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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 ¼ÒÈ­¼º ±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