PUD

Question 1

Gastroc mucosal Defense 3 Level Barrier

Answer 1

• PREEPITHELIAL
  mucus bicarbonate e phospholipid layer surface epithelial cell
• EPITHELIAL
• SUBEPITHELIAL

Question 2

• generates hest shock proteins, trefoil factor family peptides and cathelicidins
• restitution: EGF, TGF, FGF
• has microvascular system that is the key component of subepithelial defense

Answer 2

EPITHELIAL SURFACE

Question 3

• 2 Principal gastric secretory products; capable of inducing injury
• plays a role on digestion, absorption of iron and Vit B12 as well as killing bacteria

Answer 3

• HCl
• pepsinogen

Question 4

• occurs in basal and stimulated condition
• the basal acid production occur in circadian rhythm (highest level during night, lowest during morning)

Answer 4

Gastric Secretion

Question 5

• influence by cholinergic input (vagus nerve) and histaminergic input (local gastric sources)
• somatostatin, cholecystokinin, gherlin, obestatin, secretin, serotonin- plays a role in counterbalancing gastric acid secretion

Answer 5

Basal acid production

Question 6

3 Phases of Gastric Secretion

• sight, smell, taste of food

Answer 6

• cephalic phase

Question 7

3 Phases of Gastric Secretion

• activated once food enters the stomach

Answer 7

gastic phase

Question 8

3 Phases of Gastric Secretion

• initiated as food enters the intestine

Answer 8

intestinal phase

Question 9

• located in oxyntic gland
• also important in gastric secretory proceess
• secretes intrinsic factor, IL11
• express several stimulants of acid secretions (histamine 2, gastrin, Ach:M3)
• express receptors for ligands that inhibit acid production (prostaglandins, somatostatin, EGF)

Answer 9

Parietal cell

Question 10

• responsible for generating large conc of H+
• consist of alpha (active catalytic site) and beta subunit
• usses chemical energy of ATP to transfer H+ ions from parietal cell cytoplasm to the secretory canaliculi

Answer 10

H+, K+- ATPase

Question 11

• found primarily in the gastric fundus
• synthesizes and secretes pepsinogen- inactive precursor of pesin
• pepsin activity significantly diminished at pH 4, irreversibly inactivated and denatured at pH >/=7

Answer 11

Chief cell

Question 12

break in the mucosal surface >5mm in size w/ depth to the submucosa

Answer 12

Ulcer

Question 13

most common risk factor

Answer 13

H. pylori & NSAIDs

Question 14

• often occur in the 1st portion, w/ 90% located w/in 3cm of pylorus
• usually = to 1cm in diameter but occ’l can reach 3-6cm
• sharply demarcated w/ depth at times reaching the muscularis propia
• the base often consist of zone of eosinophilic necrosis w/ surrounding fibrosis

Answer 14

Duodenal Ulcer

Question 15

account for the majority of DU

Answer 15

H.pylori and NSAID

Question 16

• attributed to either H.pylori or NSAID induced mucosal damage
• gastric acid output tends to be normal or decreased
• abnormalities in resting and stimulated pyloric sphincter pressure w/ increase in duodenal gastric reflux

Answer 16

Gastric Ulcer

Question 17

Classification of Gastric Ulcer
-Type I
-Type II
- TYpe III
- Type IV

Answer 17

• Type I: gastric body; ass w/ low gastric acid production
• Type II: antrum; gastric acid vary from low to normal
• Type III: occur w/in 3cm of pylorus; acccompanied by duodenal ulcerl normal -high gastric acid production
• Type IV: found in cardia; low gastric acid secretion

Question 18

2 factors that predispose to high colonization rate

Answer 18

• poor socioeconomic status
• less education

Question 19

MOT of PUD

Answer 19

• person-person
• oral-oral
• fecal-oral

Question 20

Risk Factors for H.pylori Infection

Answer 20

• birth or residence in developing country
• domestic crowding
• unsanitary living condition
• unclean food or water
• exposure to gastric contents of an infected individual

Question 21

Pathogenic Factors Unrelated to H.pylori and NSAID in Aic Peptic Disease

Answer 21

• cigarette smoking
• genetic
• diet
• systemic mastocytosis

Question 22

Infection Causes of Ulcers

Answer 22

• CMV
• HSV
• H. heilmannii

Question 23

Drug/Toxin Causes of Ulcers

Answer 23

• biphosphonates
• chemo
• clopidogrel
• crack cocaine
• glucocorticoids
• mycophenolate mofetil
• KCl

Question 24

Clinical Features of PUD

Answer 24

• abdominal pain: epigastric (burning or gnowing)
• nausea & weight loss
• tarry stools or coffee ground emesis

Question 25

Physical Exam in PUD

Answer 25

- epigastric pain - tachycardia & orthostasis - presence of a succusion splash

Question 26

PUD related complications

Answer 26

- GI bleeding: mc - perforation: 2nd - gastric ooutlet obstruction

Question 27

Dx Evaluation of PUD

Answer 27

- Barium study - endoscopy

Question 28

Test for Detection of H.pylori Invasive

Answer 28

- rapid urease - histology

Question 29

Test for Detection of H.pylori Non Invasive

Answer 29

- serology - urea breath test - stool antigen

Question 30

Tx of PUD

Answer 30

- eradication of H. pylori & therapy prevention of NSAID induced dse - acid suppressing drugs: antacids, H2 receptors antagonists, PPI - mucosal protectives

Question 31

Surgery that is performed only in DU

Answer 31

Vagotomy

Question 32

severe peptic diathesis secondary to gastric acid hypersecretion due to unrerlated gastrni release frm a non-beta cell endocrine tumor

Answer 32

Zollinger ELisson Syndrome

Question 33

Manifestation of Zollinger Ellison Syndrome

Answer 33

- PUD-mc - diarrhea

Question 34

When to obtain fasting serum gastrin?

Answer 34

- multiple ulcers - ulcers in unsual locations - ulcer px awaiting surgery - extensive fam hx for PUD - post 0- ulcer recurrence -basal hyperchloridria - unexplained diarrhea/ steathorrea -hypercalcemia - fam hx of pancreatic islet, pituitary, parathyroid tumor - prominent gastric/duodenal folds

Question 35

Tx for Zollinger Ellison Syndrome

Answer 35

- directed at ameliorating the signs and symptoms related to hormone overproduction - PPI: tx of choice - surgery

Question 36

presence of inflammatory cell infiltrates (lympho, plasma cells, neutro)

Answer 36

Chronic Gastritis

Question 37

Types of Chronic Gastritis - Superficial - Atrophic - Gastric atrophy - Type A - type B

Answer 37

- Superficial: early phase - Atrophic: inflamm infiltrates extends deeper into the mucosa - Gastric atrophy: glandular structure are lost, there is a paucity of inflamm infiltrates - Type A: autoimmune, body predominant - type B: H.pylori related, antrall predominant

Question 38

Tx for Gastritis

Answer 38

aimed at the sequelea and not the underlying inflamm

Question 39

Miscellaneous form of gastritis - lymphocytic: - Eosinophilic: - russel body:

Answer 39

- lymphocytic: unknown etiology, described in px w/ celiac sprue - Eosinophilic: markerd eosinophilic infiltration involving any layer of the stomach - russel body: mucosal lesion of unknown etiology

Question 40

- pseudotumural appearance - presence of numerous plasma cell containing RB that expresses kappa and lambda light chains

Answer 40

Russel body gastritis

Question 41

- rare entity char. as large, totous gastric mucosal folds - massive foveolar hyperplasia - epigastric pain, nausea, vomit, anorexia, wt loss - gastric acid secretion reduced or absent - endoscopy w/ deep mucosal biopsy is required to dx

Answer 41

Menietriers dse

Question 42

Tx foe Menietriers dse

Answer 42

- medical therapy- anticolinergic agents, prostaglandins, PPI, predisone, H2 receptr antagonist - subtotal gastrectomy