Pathophys Test 2

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Pathophys Test 2
2010-03-26 22:38:00
Gastritis and ulcers

Gastritis and ulcers
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  1. Factors associated with pathogenesis of acute gastritis. (p.17)
    • Erosive gastritis
    • Involves focal necrosis of mucosa
    • Leads to erosion into deeper tissues
    • Then acute ulcer, inflammation, and hemorrhage
  2. Mechanism of injury of acute gastritis. (p.17)
    • Chemical irritants - ASA, NSAIDs, ETOH
    • Severe illness - trauma, sepsis, surgery, burns, hypothermia, bile reflux, drugs given during course of illness
  3. Cushing's Ulcer (p.18)
    • Response to traumatic/surgical injury to CNS or rapidly progressing ICH
    • Brain injury --> increased vagal tone & increased acid secretion in stomach
  4. Curling's Ulcer (p.18)
    • Occurs in severely burned patients, in shock, sepsis, and other forms of trauma
    • Probably due to autonomic response to shock
    • Shunts blood from GI tract to more critical areas --> ischemia --> inhibits PG synthesis --> impairs mucus-bicarb layer
  5. Autoimmune gastritis
    (chronic gastritis)
    • Antibodies attack parietal cells --> destruction of gastric glands
    • Causes parietal cell malfunction and eventual absence of HCl secretion (achlorydia) and intrinsic factor secretion (needed for B12 absorption)
    • Lack of B12 causes impaired folic acid metabolism, needed for DNA synthesis of new cells.
    • Ultimately leads to atrophy of gastric epithelium.
  6. Infectious gastritis
    (chronic gastritis)
    • Primarily Helicobacter pylori (H. pylori), gram-negative bacteria
    • Causes chronic gastritis of antrum and body of stomach
    • H. pylori burrows through mucus layers, attaches to epithelial cells, and colonizes
    • H. pylori damages cells by producing urease, which increases ammonia levels in stomach, increasing pH
    • H. pylori disrupts bicarb layer with mucolytic enzymes
  7. What is the gold standard for diagnosing peptic ulcers and H. pylori? (p.21)
    Biopsy and rapid urease test (CLO test - campylobacter-like organism)
  8. What is the least invasive test to document H. pylori and document bacterial eradication
    after treatment?
    Urea breath test
  9. Describe Zollinger-Ellison syndrome. How is it related to peptic ulcer disease? (p.20)
    • Endocrine syndrome affecting islet cells of pancreas (pancreatic tumor)
    • Produces gastrin, which increases secretion of acid by the stomach

    • Leads to chronic inflammation and eventual ulceration of mucosal lining
    • Further ulceration can occur as submucosa exposed to acid and gastrin