edema and facial swelling in patients with Menetrier's disease?

<p>Protein losing enteropathy (C)</p> Signup and view all the answers

Which symptom indicates a patient may need an endoscopy for dyspepsia?

<p>Weight loss and early satiety (C)</p> Signup and view all the answers

What is the hallmark finding on a CAT scan for a patient with hypertrophic gastropathy?

<p>Enlarged rugal folds (A)</p> Signup and view all the answers

What is the main clinical approach for a patient with dyspepsia who is younger and does not exhibit alarm symptoms?

<p>H.Pylori testing (A)</p> Signup and view all the answers

What condition is characterized by hyperplasia of mucus cells in the stomach?

<p>Menetrier's disease (A)</p> Signup and view all the answers

What is a consequence of excessive gastric mucus secretion in Menetrier's disease?

<p>Achlorhydria (B)</p> Signup and view all the answers

What occurs when patients with dyspepsia fail to respond to initial therapy?

<p>Send them for an endoscopy (A)</p> Signup and view all the answers

Which lymph node drains lymph from the stomach and can be involved in metastatic cancer?

<p>Left supraclavicular lymph node (D)</p> Signup and view all the answers

What is intestinal metaplasia characterized by?

<p>Presence of goblet cells in the stomach (D)</p> Signup and view all the answers

What percentage of peptic ulcers occur in the proximal duodenum?

<p>90% (C)</p> Signup and view all the answers

Which of the following is NOT a risk factor for peptic ulcer disease?

<p>Increased fiber intake (C)</p> Signup and view all the answers

What mechanism increases acid production in the presence of H.Pylori infection?

<p>Stimulation of G cells by an alkaline environment (C)</p> Signup and view all the answers

What type of gastric cancer is associated with chronic gastritis?

<p>Adenocarcinoma (B)</p> Signup and view all the answers

Which symptom is typically associated with duodenal ulcers?

<p>Epigastric pain that improves with meals (C)</p> Signup and view all the answers

What distinguishes Zollinger-Ellison Syndrome from other causes of duodenal ulcers?

<p>Presence of a gastrin-secreting tumor (B)</p> Signup and view all the answers

What occurs during metaplastic atrophic gastritis?

<p>Chronic inflammation leads to intestinal metaplasia (B)</p> Signup and view all the answers

What typical finding in patients with Zollinger-Ellison Syndrome differentiates them from those with regular duodenal ulcers?

<p>Multiple ulcers in the distal duodenum or jejunum (B)</p> Signup and view all the answers

What is the primary cause of pain worsening at night in duodenal ulcer patients?

<p>Absence of food leading to more acid exposure (B)</p> Signup and view all the answers

Which condition can lead to an increase in gastric acid production from the stomach?

<p>Gastrin-secreting tumors (A)</p> Signup and view all the answers

What is a significant concern when observing ulcers during an endoscopy?

<p>Possible presence of cancer cells in the ulcer (C)</p> Signup and view all the answers

What is the role of Brunner's glands in the duodenum during a meal?

<p>Secretion of bicarbonate (D)</p> Signup and view all the answers

Flashcards

Gastritis

Inflammation of the stomach lining (mucosa).

Erosion

Loss of stomach lining, but does not go through the muscular layer.

Ulcer

Breakdown of stomach lining going through the muscular layer.

Acute Gastritis

Short-term inflammation with neutrophil infiltration.

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Chronic Gastritis

Long-term inflammation with lymphocytes/plasma cells/macrophages.

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Dyspepsia

Symptoms of gastritis like nausea, vomiting, pain etc.

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Causes of Acute Gastritis

Often due to mucosal damage from acid.

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Chronic gastritis causes

Autoimmune disorders and H. Pylori bacteria.

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Acute Gastritis: Causes

Caused by excessive acid production or loss of stomach lining protection.

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NSAID-Induced Gastritis

Acute gastritis caused by NSAID use, which inhibits prostaglandin production, increasing acid and reducing protective mucus.

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Alcohol-Induced Gastritis

Acute gastritis caused by direct damage to the stomach lining by alcohol.

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Chemotherapy-Induced Gastritis

Acute gastritis caused by chemotherapy drugs hindering stomach lining cell growth, reducing protection .

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H. Pylori-Induced Gastritis

Acute gastritis caused by bacterial infection, leading to inflammation, though it often links to chronic problems.

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Curling's Ulcer

Acute stomach ulcer caused by decreased blood flow to the stomach, often in burn patients.

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Cushing's Ulcer

Acute stomach ulcer caused by increased intracranial pressure, leading to excessive acid production.

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Stress Ulcers

Acute stomach ulcers caused by shock, sepsis, or trauma, leading to reduced blood flow to the stomach.

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Parietal Cells

Stomach cells that secrete acid.

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Prostaglandins (Gastritis)

Substances that inhibit acid production and promote mucus/bicarb production, protecting the stomach.

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Type A Chronic Gastritis

An autoimmune disease leading to chronic stomach inflammation.

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Type B Chronic Gastritis

Chronic stomach inflammation due to H. pylori.

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Blood Flow & Gastritis

Normal blood flow is essential to maintain the stomach lining and its protective layers.

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Mucus & Bicarbonate

Stomach lining protection; they protect from acid.

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Autoimmune gastritis

Chronic gastritis caused by the immune system attacking and destroying the stomach's parietal cells.

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Parietal cells

Stomach cells that produce intrinsic factor, crucial for vitamin B12 absorption.

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Intrinsic factor

A protein produced by parietal cells that binds to vitamin B12 for absorption.

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Pernicious anemia

Anemia caused by vitamin B12 deficiency due to lack of intrinsic factor.

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H. pylori

Bacteria that causes chronic gastritis, often in the stomach antrum.

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H. pylori's Survival Mechanism

Produces an alkaline environment to protect itself from stomach acid using the enzyme urease.

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Urease

H. pylori enzyme that hydrolyzes urea to make ammonia, creating an alkaline environment.

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Urea Breath Test

A diagnostic test for H. pylori infection that detects labeled CO2 exhaled.

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MALT lymphoma

Rare B-cell cancer linked to H. pylori infection.

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Stomach Antrum

The lower part of the stomach, often affected by H. pylori infection.

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Triple Therapy

Combination of drugs used to eradicate H. pylori, a combination of a proton pump inhibitor and two antibiotics.

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Gastric adenocarcinoma

Stomach cancer linked to both chronic gastritis types (autoimmune and H. pylori).

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Stool Antigen Test

Diagnostic method for H. pylori, detecting bacterial antigens in stool samples.

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Chronic Gastritis (Autoimmune)

Long-term stomach inflammation targeting parietal cells, often associated with pernicious anemia.

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Chronic inflammation

Long-term inflammation that can lead to stomach cancer.

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Triple therapy failure rate

Approximately 20% of patients taking triple therapy for H. pylori infection do not respond.

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Type A chronic gastritis

Autoimmune form of chronic gastritis affecting the body and fundus of the stomach.

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Type B chronic gastritis

Chronic gastritis caused by H. pylori bacteria located in the antrum of the stomach

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Intestinal metaplasia

Stomach tissue transforming into intestinal-like tissue in chronic gastritis.

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Metaplastic Atrophic Gastritis

The condition of Stomach tissue changing to intestinal-like tissue with stomach-lining atrophy from chronic inflammation

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Goblet cells in biopsies

Presence of goblet cells in stomach biopsies, an indicator of intestinal metaplasia in chronic gastritis.

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Peptic ulcer disease location

Ulcers commonly found in the proximal duodenum (90%) and the stomach antrum (10%).

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H. pylori and acid secretion

H. pylori infection can increase stomach acid secretion, damaging the stomach or duodenum lining.

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NSAID and ulcers

NSAIDs are a risk factor for peptic ulcer disease due to damaging the protective stomach lining.

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Smoking and ulcers

Smoking is linked to peptic ulcer disease, although the mechanism isn't fully understood.

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Duodenal ulcer cause

H. pylori is the most frequent cause of duodenal ulcers due to increased acid production.

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Zollinger-Ellison Syndrome

Rare cause of duodenal ulcers arising from a gastrin-secreting tumor resulting in acid production that impacts the distal duodenum and jejunum

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Duodenal ulcer pain relief

Duodenal ulcer pain often improves after eating due to bicarb release neutralizing acid.

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Ulcer and cancer risk

Ulcers, especially gastric ulcers, can be a potential indicator of cancer and should be carefully examined.

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Duodenal Ulcers

Sore in the duodenum lining, mostly benign.

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Brunner's Glands

Glands in duodenum submucosa that produce alkaline fluid to neutralize stomach acid.

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Posterior Duodenal Ulcers

Duodenal ulcers located on the back of the duodenum, linked to complications like bleeding and pancreatitis.

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Upper GI Bleeding (cause)

Bleeding above the ligament of Treitz.

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Upper GI Bleeding (symptom)

Bleeding in the upper GI tract, resulting in hematemesis or melena.

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Ulcer Perforation (cause)

Breaking through the wall of a duodenal or gastric ulcer.

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Gastric Ulcers

Ulcers in the stomach, less common than duodenal ulcers, often linked to severe consequences.

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Gastric Ulcer location

Commonly occur on the lesser curvature of the stomach.

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Gastric Ulcer Pain

Pain is typically worse with meals due to increased stomach acid exposure in the stomach.

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Gastric Ulcer (H.Pylori)

70% of gastric ulcers are associated with H.Pylori infection; unlike duodenal ulcers.

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Gastric Ulcer (cancer)

Can be caused by Gastric adenocarcinoma causing more worry.

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Ulcer Treatment

Treating H. pylori infection and administering proton pump inhibitors.

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Left Gastric Artery

Artery that runs along the lesser curvature of the stomach that can be bled with a gastric ulcer.

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Lower GI Bleeding (cause)

Bleeding below the ligament of Treitz.

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Proton Pump Inhibitors (PPI) for Dyspepsia

PPIs are often used to treat dyspepsia symptoms (like heartburn, indigestion) because they treat ulcers, GERD, and gastritis, avoiding an endoscopy for a simpler workup.

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Gastric Carcinoma (Stomach Cancer)

A serious stomach cancer, usually adenocarcinoma, often asymptomatic until advanced stages.

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Early Stomach Cancer Survival

If diagnosed early and non-invasive, gastric cancer has a high 5-year survival rate (around 95%).

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Advanced Stomach Cancer Survival

If discovered at later stages (with symptoms developing), 5-year survival drops to 15%.

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Intestinal Type Stomach Cancer

Looks like a large ulcer with regular margins, similar to colon cancer, often due to intestinal metaplasia (related to H. pylori or autoimmune gastritis).

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Diffuse Type Stomach Cancer

Stomach is diffusely thickened, not ulcer-like. Less common, and has few established risk factors, but can affect healthy people.

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Risk Factors: Older Men

Gastric cancer is more common in older men, making this a major risk factor demographic.

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Risk Factors: Smoking

Smoking is linked to gastric cancer like other cancers.

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Risk Factors: Alcohol (Weak Association)

Studies have shown inconsistent results on links between alcohol and gastric cancer; Alcohol can cause gastritis, but their link is weak.

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Risk Factors: Nitrosamines

Nitrosamines, especially NDMA (found in processed meats), are linked to gastric cancer, based on case-control studies.

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Risk Factors: Type A Blood

Type A blood is linked with a potentially increased risk of autoimmune gastritis and then subsequent gastric cancer, the mechanism isn't clear.

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Signet Ring Cells

A characteristic feature of diffuse stomach cancer, formed by mucin pushing the cell's nucleus to the side, creating a signet ring-like appearance in biopsies.

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Stomach Cancer Metastasis

Liver is a common site for stomach cancer metastasis, along with other abdominal malignancies.

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Acanthosis Nigricans

Skin condition: hyper pigmented plaques, potentially connected to certain malignancies, like stomach cancer.

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Acanthosis Nigricans

Dark, velvety patches of skin, often associated with insulin resistance and rarely with malignancy, particularly gastric adenocarcinoma.

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Leser-Trélat Sign

Sudden appearance of multiple seborrheic keratoses, suggesting possible gastric carcinoma.

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Virchow's Node

Enlarged left supraclavicular lymph node, a serious sign of possible metastatic gastric cancer.

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Sister Mary Joseph Nodule

Palpable nodule near the belly button, indicating stomach cancer metastasis to the periumbilical region.

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Krukenberg Tumor

Ovarian tumor due to metastasis from another site, most commonly the stomach.

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Menetrier's Disease

Acquired stomach disorder with excessive mucus production, leading to protein loss and hypoalbuminemia-related symptoms.

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Hypertrophic Gastropathy

Rare group of disorders causing enlarged stomach folds due to mucus cell hyperplasia. Menetrier's is one example.

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Dyspepsia

Upset stomach and epigastric pain, often with no identifiable organic cause (functional dyspepsia).

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Alarm Symptoms (Dyspepsia)

Weight loss, early satiety, new onset dyspepsia and old age: these suggest a need for immediate endoscopy.

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H. Pylori

Bacteria that could cause chronic gastritis and linked to stomach disorders.

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Endoscopy (EGD)

Direct examination of the stomach and esophagus using a camera, used for diagnosing gastric problems.

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Proton Pump Inhibitors

Drugs that inhibit acid production in the stomach, treating conditions like heartburn, gastritis and ulcers.

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Gastric Adenocarcinoma

Stomach cancer.

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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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