| Chapter 6 Workbook |
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LEARNER OBJECTIVES
At the completion of this chapter, the learner will be able to:
Section 2: Anatomy
2.1 Describe the anatomy of the stomach and duodenum, including:
2.2 Blood supply
2.3 Nerve supply
2.4 Structure of the stomach and duodenum
Section 3: Physiology
3.0 Discuss the three major functions of the stomach.
3.1 Describe the factors that determine gastric motility and emptying.
3.2 List the substances found in gastric juice.
3.2.1 Describe acid secretion.
3.2.2 Describe pepsinogen secretion.
3.2.3 Describe intrinsic factor secretion.
3.3 Discuss the physiology and functions of the gastric mucosal barrier.
3.4 Outline gastric endocrine secretion.
3.5 Define basal acid output, maximal acid output, and peak acid output.
Section 4: Pathophysiology of Peptic Ulcer Disease
4.1 Describe the pathophysiologic defects found in gastric ulcer disease.
4.2 Describe the pathophysiologic defects found in duodenal ulcer disease.
4.3 List the hereditary factors found in peptic ulcer disease.
4.4 Discuss the interplay between acid, pepsin, and other factors involved
in peptic ulcer disease.
4.5 Discuss the environmental factors, hereditary associations, and
pathophysiologic abnormalities associated with peptic ulcer disease.
4.6 Describe the pathogenesis of ulcer disease at the molecular level.
4.7 Discuss the mechanisms for diagnosing ulcer disease.
4.8 Discuss the instruments used in endoscopic examination.
4.9 List the medications used in the treatment of peptic ulcer disease.
4.10 Discuss the mechanisms and side effects of the following in the
treatment of peptic ulcer disease: tricyclic agents, omeprazole,
bismuth compounds, licorice extracts, prostaglandinss.
4.11 Outline the general recommendations for treatment of ulcer disease.
4.12 Discuss the problems associated with treating peptic ulcer disease.
4.13 Describe the Zollinger-Ellison (ZE) syndrome.
Section 5: Postgastrectomy Problems
5.0 Discuss the following complications of gastric surgery:
5.1 Esophageal symptoms
5.2 Delayed gastric emptying
5.3 Recurrent ulcers
5.4 Carcinoma
5.5 Afferent loop syndrome
5.6 Diarrhea
5.7 Weight loss and malabsorption
5.8 Anemia
5.9 Cholelithiasis
Section 6: Gastritis
6.1 Define acute gastritis.
6.2 Discuss chronic gastritis, including presenting characteristics, causes,
predisposition to gastric cancer, and diagnosis.
6.2.1 Discuss the causes of hypochlorhydria.
6.2.2 Define congenital pernicious anemia.
6.3 Define chronic superficial gastritis.
6.4 Define chronic atrophic gastritis.
6.5 Define giant mucosal rugal hypertrophy.
6.6 Define granulomatous gastritis.
6.7 Define eosinophilic gastritis.
6.8 Discuss bile gastritis.
6.9 Discuss intestinal metaplasia and Ménétrier's disease.
Section 7: Premalignant Conditions of the Stomach and Gastric Cancer
7.1 Describe the following premalignant gastric conditions:
7.1.1 Pernicious anemia
7.1.2 Atrophic gastritis
7.1.3 Gastric polyps
7.1.4 Previous gastric surgery
7.2 Discuss other conditions which may influence the development of
stomach and gastric cancer.
7.3 Discuss the different forms of gastric cancer, including predisposing
factors, presenting symptoms, diagnosis, and treatment.
Section 8: Other Gastric Diseases
8.1 Discuss acute gastric diseases, including obstructions, distention,
dilation, and gastric rupture.
8.2 Describe the following chronic gastric conditions:
8.2 Hypertrophic pyloric stenosis
8.2.1 Gastric diverticula
8.2.2 Pseudolymphoma
8.2.3 Gastric infections and infestations
8.2.3.1 Helicobacter pylori gastritis
8.2.3.1.1 Diagnosis of Helicobacter pylori
8.2.3.1.2 Helicobacter pylori associated with peptic ulcer disease
8.2.3.1.3 Nonulcer dyspepsia and Helicobacter pylori
LEARNER WORKBOOK
EXERCISE 1
1.1 Briefly describe the anatomy of the stomach and the duodenum.
EXERCISE 2
2.1 The main arterial blood supply to the stomach originates in the
_________________ axis.
2.2 List the major arteries and veins that carry blood to and from the
stomach.
2.3 The nerve supply to the stomach is both ______________ and
_________________.
2.4 Briefly describe the nerve supply to the stomach.
2.5 The glands of the stomach are of two main types: ____________ and
_____________.
2.6 Briefly discuss how the two types of glands differ.
EXERCISE 3
3.1 The stomach has three major functions: ___________, ___________
and ____________.
3.2 Briefly describe each function.
3.3 What are the factors that determine gastric motility and emptying?
3.4 What are the six most important substances found in gastric juice?
3.5 Acid secretion is activated by three separate pathways:
_______________,
_______________, and ________________.
3.6 What are the major chemical transmitter substances for gastric acid?
3.7 Briefly describe gastric secretion, including acid, pepsinogen, and
intrinsic factor.
3.8 Describe the physiology and functions of the gastric mucosal barrier.
3.9 List the major products of gastric endocrine secretion and describe their
actions.
3.10 Basal acid output refers to ________________________________.
Maximal acid output refers to ______________________________.
Peak acid output refers to__________________________________.
EXERCISE 4
4.1 Describe the pathophysiologic defects found in:
a. Gastric ulcer disease
b. Duodenal ulcer disease
4.2 List the hereditary factors found in the pathogenesis of peptic ulcer
disease.
4.3 Explain the following statement: Peptic ulcer disease is thought to occur
as a result of an interplay between acid and pepsin.
4.4 When considering the pathogenesis of any disease, environmental
factors, hereditary associations and pathophysiologic abnormalities must
be considered. Briefly discuss these concepts in relation to peptic ulcer
disease.
4.5 At a molecular level, the pathogenesis of ulcer disease reflects an
imbalance between increased aggressive factors and decreased protective
factors. Briefly discuss these factors.
4.6 Describe an ulcer as seen during an endoscopy.
4.7 Briefly discuss the actions of the medications used in the treatment of
peptic ulcer disease:
| Classification | Action |
a. Inhibit or neutralize acid
secretion | |
| b. Cytoprotective | |
4.8 Outline the practical approach to the management of patients with ulcer
disease.
4.9 A number of other agents are available to reduce acid secretion. What
are they? Briefly describe their action.
4.10 What therapeutic recommendations can be made for treatment of
ulcer disease?
4.11 Briefly discuss the problems associated with treating peptic ulcer
disease.
4.12 Describe the Zollinger-Ellison (ZE) syndrome, including the
differences between ZE and peptic ulcer disease.
EXERCISE 5
5.0 Briefly discuss the following complications of gastric surgery:
5.1 Esophageal symptoms
Answer (section 5.1, p163-165)
5.2 Delayed gastric emptying
Answer (section 5.2, p165)
5.3 Recurrent ulcers
Answer (section 5.3, p165)
5.4 Carcinoma
Answer (section 5.4, p165)
5.5 Afferent loop syndrome
Answer (section 5.5, p166)
5.6 Diarrhea
Answer (section 5.6, p167)
5.7 Weight loss and malabsorption
Answer (section 5.7, p167)
5.8 Anemia
Answer (section 5.8, p167)
5.9 Cholelithiasis
Answer (section 5.9, p167)
EXERCISE 6
6.1 What is acute gastritis?
6.2 What are the causes of hypochlorhydria?
6.3 List ten causes of thickened gastric folds.
EXERCISE 7
7.1 Describe the following premalignant gastric conditions:
7.1.1 Pernicious anemia
7.1.2 Atrophic gastritis
7.1.3 Gastric polyps
7.2 What other conditions may influence the development of
gastric cancer?
7.3 Briefly discuss the different forms of gastric cancer, including
predisposing factors, diagnosis, and treatment.
EXERCISE 8
8.1 Briefly describe the following chronic gastric conditions:
8.2 Hypertrophic pyloric stenosis
8.3 Gastric diverticula
8.4 Pseudolymphoma
8.5 What is Helicobacter pylori?
8.6 How is Helicobacter pylori diagnosed?
8.7 Describe the mechanism(s) by which Helicobacter pylori causes
damage.
8.8 What treatment regimens have been used to eradicate Helicobacter
pylori?
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