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27 Cards in this Set
- Front
- Back
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What is the action of secretin on normal gastric G cells?
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Normal G cells are inhibited by secretin, and therefore serum gastrin concentrations do not rise in patients given a secretin stimulation test who have other causes of hypergastrinemia
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What is the role of secretin testing in hypergastrinemia?
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For unknown reasons, secretin stimulates the release of gastrin by gastrinoma cells, so patients with these tumors have a dramatic rise in serum gastrin in response to a secretin infusion.
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What is the most common cause of hypergastrinemia?
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secondary hypergastrinemia due to achlorhydria- in patients with pernicious anemia or atrophic gastritis.
the serum gastrin level can easily exceed 1000 pg/mL in these circumstances |
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What is CagA + H. pylori?
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Cag A is a virulence factor that causes more intense tissue inflammation and induces cytokine production. It is associated with more ulcers and more cancers.
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When should gastrin levels be checked?
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1) multiple or refractory ulcers
2) ulcer location distal to the duodenum 3) diarrhea 4) personal or family history of multiple endocrine neoplasia type 1 |
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How does NSAID gastropathy occur?
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Decrease prostaglandins which subsequently decrease bicarbonate and mucus production.
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If the gastric pH is less than 5 and the gastrin is >1000?
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This is virtually diagnostic of a gastrinoma
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How does gastrin stimulate parietal cells?
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by histamine release from ECL cells.
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How many biopsies of the stomach for H. pylori?
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Antrum, angularis, body
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Does H. pylori cause increased acid secretion?
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Yes, particularly in patients with ulcers
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Why are ulcers called peptic ulcers?
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Because pepsin + acid is more ulcerogenic than acid alone. Presumably this is because pepsin produces amino acids that further stimulate gastrin secretion.
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When should Nissen fundoplication be offered?
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Patients who are responsive to, but intolerant of, acid suppressive therapy, antireflux surgery should be recommended as an alternative
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Who does fundoplication benefit the most?
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Regurgitation
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How do the European guidelines differ from the US guiedelines regarding H. pylori eradication?
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European guidelines recomend eradicating H. pylori infection in:
1) first-degree relatives of patients with gastric cancer 2) atrophic gastritis 3) unexplained iron deficiency anemia 4) chronic idiopathic thrombocytopenic purpura |
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What antibiotics is H. pylori commonly resistant to?
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Clarithromycin
Metronidazole |
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What is the does of Pepto-bismol (bismuth subsalycilate) for H. pylori?
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2 tablets QID (525 mg QID) or 2 grams per day
One can take much less bismuth salt, such as colloidal bismuth subcitrate pottassium |
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If a patient is on a PPI and a CLOtest is done, where should biopsies be obtained?
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In addition to antrum,angularis, and body, also the fundic mucosa
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Vomiting that occurs in the morning before breakfast suggests what disorder?
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Pregnancy
Uremia Alcohol ingestion Increased intracranial pressure (brainstem tumor) |
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When does the vomiting of gastroparesis or gastric outlet obstruction occur?
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Tends to be delayed, usually by more than 1 hour, after meal ingestion
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Abdominal pain preceding vomiting indicates what?
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Usually indicates an organic lesion, such as an obstruction
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Which antibiotic used in the regimens to eradicate H. pylori has the most bacterial resistance to treatment?
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Most studies have found that the order of resistance is metronidazole> clarithromycin> tetracycline> amoxicillin the latter two being quite low
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What is normal half-time of gastric emptyingz?
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In pre-menopausal women 92 minutes +/- 15 minutes. Men empty faster- mean 78 minutes.
Most use 110 minutes as upper limit of normal. |
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Gastric cancer risk is higher in patients with which type of intestinal metaplasia? |
Incomplete |
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Gastric cancer risk is higher in patients with incomplete-type IM, and what other 3 factors? |
1) Both antral and gastric body involvement 2) IM extension over 20% of the gastric mucosa. |
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Which incomplete gastric intestinal metaplasia patients should undergo surveillance at yearly intervals? |
1) Family history of gastric cancer-1st degree relative 2) Smokers 3) IM extension > 20% |
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Does H. pylori eradication reduce the risk of gastric cancer in IM patients? |
1) Yes- reduces gastric cancer by 35% 2) Reduces progression of intestinal metaplasia |
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What medications reduce H. Pylori organism density and urease activity? |
PPIs- hold 1-2 weeks Antibiotics- hold 4 weeks Bismuth- hold 4 weeks |
