Peptic Ulcer Disease, Achalasia, and Scleroderma, Esophageal Disease Flashcards

1
Q

Patho of PUD

A

Two major factors can alter

H/pylori and NSAIDs

Most commonly between fundus and antrum and are associated with normal rates of acid secretion

Deuodenla are within 3 cm of pylorus and associated with inc acid secretion

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2
Q

H .pylori infection

A

Disrutps normal gastric acid secretion and stimulates a local immune response

Leads to release of gastrin and supp of somatostatin so more H+

Elaborates urease which damages epithelial cells and stimulates inflamm

Stimulates Th1 med response and inc IL8, IFNG, and TNF alpha…recurit leukocytes and neutrophils into mucosa

Has a catalase that neutralizies oxygen metabolites of neutrophils

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3
Q

NSAIDs and PUD

A

COX 1 is active normally

PGs - stimulate epithelial cells to secrete mucous, bicarb and phospholipids…local vasodilation…epithelial cell migration to surfaces

Maybe more for duodenal than gastric

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4
Q

Gastrinoma

A

Zollinger-Ellsion syndrome

Secretion of gastrin from duodenal or pancreatic gastrinoma

Stimulates gastric parietal cells to secrete mor gastric acid and ECL cells to release histamine which inc even more

High gastrin concentrations inhibit abs or sodium and water so chronic watery diarrhea

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5
Q

CM of PUD

A

Dyspepsia is most common sx

Epigastric pain 2-5 worse after eating

Improves with food intake or worsening

Complicated dz if pain radiating or tarry stools/coffee-ground emesis

Epigastric tenderness with both types

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6
Q

Comps of PUD

A

GI bleeding is most common

Perofration is 2nd most…duodenal is most likely…tend to occur along post wall near pancreas and lead to pancreatitis

Gastric outlet obstruction can also occur

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7
Q

PUD dx

A

Suspect in all pts with dyspepsia

SHould have endoscopy if any alarm sx are present

Tx with PPI and text for H.pylori

Upper endoscophy is most accurate diagnostic procedure…repeat after 12 weeks

Iron def anemia maybe?

If multiple ulcers in gastric or distal to duodenum, suggest gastrinoma…esp if resting gastrin levels high

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8
Q

Path of PUD

A

Punched out mucosal defects

Base is necrotic and smooth with formation of granulation tissue and fibrous scar

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9
Q

Mg of PUD

A

Erad of H pylori, withdrawl, and acid supp

Triple therapy is 1st line - amox, clarithro and PPI
Clarithro, metro PPI
Bismuth, metro, tetra and PPI

PPIs are more effective of healing than H2 receptor antagonists

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10
Q

Achalasia path

A

Inflammation and loss of ganglion cells in the myenteric plexus

Causes could be Chagas or Trypanosoma

Loss of NO inhibitory neurons with sparing of cholinergic

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11
Q

Achalaisa CM, dx, and mg

A

Sx progress slowly and primarily with dysphagia of liquids

Suspect in pts with dysphagia to both liquids and solids

Should deomnstrate aperistalsis of the distal 2/3 and incomplete relaxation

GE jxn with pirdbek appearance

Botulinum toxin injections….pneumatic dilation or myotomy

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12
Q

Scleroderma path

A

Microvascular injury and cytokine med inflammation

Lower 2/3 of esoph and sphincter

Incompetent LES leads to severe GE reflux with weak peristalsis leading to dec clearing of food and acid

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13
Q

CM, dx, and mg of scelorderma

A

Esoph reflux sx

Predominately solid dysphagia

Any pt with characteristic skin finding or raynaud phenomenon

Upper endoscopy is the test of choice and may show reflux

Manometry can be performed and would demonstrater weak or absent peristalsis with weak lower sphibcter

Dilated esophagus on barium swallow may help

No therapy so tx with PPI

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