https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj en-us 2022-02-05 15:11:19 UTC 2022-02-07 12:07:43 UTC hello@padlet.com mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2030720601 2022-02-05 15:25:25 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2030720601 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2030720844 2022-02-05 15:25:44 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2030720844 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2030721771 2022-02-05 15:27:05 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2030721771 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2030722593 2022-02-05 15:28:08 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2030722593 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2030722733 Parietal cells (blue) results in secretion of acid through H+/K+ATPase. Histamine directly activates acid secretion through a cascade that includes a G-inhibitor, which inhibits the acid secretion cascade when bound to PGs. Acid secretion is further stimulated by Gastrin and Ach. 

There is direct vagus innervation, which explains why high levels of stress can stimulate acid secretion and promote ulcer formation as a result of stressful/traumatic event. ]]> 2022-02-05 15:28:20 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2030722733 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032420020

Why does the stomach have a thicker mucous layer than the duodenum? 

• Where are prostaglandins secreted and what do they stimulate?

]]> 2022-02-07 06:58:09 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032420020 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032420104

What are different causes of gastric and duodenal disorders?

• Effect of H. Pylori infection?
• Effect of NSAIDs?

]]> 2022-02-07 06:58:14 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032420104 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032420333

Complications of Ulcers?

• Bleeding
• Perforation, gastric outlet obstruction?

]]> 2022-02-07 06:58:29 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032420333 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032420970

Symptoms?

• Difference in duodenal and gastric ulcer when eating?

]]> 2022-02-07 06:59:04 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032420970 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032421840 2022-02-07 06:59:52 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032421840 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032421981 2022-02-07 06:59:58 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032421981 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032423115 Acid Secretion (figure a, phases of Acid Secretion):
- Direct (vagal stimulation)
- Indirect (outside stimulus, food, gastric distension)
- passage of food into duodenum stimulates hormonal release (inhibits acid secretion).

Stomach Anatomy and Function:
- stomach serves as a food reservoir
- facilitates chemical and mechanical digestion.

- The stomach has 3 muscle layers (see figures):
        - Outer longitudinal
        - Inner oblique 
        - Middle Cicular 

- Parietal cells secrete HCL and chief cells secrete pepsionen

- Antral mucosal cells release PGs that stimulate mucus and bicarbonate secretions --> vasodilate cells and are involved in inflammation (inhibit platelet activity, can facilitate uterine contraction, mucus)
        - NSAIDs block PGs by inhibiting COX enzymes, which facilitate fever, pain, and attract immune cells. 
        - In short: help inflammation (therefore NSAIDs block both the protective and inflammatory functions of PGs).  

- Stomach stretches in size when food is consumed. 

-Chief cells release gastrin --> stimulate acid production. 
- Mucosal parietal cells: protect epithelium from various outer and inner substances. ]]> 2022-02-07 07:00:56 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032423115 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032425095 - Epidemiology:
90% prevalence in developping countries.
20-50% in developped countries. Infection usually occurs during childhood (foecal-oral or oral-oral). Infection is often associated with Gastric carcinomas and gastric inflammation.

- Pathogenesis:
No fully understood. Bacterium very adapted to highly acidic environmnet. Induces damage to the gastric epithelium. H. pylori creates urease and employs it to survive in the gastric environment. Pathogenesis highly dependent in Genetic Predispositions of host.

H pylori synthesizes urease that produces ammonia which neutralizes pH and allows the bacterium to live viably in the acidic environment of stomach.


- Diagnosis (Invasive Vs. Non-invasive):

Non-invasive: serological tests (IgG), Urea breath test (ingestion of urea drink, and concentration is measured after breaths as well as [CO2], method is unreliable if PPIs or antibiotics have been used before the test), stool antigen test.

Ivasive: endoscopy, biopsy (presence of urea, ammonia, histology, culture --> antobiotic sensitivity).

- Treatment & Eradication Therapy

Usually combination of 2 antibiotics paired with a PPI. This is highly practical and efficient in eliminating the bacterium from the stomach environment. ]]> 2022-02-07 07:02:36 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032425095 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032426075 Breaks in superficial epithelium of stomach/duodenum (10% in adults) that can penetrate into mucosa. Increase in inflammatory cells. Peptic ulcers are more common in higher ages, and are highly variable according to region/geography.

- Epidemiology (**remaining edit)


- Clinical Features
Burning epigastric pain, patients experience weight loss, nausea, emesis. Can also result in posterior pain dependent on location of ulcer.

Patients under 55 y/o --> eradication therapy if (+) for H pylori w/o further investigations. Older patients may require more investigations to eliminate risk of cancer. 

Gastric ulcers are more painful when eating, but duodenal ulcers get better after a meal (not a good diagnostic tool, better to assume general ulcer and confirm it with with an endoscopy).

- Complications of Peptic Ulcers:

• Hemorrhage 
  • Bleeding due to ulcers eroding into blood vessels underneath (can become a problem when they portrude on a medium/large vein/artery). 
  • If the patient has a non-evident ulcer, it can result in development of chronic anaemia.
• Perforation 
  • Ulcers go through layers of disgestive tract and form a 'hole'. More common in gastric ulcers. 
• Gastric Outlet Obstruction 
  • Namely caused when an active ulcer has an acting oedema. When ulcer scars and results in fibrotic tissue, forming an obstruction of the gastric outlet. 
• Surgical Treatments
  • surgical only performed with severe complications that require invasive/acute treatment. 
  • More employed in the past. 
• The role of associated diseases (gastric adenocarcinoma & gastric B cell lymphoma) 
• NSAIDS, H. Pylori and ulcers 

]]> 2022-02-07 07:03:26 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032426075 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032427232 2022-02-07 07:04:26 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032427232 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032430431 4th most common cancer wordwide. Associated with Barret's oeasphagus, arises from previously modified cells. Strong link to H. pylori and has certain lifestyle and genetic risk factors.

Type 1: intestinal, well formed glandular structure. Polypoid or ulcerating lesions. Metaplasia.

Type 2: Diffuse. Undifferentiated tumour from rest of parenchyma, worse prognosis than type 1.

- Epidemiology & Pathogenesis (link to H. pylori)
High prevalence in japan due to high sodium in diet and 'smoky' foods.

- Screening


- Pathology 



- Clinical features and symptoms 
Half the cases asymptomatic. Anorexia, weight loss, anaemia, gastric pain (**remaining).

- Diagnosis 
Gastroscopy (and subsequent biopsy) and numerous imaging techniques. CT, transabdominal ultrasound, endoscopy, PET scan.

- Staging/Investigation 
Staging employed to categorize tumours and predict survival and prognosis.

- Treatment
Early, non-ulcerated lesions can be removed successfully. Surgery is most succesful form of treatment, and can be paired with chemoradiation. Palliative care common due to high mortality.

]]> 2022-02-07 07:06:59 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032430431 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032430618 GI Stromal tumours mesenchymal tumours associated with mutation in protooncogene KIT, increases expression of Tyrosine Kinase (**remaining edit). 

Usually asymptomatic. 


]]> 2022-02-07 07:07:10 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032430618 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032431295 PGL are 90% caused by H pylori. R

Results in epigastric pain and ulcers. Associated with muscosa of lymphatic tissues. ]]> 2022-02-07 07:07:43 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032431295 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032431472 GPs are usually found in 1% of endoscopies by chance, rarely symptomatic. 

Histological analysis through biopsy can suggest whether removal is necessary or not

Hyperplastic polyps (most common), adenomatous, cystic gland polyps, inflammatory polyps (eosinophil infiltrated). ]]> 2022-02-07 07:07:52 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032431472 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032434023 2022-02-07 07:09:48 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032434023 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032434751 Disease involves duodenum. 

Inflammation of mucosa of small bowel, characterized by autoimmune inflammation due to intolerance to gluten. ]]> 2022-02-07 07:10:23 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032434751 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032435328 (**remaining edit: summarize figure in short text). ]]> 2022-02-07 07:10:45 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032435328 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032435583 Either no symptoms or non-specific ones:
- fatigue
- diarrhoea 
- long-term induced osteoporosis (possible in young patients whose bone structure is of weak quality).

Toddlers can have failure to thrive due to destruction of villi. Despite intake of normal nutrition babies can display sign of malnutrition. ]]> 2022-02-07 07:10:58 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032435583 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032435742 Often misdiagnosed (patients diagnosed at late age). 

]]> 2022-02-07 07:11:04 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032435742 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032435876 Blood analysis (anaemia)
Serology (Igs)
(**remaining edits)
--> osteoporotic patients (vit D, B12, Calcium)

]]> 2022-02-07 07:11:10 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032435876 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032435988 Important to stop the intake of gluten to limit the inflammation of the intestinal lining. 
- Fe
- Vit D. 
- supplements that might provide non-diet absorbed nutrients. ]]> 2022-02-07 07:11:15 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032435988 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032436158 - Oesophageal cancer
- T-cell lymphoma
- Refractor Coeliac disease. 
- Additional complications if pateint unresponsive to gluten free diet. 
- Clusters of itchy rashes at joints (knees, elbows)

]]> 2022-02-07 07:11:23 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032436158 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032436899 2022-02-07 07:11:58 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032436899 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032438706

Physiological effects of PGs

• What is their relationship to NSAIDs? 

]]> 2022-02-07 07:13:29 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032438706 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032439622 2022-02-07 07:14:11 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032439622 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032439878 2022-02-07 07:14:24 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032439878 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032440109 2022-02-07 07:14:35 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032440109 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032440319 2022-02-07 07:14:45 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032440319 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032440503 2022-02-07 07:14:55 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032440503 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032440757 2022-02-07 07:15:09 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032440757 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032441257 2022-02-07 07:15:33 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032441257 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032441489 2022-02-07 07:15:46 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032441489 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032446083 2022-02-07 07:19:15 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032446083 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032446443 2022-02-07 07:19:29 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032446443 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032446695 2022-02-07 07:19:41 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032446695 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032447260 2022-02-07 07:20:07 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032447260 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032448236 2022-02-07 07:20:49 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032448236 mateoaclaude https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032448927 2022-02-07 07:21:16 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032448927 bnmargrate https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032522596 2022-02-07 08:10:15 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032522596 https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032522948 2022-02-07 08:10:30 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032522948 https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032547437 2022-02-07 08:26:54 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032547437 mmtzclaros1 https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032893086 2022-02-07 12:07:43 UTC https://padlet.com/mateoaclaude/wolrpmwn7o8ivyzj/wish/2032893086