Stomach and Duodenum MCQs

The likely answer is gastric erosions because the bleeding occurred after only one dose of Ibuprofen. There is no previous history of dyspepsia or upper GI bleeding. Nonsteroidal anti-inflammatory drugs ( NSAIDs ) such as aspirin, ibuprofen, and naproxen cause gastric erosions via - Can be direct irritants of gastric mucosa Prostaglandins have a protective role in maintaining mucosal integrity. NSAIDs inhibit prostaglandin production . Because of gravity, the irritants lie on the greater curvature of the stomach, and therefore, gastritis and ulcers are seen distally on or near the greater curvature of the stomach . Reference : Harrison's Principles of Internal Medicine, 21 st Ed, Ch: 48, Pg: 312

The main pharmacological therapy for GERD is inhibition of gastric acid suppression . Proton pump inhibitors such as omeprazole, lansoprazole and pantoprazole are more effective than H2 receptor blockers such as ranitidine, cimetidine or nizatidine. Healing in oesophagitis is better with a PPI. Bismuth is a mucosal protective agent used in the treatment of peptic ulcer disease. Magnesium hydroxide is an antacid. It is not as effective as PPI for GERD. Reference : Harrison's Principles of Internal Medicine 21 st ed, Ch: 323, Pg: 2429-2431

Treatment of gastric outlet obstruction: Treating the patient involves correcting the metabolic abnormalities and dealing with the mechanical obstruction. The patient should be rehydrated with intravenous isotonic saline with potassium supplementation. Replacing the sodium chloride and water allows the kidney to correct the acid-base abnormality. The metabolic abnormalities may be less if the obstruction is due to malignancy, as the acid-base disturbance is less pronounced.

With the above history , bilious vomiting suggest the obstruction may be form duodenum and beyond Barium meal follow through helps in delineating the small bowel hence is used for diagnosis Gastrograffin dye is used most of the time instead of barium

Common sites for peptic ulcers are the first part of the duodenum and the lesser curve of the stomach , but they also occur on the stoma following gastric surgery, the oesophagus and even in a Meckel's diverticulum , which contains ectopic gastric epithelium. In general, the ulcer occurs at a junction between different types of epithelia, the ulcer occurring in the epithelium least resistant to acid damage. Reference: Bailey & Love's short practice of surgery, chapter: 67, Edition: 28th, Pg: 1157

Pathology This is essentially similar to that of a duodenal ulcer, except that gastric ulcers tend to be larger. Fibrosis, when it occurs, may result in the now rarely seen hourglass contraction of the stomach. Large chronic ulcers may erode posteriorly into the pancreas and, on other occasions, into major vessels such as the splenic artery. Less commonly, they may erode into other organs such as the transverse colon. Chronic gastric ulcers are much more common on the lesser curve (especially at the incisura angularis; than on the greater curve and, even when high on the lesser curve, they tend to be at the boundary between the acid-secreting and the non-acid secreting epithelia. With atrophy of parietal cell mass, non-acid-secreting epithelium migrates up the lesser curvature. Reference: Bailey & Love's short practice of surgery, chapter: 67, Edition: 28th, Pg: 1158

There are patients who have small leaks from a perforated peptic ulcer and relatively mild peritoneal contamination, who may be managed with intravenous fluids, nasogastric suction and antibiotics. These patients are in the minority. A number of factors have been associated with poor outcome after perforated peptic ulcer, including: Delay in diagnosis (>24 hours); Medical comorbidities; Shock; Increasing age (>75). Reference: Bailey & Love's short practice of surgery, chapter: 67, Edition: 28th, Pg: 1164-1165

The most common site of the gastrointestinal TB is ileocecal location (ileocecal TB), followed by jejunum and colon. The esophagus, stomach and duodenum are rarely involved. Reference: www.ncbi.nlm.nih.gov/pmc/articles/PMC4209546