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33 Cards in this Set
- Front
- Back
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What are the four anatomic regions of the stomach?
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cardia
fundus body antrum |
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What is the difference between the cardia and antral glands?
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The cardia and antrum are lined mainly mucin- secreting foveolar cells that form small glands.
The antral glands also contain endocrine cell, such as G cells, that release gastrin to stimulate luminal acid secretion by parietal cells |
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what do chief cells produce?
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Pepsin
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Name the protective mechanisms of the gastric mucosa.
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1. the mucin produced by the surface foveolar cells that forms a thin mucus layer that keeps large food particles from touching the epithelium
2. rich vascular supply that washes away the acid that has back-diffused into the lamina propria |
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How do the NSAIDs contribute to gastric muscosa?
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NSAIDs may interfere with cytoprotection normally provided by prostaglandins or reduce bicarbonate secretion --> these increase the susceptibilty of the gatric mucosa
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How often is the entire gastric mucosa replaced?
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every 2 to 6 days
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What does the presence of neutrophils above the basement membrane in the gastric mucosa indicate?
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The presence of neutrophils above the basement membrane in direct contact with epithelial cells is abnormal in all parts of the GI tract and means active inflammation
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What levels are damaged with an erosion to the gastric epithelium?
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An erosion denotes loss of the superficial epithelium, generating a defect in the mucosa that is limited to the lamina propria
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What location in the GI tract is associated with Curling ulcers?
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Ulcers occurring in the proximal duodenum and associated with severe burns or trauma
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In whom is stress ulcers common?
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Individuals with shock, sepsis, or severe trauma
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What ulcers are common in persons with intracranial disease?
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Gastric, duodenal, and esophageal ulcers arising in persons with intracranial disease are termed Cushing ulcers and carry a high incidence of perforation
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What is the role of prostaglandins in the protection of stomach mucosa?
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Prostaglandins enhance bicarbonate secretion, inhibit acid secretion, promote mucin synthesis, and increase vascular perfusion
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Why do patients with intracranial disease have a tendency to develop stomach ulcers?
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Lesions associated with intracranial injury are thought to be caused by direct stimulation of vagal nuclei which causes hypersecretion of gastric acid
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Why do stress ulcers form?
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Hypoxia and reduced blood flow caused by stress - induced splanchic vasoconstriction in addition to systemic acidosis that can can lower the intracellular pH of mucosal cells
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Where do stress ulcers commonly occur?
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They can occur anywhere in the stomach
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What is the difference in appearance between acute and chronic gastric ulcers
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Acute
- they are rounded and less than 1 cm in diameter - they are sharply demarcated with normal adjacent mucosa the base is stained brown to black with acid extravasation of digested blood Chronic - There is scarring and thickening of blood vessels -The base may have a fibrinoid debris underlaid by a neutrophilic inflammatory infiltrate |
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What is the most common cause of chronic gastritis?
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Helicobacter pylori infection
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What is the most common cause of atrophic gastritis?
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Autoimmune gastritis
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What area does H. pylori most often affect?
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H. pylori organisms are present in 90% of individuals to seek treatment
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H. pylori is associated with ______ gastrin levels.
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low
H. pylori is predominantly antral gastritis with high acid production despite hypogastrinemia |
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What are features of H. pylori pangastritis?
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This pangastritis is associated with multifocal mucosal atrophy, reduced acid secretion, intestinal metaplasia, and increased risk gastric adenocarcinoma
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When do we normally diagnoses H. pylori - acute or chronic infection?
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in chronic infection
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What are the features of H. Pylori that make it able to survive in gastric environment?
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1. Flagella - motility in viscous mucus
2. Urease- makes ammonia from endogenous that elevates local gastric pH 3. adhesins that allow it to adhere to surface foveolar cels 4. Toxins- cytotoxin associated gene A |
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Where is H.pylori patriculary concentrated in the stomach?
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The organism is concentrated within the superficial mucus overlying the surface and neck regions
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if you suspect, H. pylori gastritis where should you biopsy?
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In the antrum
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_____ neutrophils and ______ plasma cells are characteristic of H.pylori gastritis.
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Intraepithelial
subepithelial |
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______ __________ are responsible for accumulating in the gastric lumen to create pit abscesses
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Intraepithelial neutropils
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What are the diagnostic tests for H. pylori infection?
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Serologic test for antibodies for H. pylori
Fecal bacterial detection Urea breath test |
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What are the effects of achlorhydia?
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Hypergastrinemia
Hyperplasia of antral gastrin- producing G cells |
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What features are associated with autoimmune gastritis?
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Antibodies to parietal cells and intrinsic factor
reduced serum pepsinogen I concentration Antral endocrine cell hyperplasia Achlorhydria |
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How does the body attack the parietal cells in autoimmune gastritis?
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CD4+ T cells attack parietal cell components, like H+,K+,-ATPase
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What gastritis most commonly affects oxyntic mucosa?
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Autoimmune gastritis is characterized by diffuse mucosal damage of the oxyntic mucosa
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What gastritis is characterized gastric antral vascular ectasia?
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Gastric antral vascular ectasia AKA watermelon stomach is characterized by reactive gastropathy
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