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1. Clin Med III > 1- PUD and Gastric CA > Flashcards

1- PUD and Gastric CA Flashcards

1
Q

Parietal cells produce what?

A

HCl, IF

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2
Q

Cheif cells secrete what?

A

Pepsinogen (converted to pepsin)

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3
Q

Mucous neck cells secrete what?

A

Thin, acidic mucous

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4
Q

Enteroendocrine cells secrete what?

A

Various hormones

G cells secrete gastrin

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5
Q

What do G cells secrete?

A

Gastrin

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6
Q

What are the 4 protective features of the stomach mucosa?

A
  1. Coated w/ bicarbonate-rich mucous
  2. Epithelial cells meet at tight junctions
  3. Stem cells (where gastric glands join gastric pits) replace damaged epithelial mucosal cells
  4. Production of prostaglandins (stimulate mucus & bicarb, ↑ blood flow → epithelial cell growth and inhibit acid secretion)
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7
Q

Pt presents with abd discomfort, bloating, belching and distention. What disease are you concerned about?

A

Dyspepsia

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8
Q

T or F: The cause of dyspepsia is unknown?

A

TRUE. Organic vs functional causes

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9
Q

35 y/o F pt presents with chronic sx of dyspepsia. She denies any weight loss, vomiting, hematemesis or rectal bleeding, or difficulty or pain with swallowing. PE is normal. Do you need to order an EGD?

A

No. EDG is only ordered if clinically significant weight loss, overt GI bleeding, 2+ alarm features, rapidly progressing red flags

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10
Q

The following are red flags for what medical condition? Unintentional weight loss, progressive dysphagia/odynophagia, unexplained iron deficiency anemia, persistent vomiting, palpable mass or lymphadenopathy, FHX of upper GI

A

Dyspepsia

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11
Q

It pt is ≥ 60 yrs old do you need to order an EGD if suspected dyspepsia?

A

Yes. Order EGD if 60+

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12
Q

If 60+ y/o pt presents with sx of dyspepsia but you can’t find any evidence of organic disease. How should you proceed?

A

Consider “functional dyspepsia & test for H. pylori

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13
Q

What is the tx for pt w/ dyspepsia that is H.pylori (+)

A

Treat/ eradicate

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14
Q

What is the tx for pt w/ dyspepsia that is H.pylori (-)

A

Treat w/ trial of PPI

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15
Q

If you tx pt w/ dyspepsia, but no resolution w/ medical therapy what should you consider?

A

EGD

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16
Q

What disease is characterized by a defect in gastric or duodenal mucosa that extends through the muscularis mucosa into the deeper layers of the wall?

A

PUD

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17
Q

If hostile factors in the stomach are > protective factors. What can result?

A

Ulcers formation

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18
Q

Does risk for PUD increase w/ age?

A

Yes

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19
Q

What PUD risk factor disrupts balance of mucosal aggressive & protective factors, ↑ risk for ulcer perforation?

A

Smoking

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20
Q

What PUD risk factor stimulates acid secretion, damages gastric mucosal barrier, ↑ risk of ulcer bleeding?

A

Alcohol

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21
Q

What PUD risk factor is due gene variations in proinflammatory cytokines & has increased risk if blood types O & A?

A

Genetic factors

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22
Q

What PUD risk factor generates toxin from food storage, possible protective effects from some foods?

A

Diet

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23
Q

What PUD risk factor increases gastric acid secretion and impairs endoscopic healing?

A

Psych factors (stress, depression)

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24
Q

What pathogen results in decreased gastric mucus and bicarb secretion?

A

H. pylori

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25
Q

What is the most common cause of PUD worldwide?

A

H. pylori

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26
Q

H. pylori predisposes pts to what?

A

Gastric CA

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27
Q

What are virulence factors of H. pylori? (4)

A

flagella, urease, adhesins, inflammation (G cells increase HCl)

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28
Q

How do NSAIDs contribute to PUD?

A

Inhibits COX → decreased PGE2 synthesis

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29
Q

Chronic NSAID abuse and concamitant use of what other medications is a RF for PUD?

A

Steroids, anticoagulants, aspirin SSRIs, alendronate

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30
Q

Pt presents with CC of upper abd pain/discomfort, hematemesis and fatigue. Further hx reveals 3 yr hx of dyspepsia sx w/ increasing episode of N/V and early satiety/ What disease are you concerned about?

A

Late stage PUD (other late stage sx inclue: melena and dyspnea)

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31
Q

The following are red flags for what medical condition? Bleeding, unexplained iron deficiency anemia, early satiety, unintentional weight loss, progressive dysphagia/odynophagia, acute onset of intense upper abd pain, persistent vomiting, FHX of upper GI

A

PUD

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32
Q

Gastric vs Duodenal Ulcers. Which will cause pain 30 min-1 hr postprandial?

A

Gastric

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33
Q

Gastric vs Duodenal Ulcers. Which will cause pain 2-3 hr postprandial?

A

Duodenal

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34
Q

Gastric vs Duodenal Ulcers. Which is more likely to cause vomiting/hematemesis & hemorrhage?

A

Gastric

35
Q

Gastric vs Duodenal Ulcers. Which is less likely to cause vomiting and hemorrhage that will manfest a melana if it occurs?

A

Duodenal

36
Q

Gastric vs Duodenal Ulcers. Which will cause weight loss?

A

Gastric

37
Q

Gastric vs Duodenal Ulcers. Which will cause weight gain?

A

Duodenal

38
Q

What is the succussion splash test? What does it indicate?

A

stethoscope over upper abd & rock pt back and forth at hips → retained gastric material > 3 hours after a meal → splash sound = indicates presence of a hollow viscus filled w/ fluid & gas

39
Q

What might the vitals for pt with PUD show?

A

Hypotension, tachycardia

40
Q

GI exam for pt with suspected PUD may show what?

A

Epigastric/RUQ TTP, + peritoneal signs

41
Q

Exam for pt w/ suspected PUD should include what?

A

Rectal exam. Possible melena (in rectal vault), hemoccult +, bright red blood per rectum

42
Q

What is the diagnostic test of choice for PUD?

A

EGC (upper GI = 2nd)

43
Q

Urea breath test, stool antigen test, serology and biopsy (during EDG) are used to dx what disease?

A

PUD

44
Q

What will Urea breath test & Stool antigen test show in pt w/ PUD? What must be discontinued prior to starting either test?

A

Identifies active H. pylori infection/ eradication D/c PPI use 1-2 wks prior

45
Q

What IG Ab are you looking for with H. pylori serology test? Is it recommend?

A

IgG. No recommended due to high false positive rate

46
Q

What is the tx in all pts w/ PUD?

A

D/C all exacerbating factors (NSAIDs, aspirin, EtOH/tobacco), consider long-term daily PPI

47
Q

Pt w/ PUD tests + for H. pylori. How do you tx?

A

treat w/ Clarithromycin Triple therapy or Bismuth quadruple therapy. Confirm eradication 4 weeks after tx completion

48
Q

Clarithromycin triple therapy consists of what?

A

14 days (PPI BID, Clarithro 500mg BID, Amoxicillin 1000mg BID)

49
Q

Bismuth quadruple therapy consists of what?

A

14 days (PPI, Bismuth subsalicylate, Metronidazole, Tetracycline)

50
Q

What is the most common complication of PUD?

A

Bleeding

51
Q

PT with hx of PUD presents with hematemesis, melena or hematochezia. What complication are you concerned about?

A

Bleeding

52
Q

What test id both diagnostic and therapeutic for bleeding peptic ulcer?

A

EGD

53
Q

What is the TX for bleeding PUD?

A

Stabilize w/ IV fluids, PRBCs, start IV PPI, perform, thermal coagulation, hemoclip placements, injection therapy

54
Q

What complication of PUD occurs when an ulcer extends through a bowel wall without free perforation/ leakage of luminal contents into peritoneal cavity?

A

Penetration

55
Q

Pt w/ hx of PUD presents with sever diffuse abd pain and on exam you note “board-like abd rigidity. What complication are you concered about?

A

Perforation

56
Q

What is the dx study to evaluate if ulcer has cause gastric perforation?

A

Upright CXR and 2 view abd XR. You will see free air under the diaphragm

57
Q

What test should NOT be performed if you suspect gastric perforation from PUD?

A

UGI w/ barium

58
Q

What is the tx for PUD w/ perforation? (3)

A

Stabilize (IV fluids, NG tube/ NG suction for gastric decompression, IV PPI), spectrum abx, surgery

59
Q

What organ is most commonly affected if penetration from PUD occurs?

A

Pancreas

60
Q

Why is dx of penetration from PUD difficult?

A

Sx/presentation vary based on involvement of other affected structures

61
Q

What tests can be used to DX penetration from PUD?

A

UGI, CT

62
Q

What is a rare complication of PUD that results from scarring/ fibrosis or inflammation/ edema in pyloric channel?

A

Gastric outlet obstruction

63
Q

Pt w/ hx of PUD presents with vomiting, epigstric pain, early statiety and weight loss. What complication should you be concerned about?

A

Gastric outlet obstruction

64
Q

How is gastric outlet obstruction dx?

A

Dilated stomach on imaging, + succussion splash

65
Q

What is the tx for gastric outlet obstruction?

A

Stabilize (IV fluids, NG tube, gastric decompression, IV PPI)

66
Q

If pt w/ gastric outlet obstruction fails medical tx what is the next step?

A

EGD w/ endoscopic balloon dilation or surgery

67
Q

What disease is due to hypersecrete gastrin → ↑HCl & stomach motility caused by duodenal or pancreatic gastrinomas ?

A

Zollinger-Ellison Syndrome (ZES)

68
Q

What % of ZES is associated w/ MEN1?

A

20%

69
Q

What % of ZES is sporadic?

A

80%

70
Q

Pt presents w/ recurrent PUD to the distal duodenal bulb, upper abd pain, and steatorrhea. What disease should you be concerned about?

A

Zollinger-Ellison Syndrome (ZES)

71
Q

What is diagnostic for ZES?

A

Fasting serum gastrin > 1000 pg/mL + gastric pH < 2

72
Q

If pt w/ suspected ZES is given secretin stimulation test, what is the expected effect on gastrin?

A

Levels w/ increase by > 200 pg/mL

73
Q

What imaging can be used to help dx ZES?

A

CT Abd. Used to localize tumor

74
Q

What is the tx for ZES?

A

PPIs and surgical resection if possible

75
Q

More commonly is gastric cancer asymptomic or symptomatic?

A

Asymptomatic

76
Q

Pt w/ hx of gastric ulcer presents w/ recent unintentional weight loss, persistent abd pain. On exam you note + succusion splash and palpable stomach mass. What disease are you concerned about?

A

Gastric CA

77
Q

What is first line for dx of gastric CA?

A

EDG (UGI = 2nd line)

78
Q

Most gastric CA are what?

A

adenocarcinomas

79
Q

On EGD you note subtle polypoid, protrusion, superficial plaque, mucosal discoloration, depression or ulcer. As a PA this is what until proven otherwise?

A

Gastric CA

80
Q

What staging system is used for gastric CA?

A

TNM

81
Q

Virchow’s node, Sister Mary Joseph’s node, and Irish node are all signs of what?

A

Sign of gastric CA w/ mets. Virchow’s node (L supraclavicular,) Sister Mary Joseph’s node (periumbilical), Irish node (L axillary)

82
Q

What is the tx for early gastric CA? (very rare)

A

Endoscopic mucosal resection

83
Q

What is the tx for advanced gastric CA?

A

Total or partial gastrectomy

84
Q

What is the tx for unresectable gastric CA?

A

Chemo vs chemoradiotherapy

1. Clin Med III (29 decks)

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