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26 Cards in this Set

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What is the Alkaline Tide?
Parietal cells secreting HCl into the gastric lumen and bicarb into the gastric venous circulation, which goes to the gastric mucous cell
What hormones/NT stimulate parietal cells?
(3)
Holds Gastric Acid:

Histamine (H-2);

Anticholinergic (from vagus);

Gastrin
What hormone stimulates release of Gastrin? From what cells and where?
Gastrin-releasing peptide

(from G-cells in antrum of stomach)
What hormone inhibits Gastrin? From which cells?
Somatostatin

(from D-cells in the pancreas and GI mucosa)
What inhibits the Gastric Bicarb secretion (from the alkaline tide) from entering the mucous gel to line the stomach?
(4)
NSAIDs;

Alcohol;

Acetazolamide;

Alpha-blockers
What increases the thickness of the mucous gel of the stomach?

What decreases it?
(2)
Increases:
Prostaglandin E

Decreases (by inhibiting PGE):
NSAIDs;
Steroids
Dx:
A patient has large, multiple ulcers that are recurrent and distal in origin.

First test?
What are diagnostic levels?

if this Dx is still suspected and diagnostic levels of the first test are not reached, what is the next test?

what syndrome is it assoc with?
Zollinger-Ellison syndrome

First test:
Gastrin Level
(> 1,000pg/mL is diagnostic)

Next if not at Dx level:
Secretin Stimulation test
(Gastrin levels will still be high)

Assoc w/: MEN-1
Dx:
52-yo woman presents w/ 3 months of early satiety, weight loss, and vomiting
Gastric Outlet Obstruction
Definition:
Syndrome involving a gastrin-secreting tumor in or near the pancreas
Zollinger-Ellison Syndrome
Triad of Zollinger-Ellison syndrome
PUD;

Elevated Gastrin levels;

Gastric Acid hypersecretion
Dx:
Burning epigastric pain that is releived w/i 30 minutes of ingesting food; causes nighttime awakening, N/V, possible melena

What blood type is it associated with?
Duodenal Ulcer

(better after eating)

(blood type O)
If an ulcer is found on endoscopy, what is the test of choice to see if it is H.pylori?

After treatment of H.pylori w/ a PPI, what is the best test if the patient still has symptoms or to confirm eradication of the bug?
if ulcer is found:
Biopsy

No change after PPI:
Urease Breath test
What from H.pylori decreases the gastric mucosal defenses?
Urease
Dx Test for Zollinger-Ellison?
Secretin stimulation test

(if gastrin levels are still high after this inhibitor, then probable ZE)
Triple therapy for H. pylori
CAP:
Clarithromycin
Amoxicillin
Proton Pump inhibitor
If patient is bleeding from an ulcer, what is drug Tx after endoscopy?
(2 possible plus MOA)
Sucralfate
(enhances mucosal barrier)

or

Misoprostol
(prostaglandin analog)
45-yo Japanese male smoker presents w/ epigastric pain, exacerbated by eating, and weight loss
Gastric Ulcer
Dx:
burning epigastric pain that occurs within minutes after eating, anorexia, vomiting

What blood type is it associated with?
Gastric Ulcer

(worse after eating)

(blood type A)
Dx test for Gastric Ulcers
Endoscopy w/ Bx

(all confirmed GU are Bx due to risk of CA)
Type of PUD related to an increase in acid production?
Duodenal Ulcer
Type of PUD that can occur w/ achlorhydria?
Gastric Ulcer
Best Tx for Gastritis or any ulcer of unknown etiology
(3 together)
Combo:

1. Mucosal protector
(Bismuth, Sulcrafate, Misoprostol)

2. H-2 blocker or Proton pump inhibitor

3. Abx for H. pylori
(amoxicillin; clarithromycin)
Dx:
burning, gnawing epigastric pain usually worse w/ food and relieved w/ antacids
Gastritis
Etiology of Gastritis
(8)
GNASHING pain:
Gastric reflux (of bile or pancreatic secretions);
Nicotine;
Alcohol;
Stress;
H. pylori;
Ischemia;
NSAIDs;
Glucocorticoids (long-term use)
Difference b/t acute and chronic gastritis
Acute: Erosive

Chronic: Non-erosive
Difference b/t the causes of the (2) types of Chronic Gastritis

where is each located in stomach?
A = A's / B = Bug
Type A (Fundal):
Auto-Ab to parietal cells;
Anemia (pernicious);
Achlorhydria;

Type B:
Bug = H. pylori