Question | Answer |
inflammation of gastric mucosa | gastritis |
S and S of gastritis | ab pain, indigestion, loss of appetite, N/V, melena |
develops shortly after exposure to insult, petechial hemorrhages and small erosions | acute hemorrhagic gastritis |
causes of acute hemorrhagic gastritis | stress lesions, drugs (NSAIDS, alcohol, corrosives, trauma, radiation, H. pylori |
H. pylori can cause both | acute and chronic gastritis |
__ is helpful if specific cause unknown | biopsy |
lifetime PUD prevalence is __% | 11-14 |
the three most important etiologic factors for PUD | H. pylori, NSAIDS, Acid |
H. pylori is more common in __ | blacks and hispanics |
H. pylori lives in the | gastric mucous layer adjacent to the epithelial surface |
adaptations of H. pylori | urease production provides buffering, residenc in mucus layer, creates ionic gradient at low pH |
concurrent use of __ will cause false negative results except on H. pylori serology or biopsy w/ histology | PPI, antibiotics, or bismuth |
triple therapy for H. pylori eradication | PPI (prevacid), clarithromycin, Amoxicillin |
confirmation of eradication of H. pylori | urease breath or blood test or stool test |
__ is no the first line treatment for H. pylori eradication b/c of resistance | flagyl |
H. pylori is associated with | gastric adeno carcinoma, and MALT (mucosa associated lymphoid tissue) lymphoma |
is the syndrom associated with a gastrinoma (gastrin secreting tumor) | Zollinger-Ellison Syndrome |
MEN I | parathyroid, pancreas, and pituitary tumors |
clinical findings in Zollinger-Ellison | PUD-majority in duodenal bulb, usually resistant to treatmen, Gerd, Diarrhea-volume load of acid, acid inactivates pancreatic enzymes, causes steatorrhea |
PPI's increase the amount of __ secreted | gastrin |
very sensitive and specific test for gastrinoma | Secretin stimulation test |
secretin has no effect on __ in normal patients but dramatically increases levels in ZE patients | gastrin |
treatment of gastrinoma | high dose PPI, surgical resection if not metastatic |
without metastasis 15 year survival rate of gastrinoma is __% | 83 |
burning pain localized to the epigastrum , non radiating that gets worse with meals | gastric ulcer |
burning pain localized to the epigastrum, non-radiating that gets better with meals | duodenal ulcer |
most discriminating symptom of PUD is the presence of | pain that awakens the patient from sleep between 2-3 am |
__ allows characterization of the lesion and biopsy which is important since about 4% of GU are cancerous | EGD |
most common complication of PUD | hemorrhage |
occurs in 15% of PUD patients and 2% of NSAID users | hemorrhage |
perforation occurs in __% of PUD patients | 7 |
treatment for PUD | antacids, H2 blockers, proton pump inhibitors |
three principal stimuli of HCl secretion via the parietal cells | histamine, acetylcholine, gastrin |
principle inhibitor of HCl secretion via parietal cells is | somatostatin |
less effective than PPI's | H2 blockers |
blocks parietal cell H+/K+ ATPase pump | PPI's |
stomach can be rendered anchlorhydric with __ use | PPI |
PPI's are most effective when taken __ min before meals | 15-30 |
increased risk of __ with long term use of PPI's | hip fracture |
side effects of PPI's | diarrhea, nausea, abdominal pain, HA |
who is high risk for PUD from NSAID use | previous event, older age, also on anticoagulants/corticosteroids/other NSAIDS, high dose NSAIDS, chronic disease |
strategies for preventing NSAID complications | Cox-2 therapy, Mucosal protection (misoprostol, PPI, High dose H2 blocker) |
synthetic prostaglandin E1 analog, prevention of NSAID-induced gastric ulcers, not for use in women of childbearing age | misoprostol |
most common cause of PUD in US | H. pylori, and NSAIDS |
think of __ in cases of multiple ulcers or refractory ulcers | Zollinger-Ellison |
__ are most effective in prevention of gastrodudenal toxicity with NSAIDs | PPI's and Misoprostol |