Gastritis & H. pylori, Peptic ulcer ´ëÀå°æ Á¤¸®
<Gastritis>
1. À§Á¡¸· À庮À» ¼Õ»ó½ÃŰ´Â ¹°Áú 4°¡Áö: ethanol, bile acid, salicylate, weak organic acids
2. type A gastritis(fundus & body)
- parietal cell Ab(+), IF¿¡ ´ëÇÑ Ab(+)
- pernicious anemia¸¦ µ¿¹ÝÇÏ´Â ¼ö°¡ ¸¹´Ù.
- gastrin levelÀº Áõ°¡µÇ¾î ÀÖ´Ù.
3. type B gastritis(antrum) - more common form of chronic gastritis
- parietal cell Ab, IF¿¡ ´ëÇÑ Ab¸ðµÎ À½¼ºÀÌ´Ù.
- ÀϺÎȯÀÚ¿¡¼ gastrin¿¡ ´ëÇÑ Ab(+)
- gastrin levelÀº Á¤»óÀ̸ç acid secretionÀº °¨¼Ò
4. parietal cell Ab ¾ç¼ºÀÎ °æ¿ì
i) pernicious anemia(90%)
ii) 60¼¼ ÀÌ»ó ³ëÀÎ(20%)
iii) thyroid disease(30%)
iv) hypoparathyroidism, Addson's disease, vitiligo(20%)
cf. hypoparathyroismÀº 15ÆÇ¿¡¼ ºüÁü
5. autoimmune chronic atrophic gastritisÀÇ ¿øÀο¡ °ü°èÇÏ´Â µÎ°¡Áö Ab?
i) anti-parietal cell Ab ii) anti-IF Ab
6. eosinophilic gastritis¿¡¼ food allergy´Â 20%¹Ì¸¸
alllergy & food sensitivity´Â ¾ø´Ù.
7. »ö¼Ò³»½Ã°æ
- Indigocarmine: ¿äö
<H. pylori>
8. H. pylori°¡ ±Ë¾çÀ» ÀÏÀ¸Å°´Âµ¥ °ü¿©ÇÏ´Â °ÍÀ¸·Î ¾Ë·ÁÁø ¼¼±ÕÀÇ À¯ÀüÀû ¼ÒÀÎ 3°¡Áö
i) cag A(cytotoxin-associated gene)
ii) vac A(gene associated with vacuolating cytotoxin)
iii) pic B
9.
- ±ÙÀ§ ½ÊÀÌÁöÀåÀÇ »ê¼ºÈ´Â °á±¹ H. pyloriÀÇ colonizationÀ» ÀÏÀ¸ÄÑ ½ÊÀÌÁöÀå ±Ë¾çÀ»
ÀÏÀ¸Å²´Ù.
- À§ÀüÁ¤ºÎ¿¡ H. pylori¼ö°¡ ¸¹À¸¸é ureaseÀÇ È°µ¿¼ºÀÌ Áõ°¡ÇϹǷΠ½ÊÀÌÁöÀå ±Ë¾ç ¹ßº´
°¡´É¼ºÀÌ Áõ°¡ÇÑ´Ù.
- H. pylori¿¡ ´ëÇÑ IgGÇ×ü°¡ ¸¹À»¼ö·Ï ½ÊÀÌÁöÀå ±Ë¾çÀ̳ª À§±Ë¾çÀÇ À§ÇèÀÌ Áõ°¡ÇÑ´Ù.
- 15¼¼ ¹Ì¸¸¿¡¼ ½ÊÀÌÁöÀå ±Ë¾çÀÌ ÀûÀº ÀÌÀ¯´Â H. pylori°¡ ÀÌ ½Ã±â ÀÌÈÄ¿¡ º¸Á¸µÇ´Â
º®¼¼Æ÷¿¡ °¨¿°µÇ¾î¾ß Çϱ⠶§¹®ÀÌ´Ù.
- ¼ºÀο¡¼ ÀÚ¿¬ÀûÀ¸·Î ¾ø¾îÁö´Â °æ¿ì´Â ¾ø´Ù.
10. H. pylori¿¡¼ À§¾ÏÀ» ÀÏÀ¸Å°´Â ±âÀü
i) ascorbic acid ºÐºñ°¨¼Ò
ii) carcinogenic N-nitroso compoundÀÇ Áõ°¡
iii) mucosal hyperproliferationÀ¯¹ß
iv) ȯ°æ, ½Ä»ç¿¡¼ ¿À´Â carcinogen¿¡ ´ëÇÑ ÀúÇ×¼ºÀ» ÀúÇÏ
11. H. pylori¿¡ ´ëÇÑ Ab levelÀÌ ¼Òȼº ±Ë¾çÀÇ ¹ß»ý À§Çèµµ¿Í »ó°ü°ü°è°¡ ÀÖ´Ù.
12. H. pylori´Â ´ë±âÁߺ¸´Ù CO2³óµµ°¡ ¾à°£ ³ôÀº »óÅ¿¡¼ ¹è¾çÇÏ¿©¾ß ÇÑ´Ù.
(O2¾Æ´Ô)
13. H. pylori¿Í °ü·ÃµÈ À§¿°ÀÇ Á¤µµ¸¦ ±â¼úÇϱâ À§ÇØ 1994³â Á¦¾ÈµÈ up to dated Sydney
system¿¡¼ Á¦½ÃÇÏ´Â grading variablesÀ» ±â¼úÇϽÿÀ.
: H. pylori density, PMN neutrophil activity, glandular atrophy, intestinal metaplasia
14. H2 blocker´Â 13C-UBT¿¡´Â ¿µÇâÀ» ÁÖÁö ¾Ê´Â´Ù.
±×·¯³ª 14C-UBT¿¡´Â ¿µÇâÀ» ³¢Ä£´Ù.
<Peptic ulcer disease>
15. parietal cell¿¡ Á¸ÀçÇÏ´Â ¼ö¿ëü Á¾·ù
À§»êºÐºñ ÃËÁø: Ach, gastrin, histamine
À§»êºÐºñ ¾ïÁ¦: PG, somatostatin
16. gastrinÀÌ À§»êºÐºñ¸¦ ÀÚ±ØÇÏ´Â ±âÀü
i) parietal cellÀ» Á÷Á¢ ÀÚ±Ø
ii) ECL cell·ÎºÎÅÍ histamine release ÀÚ±Ø
17. À§³»»êµµ°¡ 3.0ÀÌÇϰ¡ µÇ¸é gastrinºÐºñ°¡ ¾ïÁ¦µÇ´Âµ¥ ÀÌ·± ±âÀü¿¡ ÀÛ¿ëÇÏ´Â Áß¿äÇÑ
mediator? somatostatin
18. gastric ulcer°¡ aspirin, NSAID¿Í °ü·ÃÀÌ ÀÖÀ¸¸é µ¿¹ÝµÈ À§¿°Àº ¾ø´Ù.
½ÊÀÌÁöÀå±Ë¾çÀÇ È°µ¿¼ºÀº Áõ»óÈ£Àü, Ä¡À¯¿Í °ü°è°¡ ¾ø´Ù.
19. hypergastrinemiaÀÇ ¿øÀÎ
i) hypochlorhydria or achlorhydria c/s pernicious anemia
ii) retained gastric antrum
iii) antral G cell hyperplasia
iv) renal insufficiency
v) massive small bowel resection
vi) gastric outlet obstruction
vii) pheochromocytoma
20. peptic ulcer¿¡¼ serum gastrin levelÀ» ÃøÁ¤ÇØ¾ß ÇÏ´Â °æ¿ì
i) multiple ulcer or ulcer in unusual location
ii) ulcer resistant to therapy or with frequent recurrence
iii) ulcers requiring surgery
iv) extensive family history of PUD
v) postop ulcer recurrence
vi) severe esophagitis
vii) basal hyperchlorhydria
viii) unexplained diarrhea or steatorrhea
ix) hypercalcemia
x) family history of pancreatic islet, pituitary, or parathyroid tumor
xi) prominent gastric or duodenal folds
21. Èí¿¬Àº À§»êºÐºñ¸¦ Áõ°¡½ÃŰÁö ¾Ê´Â´Ù.
- pancreas bicarbonateºÐºñ¡é
- gastric emptying¡è
- H. pylori infection Á¶ÀåÀ» ÅëÇØ¼ peptic ulcer¸¦ ÀÏÀ¸Å²´Ù.
22. ½ÊÀÌÁöÀå ±Ë¾çÀÌ È£¹ßÇÏ´Â Áúȯ
* strong association: systemic mastocytosis, COPD, CRF, cirrhosis,
nephrolithiasis, ¥á1-AT deficiency
* possible association: hyperparathyroidism, coronary artery disease, PV, chronic
pancreatitis
23. GE jx¿¡ ÀÖ´Â gastric cancerÀÇ ¼ö¼úÀû Ä¡·á¹æ¹ý
resection & esophagogastrojejunostomy
24. peptic ulcer¼ö¼úÈÄ Àç¹ßÀ» ÀÏÀ¸Å°´Â ¾àÁ¦: NSAID, steroid, reserpine
25. A-loop syndromeÀÇ ¿øÀÎ
i) A-loopÀÌ incomplete drainageµÇ¾î ÃéÀå°ú ´ãµµ·ÎºÎÅÍÀÇ ºÐºñ¹°¿¡ ÀÇÇØ ÆØ¸¸µÈ´Ù.
ii) A-loop¿¡ stasis with bacterial overgrowth
* Ä¡·á: surgical correction of incomplete afferent loop obstruction
26. NSAID-induced mucosal injuryÀÇ À§ÇèÀÎÀÚ
³ëÀÎ, ¿©ÀÚ, °í¿ë·®, Àå±â»ç¿ë, steroid¿Í º´¿ë, severe intercurrent illness
* unproven: H. pylori, smoking, caffeine, alcohol
27. misoprostolÀÌ ºÎÀÛ¿ë: diarrhea, uterine contraction
28. ±ÙÀ§¼ÒÀå¿¡ ´Üµ¶¼º ±Ë¾çÀ» ÀÏÀ¸Å³¼ö ÀÖ´Â ¾àÁ¦ 2°¡Áö
slow-release potassium pills, NSAID
29. stress-related mucosal injuryÀÇ À§ÇèÀÎÀÚ
mechanical ventilation, coagulopathy, sepsis and multiorgan failure, burns.
CNS trauma