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</p> Signup and view all the answers

    What is the primary symptom associated with gastritis?

    <p>Dyspepsia</p> Signup and view all the answers

    Why might symptoms of gastritis worsen after eating?

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

    Which type of gastritis typically has a lymphocytic infiltrate?

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

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

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

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

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

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

    <p>Prostaglandins</p> Signup and view all the answers

    How do NSAIDs contribute to acute gastritis?

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

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

    <p>Burns</p> Signup and view all the answers

    What is a common cause of Cushing's ulcers?

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

    Which type of gastritis is characterized by an autoimmune response?

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

    How does alcohol contribute to acute gastritis?

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

    What is a common characteristic of stress ulcers?

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

    What is a primary symptom of acute gastritis?

    <p>Dyspepsia</p> Signup and view all the answers

    Which bacterial infection is notably linked to gastritis?

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

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

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

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

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

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

    <p>Urease</p> Signup and view all the answers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    <p>Pancreatitis</p> Signup and view all the answers

    What is a typical symptom of upper GI bleeding?

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

    Where do gastric ulcers most commonly occur?

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

    What is a typical presentation of lower GI bleeding?

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

    Why are gastric ulcers often biopsied?

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

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

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

    What is melena a term for?

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

    Where does the ligament of Treitz attach?

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

    What is the most common type of gastric cancer?

    <p>Adenocarcinoma</p> Signup and view all the answers

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

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

    What is the prognosis for noninvasive gastric cancer identified early?

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

    Which type of gastric cancer resembles an ulcer during examination?

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

    What is considered a protective factor against gastric cancer?

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

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

    <p>Nitrosamines</p> Signup and view all the answers

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

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

    What is a common skin finding associated with gastric cancer?

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

    Which demographic is at higher risk for gastric cancer?

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

    What is the characteristic pathology finding in diffuse gastric cancer?

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

    What is the primary site of metastasis for gastric cancer?

    <p>Liver</p> Signup and view all the answers

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

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

    What happens to the stomach in diffuse gastric cancer?

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

    Where does acanthosis nigricans most characteristically occur?

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

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

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

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

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

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

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

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

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

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

    <p>Achlorhydria</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</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</p> Signup and view all the answers

    What is intestinal metaplasia characterized by?

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

    What percentage of peptic ulcers occur in the proximal duodenum?

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

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

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

    What type of gastric cancer is associated with chronic gastritis?

    <p>Adenocarcinoma</p> Signup and view all the answers

    Which symptom is typically associated with duodenal ulcers?

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

    What occurs during metaplastic atrophic gastritis?

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

    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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    Description

    This quiz covers various gastric disorders, focusing on gastritis and its types, erosions, and ulcers. Participants will learn about the causes, symptoms, and implications of acute and chronic gastritis, as well as the differences between erosions and ulcers. Perfect for medical students and healthcare professionals.

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