Stomach and Peptic Ulcer Disease Overview

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Questions and Answers

Which of the following substances stimulates gastric secretion?

Histamine (correct)

Duodenal acid

Somatostatin

H.pylori

What is one of the primary functions of the gastric mucosa?

Storage of nutrients

Temperature regulation of ingested substances

Secretion of intrinsic factor

Barrier against pathogens (correct)

Which of the following is a common cause of Peptic Ulcer Disease?

High protein diet

Excessive exercise

Dehydration

H.pylori infection (correct)

Which complication is associated with gastritis?

Life-threatening bleeding Signup and view all the answers

Which medication class is used to reduce stomach acid secretion?

Antisecretory drugs Signup and view all the answers

What risk factor is associated with duodenal ulcers?

Excess acid and pepsin Signup and view all the answers

Which sphincter is located at the entrance of the stomach?

Lower esophageal sphincter Signup and view all the answers

What is a key treatment for immediate support in cases of severe gastritis?

Fluid resuscitation Signup and view all the answers

What is the primary trigger for systemic activation during the third phase of acute pancreatitis?

Systemic activation of the immune system Signup and view all the answers

Which of the following symptoms is NOT directly associated with acute pancreatitis?

Hypercalcemia Signup and view all the answers

What is the most common cause of chronic pancreatitis?

Alcohol abuse Signup and view all the answers

Which electrolyte imbalance is commonly associated with chronic pancreatitis?

Hypomagnesemia Signup and view all the answers

Which treatment is indicated for managing fluid resuscitation in acute pancreatitis?

Providing nutritional support early Signup and view all the answers

What is NOT a component of the 'classic triad' associated with the diagnosis of chronic pancreatitis?

Hypomagnesemia Signup and view all the answers

In acute pancreatitis, which factor can mimic a myocardial infarction (MI)?

Severe pain Signup and view all the answers

Which condition is likely to develop in approximately half of patients suffering from chronic pancreatitis?

Diabetes mellitus Signup and view all the answers

What is the primary focus of medical therapy for peptic ulcer disease?

H.pylori eradication Signup and view all the answers

Which medication is NOT considered a proton pump inhibitor?

Cimetidine Signup and view all the answers

What is a potential complication of using antacids?

Milk-alkali syndrome Signup and view all the answers

Which of the following is a potential side effect of H2-receptor antagonists?

Altered drug metabolism Signup and view all the answers

In what scenario is surgical intervention considered for patients with peptic ulcer disease?

Persistent symptoms despite medication Signup and view all the answers

What is a common symptom of gastric neoplastic disease?

Hematemesis Signup and view all the answers

Which therapeutic option is specifically aimed at preventing ulcers in NSAID users?

Misoprostol Signup and view all the answers

What significant alteration should be considered when administering H2-receptor antagonists?

Adjustment of dosage for kidney function Signup and view all the answers

What is a primary reason for performing a total pancreatectomy?

Tumors (benign or malignant) Signup and view all the answers

Which layer of the small intestine contains immune cells and helps protect against pathogens?

Lamina propria Signup and view all the answers

What is the role of the Auerbach plexus in the small intestine?

Regulates motility and secretion Signup and view all the answers

During a partial pancreatectomy, which organ is NOT typically removed?

Spleen Signup and view all the answers

What type of anesthesia is generally preferred for a pancreatectomy procedure?

General endotracheal with muscle relaxants Signup and view all the answers

Which function is associated with the sympathetic nervous system in the context of the small intestine?

Inhibits motility Signup and view all the answers

What type of pain management might be used postoperatively for patients undergoing pancreatectomy?

Epidural or intrathecal morphine Signup and view all the answers

What is the primary muscle type found in the muscularis propria of the small intestine?

Smooth muscle Signup and view all the answers

What is the primary distinction between maldigestion and malabsorption?

Maldigestion specifically involves breakdown issues, whereas malabsorption refers to absorption issues. Signup and view all the answers

Which symptom is most indicative of maldigestion?

Steatorrhea (fatty stool) Signup and view all the answers

Which of the following is NOT a potential cause of pancreatic insufficiency?

Ileostomy Signup and view all the answers

What is the main function of the large intestine?

Store and expel waste Signup and view all the answers

Which artery is NOT involved in the blood supply to the large intestine?

Celiac trunk Signup and view all the answers

Which statement regarding electrolyte absorption in the large intestine is accurate?

Sodium loss after colectomy can exceed compensatory capacity of the small intestine. Signup and view all the answers

What structures are considered parts of the large intestine?

Cecum, appendix, colon, rectum, anal canal Signup and view all the answers

Which type of inflammatory bowel disease primarily affects the distal ileum and proximal colon?

Crohn's disease Signup and view all the answers

Study Notes

Stomach

Stimulated by acetylcholine, gastrin, and histamine
Inhibited by somatostatin, duodenal acid, and negative feedback from gastrin
Contains glands responsible for various functions
- Fundus: Secretes mucus for protection and hydrochloric acid for digestion
- Antrum: Secretes mucus for protection and gastrin (a hormone)
- Sphincters: Lower esophageal sphincter (LES) and pyloric sphincter
Stores up to 1.5 liters of fluid
Food storage up to 4 hours
Other functions:
- Barrier against pathogens (acidic environment and immune function)
- Temperature regulation of ingested substances
- Secretion of intrinsic factor (for vitamin B12 absorption)

Peptic Ulcer Disease

Loss of stomach lining due to inflammation, can extend deeper into the stomach wall
Types: Acute vs. Chronic (most common)
Causes:
- H. pylori infection (most common)
- NSAID use
Complications: Hemorrhage, perforation, obstruction
Duodenal ulcers:
- More common in men 45-65 and women >55
- Caused by excess acid and pepsin
- Can involve the lower stomach

Gastritis

Inflammatory disorder of the stomach lining (gastric mucosa)
Also called stress ulcers, erosive gastritis, or hemorrhagic gastritis
Can cause life-threatening bleeding
Causes:
- Multifactorial: physical trauma, shock, sepsis, medications, chemicals, or H. pylori infection
- Reduced blood flow, mucus, or bicarbonate secretion
- Reduced prostaglandins
- Stress: Hypoxia, sepsis, or organ failure
Symptoms: Upper GI bleeding

Therapeutic Options in Peptic Ulcer Disease

Goals:
- Relieve symptoms
- Heal the ulcer
- Prevent recurrence
- H. pylori eradication: Main focus of medical therapy
Medications:
- Antacids: Short-term symptom relief, can cause acid rebound and milk-alkali syndrome
- H2-receptor antagonists: Block acid secretion, adjust dosage for kidney function, potential side effects include altered drug metabolism, mental confusion, and decreased blood flow
- Proton pump inhibitors: Most effective acid blockers
- Sucralfate: Promotes healing and protects the ulcer, minimal side effects
- Misoprostol: Prevents ulcers in NSAID users, minimal side effects
- Antibiotics: Eradicate H. pylori
Surgery: Reserved for intractable symptoms despite medication. Complications: bleeding, perforation, obstruction

Gastric Neoplastic Disease

Second most common cancer worldwide
Causes:
- Alcohol abuse
- Gallstones
- Other factors: trauma, infections, medications

Acute Pancreatitis

Causes:
- Alcohol abuse
- Gallstones
- Other factors: trauma, infections, medications
Symptoms:
- Pain (severe, radiating)
- Nausea, vomiting, and fever
- Hypotension
Treatment:
- Fluid resuscitation
- Pain management (avoid morphine)
- Nutritional support
- Surgery (for gallstones)
CRP level
Anesthetic:
- Choice depends on patient presentation
- Anticipate labile hemodynamics and altered hepatic function

Chronic Pancreatitis

Permanent damage to the pancreas with inflammation, scarring, and tissue destruction
Causes:
- Most common: Alcohol abuse (70% of cases)
- Other causes: Smoking, genetics, autoimmune disease, duct obstruction
Diagnosis:
- Classic triad: steatorrhea, pancreatic calcification, diabetes mellitus
- Steatorrhea only occurs with very low lipase secretion
Reasons for surgery:
- Ductal obstruction
- Pancreatic stones or cysts
- Trauma
- Tumors (benign or malignant)
- Chronic pancreatitis
- Endocrine tumors
Surgery types:
- Partial pancreatectomy: Removes part of pancreas, duodenum, gallbladder, and bile duct.
- Total pancreatectomy: Removes part of stomach, gallbladder, bile duct, spleen, lymph nodes, and entire pancreas.
Anesthesia:
- General endotracheal preferred, with muscle relaxants.
- Avoid nitrous oxide.
- Epidural or intrathecal morphine for pain control
Postoperative care:
- May require ventilation and ICU monitoring due to surgery duration and patient health

Small Intestine

Layers:
- Serosa: Outermost layer, single layer of cells.
- Muscularis propria: Composed of smooth muscle for contraction.
  - Auerbach plexus: Between muscle layers, controls motility and secretion.
- Submucosa: Strongest layer, contains connective tissue and:
  - Meissner plexus: Regulates blood flow, motility, and secretions.
- Mucosa: Innermost layer, with folds and villi for increased surface area:
  - Muscularis mucosae: Thin muscle layer separating mucosa and submucosa.
  - Lamina propria: Connective tissue with immune cells and support functions.
  - Epithelial layer: Covers villi and crypts, contains various cell types for absorption.
Immune function:
- Lamina propria: Has immune cells for protection.
- IgA antibodies: In lamina propria prevent pathogen entry.
Nervous system:
- Autonomic nervous system:
  - Parasympathetic: Increases motility and secretions.
  - Sympathetic: Inhibits motility and causes vasoconstriction.
- Enteric nervous system: Intrinsic neurons within the wall of the small intestine, pancreas, and gallbladder, controls local functions like digestion and peristalsis.
Motility: Intestinal reflexes regulate movement and emptying.
Absorption: Absorptive cells take up nutrients.

Maldigestion vs. Malabsorption

Maldigestion: Refers specifically to the breakdown issue.
Malabsorption: Refers to the absorption issue.

Causes of Maldigestion

Pancreatic deficiency
Lactase deficiency
Bile salt deficiency

Pancreatic Insufficiency

Usually present due to its large functional reserve.
Other causes:
- Cystic fibrosis
- Fistulas
- Gallstones
- Ischemic enteritis
- Neoplastic diseases
- Diabetes mellitus
- Vitamin B6 or B12 deficiency

Key Symptom of Maldigestion

Steatorrhea (fatty stool)

Large Intestine

Anatomy:
- Length: 3-5 feet
- Parts: Cecum, appendix, colon, rectum, anal canal
Blood Supply:
- Arteries: Superior mesenteric, inferior mesenteric, internal iliac
- Veins: Drain into portal venous system (except rectum)
Lymphatic Drainage:
- Upper rectum and colon: Superior rectal and inferior mesenteric nodes
- Lower rectum and anal canal: Inguinal lymph nodes
Innervation:
- Motor and secretory control: Myenteric plexus
- Sympathetic: T10-T12 (right), L1-L3 (left), presacral nerves (rectum)
- Parasympathetic: Vagus nerve (right & transverse colon), S2-S4 (descending colon, sigmoid colon, and rectum)
Functions:
- Store and expel waste
- Absorb water and sodium (mostly in the right colon)
- Efficient absorption: Only 100-200mL out of 1-2L daily fluid reaches the end
- Importance: Individuals with ileostomy need extra sodium intake
Electrolyte Balance
- Sodium: Actively reabsorbed, efficient process (5 mEq/day needed for balance)
- Potassium: Passively absorbed/secreted, lost in mucoid stools (colitis, villous adenoma)
- Chloride: Absorbed with sodium, exchanged for bicarbonate

Inflammatory Bowel Disease

Types:
- Crohn's disease: Affects any part of the GI tract, often the distal ileum and proximal colon.

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Description

Explore the anatomy and physiology of the stomach, including its functions and hormones. Additionally, delve into peptic ulcer disease, its types, causes, and potential complications. This quiz covers essential concepts related to stomach health and related disorders.