Diseases of the Stomach and Duodenum
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What are the main diseases of the stomach and duodenum?
- Peptic ulcer disease
- Zollinger Ellison Syndrome
- Malignant tumors of the stomach
What are the four layers throughout the GI Tract?
- Muscularis (stomach has a third, oblique layer)
What are the four main zones of the stomach?
- Cardia (proximal)
- Fundus: That part of the stomach that is above the gastroesophageal junction (GEJ)
- Body (corpus)
- Antrum (distal)
Which zones of the stomach share histological traits?
- Cardia and antrum share histological traits
- Fundus and body share histological traits
Which zones of the stomach make the acids and enzymes?
The fundus and the body
Which zones of the stomach have the job of protecting the esophagus and the duodenum from the acids and the enzymes?
The cardia and antrum
What are gastric juices made up of?
Combined secretions of mucous cells, parietal cells and chief cells
What do mucous cells, parietal cells, and chief cells produce?
- Mucous cells produce mucous (lol)
- Parietal cells produce HCl and intrinsic factor
- Chief cells produce pepsinogen I and II
What are the 3 types of gastritis?
- Erosive and hemorrhagic "gastritis"
- Nonerosive, nonspecific
- Specific types of gastritis
What are the common causes of "gastritis?"
- Stress (medical/surgical, not emotional)
- Portal HTN
What is the main sign of "gastritis?" Also, what is the main tool of diagnosis?
- Main sign -> Hematemesis
- Diagnosis is by endoscopy, which also rules out other causes of bleeding (PUD, varices)
What are the types of endoscopic findings you can get while diagnosing Erosive and Hemorrhagic Gastritis?
- Subepithelial hemorrhages
- Usually there is no significant inflammation on histologic examination
Stress-related mucosal erosions and subepithelial hemorrhages develop within ___ hours in the majority of critically ill patients.
_____ is associated with the high mortality, however this is seldom the cause of death.
What are the specific causes of stress gastritis?
- Mechanical ventilation
- Central nervous system injury
- Hepatic or renal failure
- Multi-organ failure
The incidence of bleeding can be reduced by 50% in critically ill patients with stress gastritis prophylaxis by using what?
- Continuous IV H2 antagonists
- OR Proton pump inhibitors
What is used for stress gastritis treatment?
- Continuous infusion IV Proton pump inhibitors
- Endoscopy is performed as needed to ensure there are no other treatable causes.
What % of patients receiving chronic NSAIDs develop gastritis?
What % of NSAID Gastritis patients have ulcers at endoscopy?
Only NSAID Gastritis patients with ________ should undergo diagnostic endoscopy.
NSAID Gastritis: Those without significant NSAID ulceration should be treated _____________
symptomatically with PPIs
True or false: Upper GI bleeding due to NSAID gastritis is generally severe.
False. It is generally not severe.
What kind of treatment is utilized for alcoholic gastritis?
Therapy with PPIs or H2 receptor antagonists for 2-4 weeks.
Nonerosive, Nonspecific Gastritis is caused by Helicobacter pylori. What are the defining characteristics of Helicobacter pylori?
- Spiral, gram-negative rod
- Chronic, diffuse mucosal inflammation
- Present in 30-50% of the population -> Most are asymptomatic -> 15% of those infected develop PUD -> Chronic infection associated with increased risk of adenocarcinoma and B cell gastric lymphoma
Describe the testing standards for Helicobacter pylori.
- Serologic tests NOT recommended due to low sensitivity and low specificity
- Fecal antigen immunoassay (>95% sensitivity and specificity)
- Urea breath test (>95% sensitivity and specificity)
- Discontinue PPIs 7-14 days prior to testing
Describe the defining features of Pernicious Anemia Gastritis
- Autoimmune disorder
- Parietal cell antibodies -> Destroy the H+-K+-ATPase pump -> Loss of intrinsic factor -> Achlorhydria and vitamin B12 malabsorbtion
- Risk of adenocarcinoma increased 3x
What causes infectious gastritis?
- Bacterial (necrotizing gastritis)
- Viral (CMV with AIDS and organ transplantation)
- Fungal (Candida)
What causes Granulomtous gastritis?
Crohn's, H. pylori, TB, syphilis, sarcoid (may be symptomatic or asymptomatic)
What are the three rare causes of gastritis?
- Menetrier's disease (giant thickened gastric folds, cause is unknown, treated with cetuximab)
Definition: Break in the mucosa
Caused when normal mucosal defenses are impaired or overwhelmed by acid or pepsin
Extend through the muscularis mucosa
Peptic Ulcer Disease (PUD)
What % is the lifetime risk of Peptic Ulcer Disease?
Duodenal ulcers are _x as common as gastric ulcers.
What are the risk factors for Peptic Ulcer Disease?
Risk factors are smoking and NSAID use (diet, ETOH, emotional stress are not risk factors)
What are the three causes for Peptic Ulcer Disease (PUD)?
- H. pylori
- NSAID use -> 1-2% of long-term NSAID users have major complications (bleeding, perforation) within 1 year -> Cox 2 inhibitors reduce major complications by 50%
- Acid hypersecretory states (Z-E syndrome)
What are the signs and symptoms of Peptic Ulcer Disease?
- Dyspepsia -> 80-90% of patients -> less than 25% of patients with dyspepsia will have PUD
- Relieved by food (50%)
- Physical exam: mild epigastric pain
- Labs: -> Anemia if bleeding -> Leukocytosis if perforation -> Increased amylase if penetration into pancreas
What is used to diagnose Peptic Ulcer Disease?
- Endoscopy -> Procedure of choice -> Best diagnostic accuracy and can take biopsies -> ALL gastric ulcers need to be biopsied
- Barium Upper GI -> Acceptable alternative to endoscopy -> Not capable of biopsy
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