Answer:

Ménétrier’s disease differs from the other forms of chronic gastritis in that it is not associated with any significant degree of mucosal inflammation. The disease is seen usually in middle-aged adults. They often present with weight loss, diarrhea, and hypoproteinemic edema. Low acid secretion, loss of parietal cell mass, and protein-losing gastropathy are typical of this disease. The degree of symptomatology varies greatly between patients. Its most severe manifestation is severe wasting secondary to GI protein loss. The endoscopic appearance is that of large folds in the upper stomach, and maximal inflation does not bring about the disappearance of these thick fundal rugae. Diagnosis is by endoscopic biopsy. Loop biopsy from the top of a large fold is usually necessary to obtain adequate tissue for diagnosis. Full-thickness mucosal biopsies show the characteristic massive foveolar hyperplasia seen with this disease. Regular or jumbo forceps biopsies are not adequate for the diagnosis. Endoscopic ultrasound has greatly enhanced the ability of the clinician to differentiate between the various pathologic entities presenting with large or giant gastric folds. This technique defines five distinct layers of the gastric wall. Ménétrier’s disease typically produces thickening in the second layer only, corresponding to the mucosa, whereas carcinoma and lymphoma will also usually involve the third and fourth layers (i.e., the submucosa and muscularis propria). Lymphoma and simple rugal hyperplasia typically involve the second and third layers and can thus be differentiated from Ménétrier’s disease. The treatment of Ménétrier’s disease with H2-blockers, prostaglandins, and proton pump inhibitors has generally been unsatisfactory. High doses of anticholinergics have reduced albumin loss. Subtotal or total gastrectomies have been performed in patients with severe and intractable symptomatology.

Reference: Wolfsen HC, Carpenter HA, Talley NJ: Ménétrièr’s disease: A form of hypertrophic gastropathy or gastritis? Gastroenterology 104:1310-1319, 1993

Answer:

Granulomatous and eosinophilic gastritis probably do not exist as diseases isolated to the stomach. They are more often associated with other systemic diseases. Granulomatous gastritis, when it involves the stomach, is usually part of the spectrum of Crohn’s disease. Because the antrum is the portion of the stomach most often involved with this disease, the most common clinical presentation is gastric outlet obstruction. Endoscopically, the entire antrum feels firm, and the pylorus is small and rigid. Aphthous ulcers are often seen in the antrum, but the deep crevice-like ulcers seen elsewhere in the gastrointestinal tract are not normally noted in the stomach. Histologic confirmation is difficult to obtain; however, biopsies taken with jumbo forceps are sometimes diagnostic. Other diseases that can produce this picture are sarcoidosis, Wegener’s granulomatosis, and systemic granulomatosis. Eosinophilic gastritis is part of the overall syndrome of eosinophilic gastroenteritis. The most common areas of involvement, however, are the stomach and small bowel. The most common clinical presentation of this entity is antral ulceration, and the patient often presents with the typical symptoms of ulcer disease. Biopsies are diagnostic. No definite therapy is recommended, except treatment for the ulcers; however, there are empiric reports of success with corticosteroid therapy.

Reference: Cello JP: Eosinophilic gastroenteritis: A complex entity. Am J Med 67:1097-1104, 1979.

Answer:

Gastritis is best defined, in most cases, as inflammation of the gastric mucosa.
The symptoms of gastritis are also the symptoms of many other upper gastrointestinal (GI) problems. Patients may complain of epigastric burning, nausea, postprandial fullness, or “bloating,” as well as other nonspecific upper GI-type complaints. Unfortunately, these are also the symptoms of other upper GI disorders (e.g., gallbladder disease, gastric neoplasm, gastroesophageal reflux disease [GERD], gastroparesis). These diagnoses need to be excluded in patients with these symptoms before a diagnosis of symptomatic gastritis can be considered.

Reference: Wolfsen HC, Carpenter HA, Talley NJ: Ménétrièr’s disease: A form of hypertrophic gastropathy or gastritis? Gastroenterology 104:1310-1319, 1993.

Answer:

HELLP is an acronym for a syndrome of hemolysis, elevated liver function, and/or low platelets. HELLP syndrome is thought to be a subcategory of severe preeclampsia. Patients may or may not have other signs of preeclampsia. HELLP syndrome often has a rapidly accelerating downhill course. Most clinicians deliver infants expeditiously regardless of the gestational age.

Reference: Weinstein L: Preeclampsia/eclampsia with hemolysis, elevated liver enzymes, and thrombocytopenia. Obstet Gynecol 66:657, 1985. Medline Similar articles

Answer:

In the past there have been advocates for other agents, particularly phenytoin. However, a randomized controlled trial in women with eclampsia clearly favored MgSO4 over phenytoin for recurrent seizure prophylaxis.

Reference: Witlin AG, Sibai BM: Magnesium sulfate therapy in preeclampsia and eclampsia. Obstet Gynecol 92:883-889, 1998. Medline Similar articles Full article

Answer:

Mild elevations in blood pressure usually are not treated with antihypertensives. With more marked elevations (diastolic > 110 mmHg or a mean arterial pressure > 125 mmHg), medications with rapid onset, such as hydralazine and labetalol, are used intravenously. Generally such management is undertaken while also proceeding with delivery, due to the severity of the disease.
Diuretics are generally not used as a first-line treatment because preeclampsia is characterized by vasoconstriction and intravascular depletion, which are worsened by diuretics. As for other antihypertensive agents, work has shown that treatment of patients with mild-to-moderate hypertension (i.e., 90-110 mmHg diastolic pressure) does not decrease perinatal morbidity or mortality. Therefore, antihypertensive therapy is not usually used. Severe hypertension (> 110 mmHg diastolic pressure) is associated with severe preeclampsia. More than likely, delivery needs to be undertaken in this circumstance, and rapid-acting antihypertensive agents (i.e., intravenous hydralazine or labetalol) are used to control severe hypertension during labor.
In a patient with known chronic hypertension whose elevated blood pressure is believed to be due to underlying disease rather than preeclampsia, an increase in antihypertensive therapy may be appropriate

Reference:

1. American College of Obstetricians and Gynecologists: Diagnosis and Management of Preeclampsia and Eclampsia. ACOG Practice Bulletin No. 33. Obstet Gynecol 99:159-167, 2002.
2. National High Blood Pressure Education Program: Working Group Report on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 183:S1-S22, 2000.

Answer:

In the past there have been advocates for other agents, particularly phenytoin. However, a randomized controlled trial in women with eclampsia clearly favored MgSO4 over phenytoin for recurrent seizure prophylaxis.

Reference:

1. Witlin AG, Sibai BM: Magnesium sulfate therapy in preeclampsia and eclampsia. Obstet Gynecol 92:883-889, 1998. Medline Similar articles Full article
2. Lucas MJ, Leveno KJ, Cunningham FG: A comparison of magniesuium sulfate with phenytoin for the prevention of eclampsia. N Engl J Med 333:201, 1995. Medline Similar articles Full article