3 STOMACH AND DUODENUM Flashcards
What is Pyloric Stenosis?
A narrowing (stenosis) of the pylorus due to hypertrophy of the sphincter muscle, or scarring of the tissue surrounding the opening from the stomach to duodenum
What are the etiologies of Pyloric Stenosis?
Congenital and Acquired
What is Congenital Pyloric Stenosis?
Hypertrophic pyloric stenosis
What is the gender/prevalence in Hypertrophic Pyloric Stenosis (Congenital)?
Male:Female = 4:1 - Prevalence 2-4 per 1,000 newborns
What happens with Acquired Pyloric Stenosis?
Scarring of stomach peptic ulcer or duodenal bulb
What is the etiology of acquired Pyloric Stenosis?
Tumors (stomach, Pancreatic, etc.)
What are the signs and symptoms of Pyloric Stenosis?
- Severe worsening vomiting - Weight loss - Dehydration - Constant Hunger - Visible or palpable peristaltic waves
In Hypertrophic Pyloric stenosis (congenital), when do symptoms appear?
In the first 2-6 weeks of life
In Hypertrophic Pyloric stenosis (congenital), what are the symptoms to appear?
THere is progressive vomiting with partially digested food after each or few feedings
How would you diagnose Pyloric Stenosis?
Ultrasound (visualizes the thickened pylorus) Upper Endoscopy
What signs do you see from imaging a Pyloric Stenosis?
String sign or “Railroad track sign”
What blood test would you do for Pyloric Stenosis?
Hypochloremic, metabolic alkalosis with hypokalemia
What is treatment for Pyloric Stenosis ?
Surgery
What is Acute Gastritis?
Sudden Inflammation of the lining of the stomach
What are the common etiologies of Acute Gastritis?
- Foodpoisoning/food infection - Severe alcohol consumption - Heavy smoking - NSAIDs, especially Aspirin - Extreme stress (severe trauma, burns, surgery etc.)
What are the signs and symptoms of Acute Gastritis?
- Constant or sporadic pain in epigastric area (achy, burning, sharp, dull) - Nausea - Vomiting - Fever, chills - Belching, bloating
What are the forms of Acute Gastritis, and what is it based on?
* Based on degree of mucosal damage * 1. Erosive (mucosal damage) 2. Non erosive 3. Focal 4. Pan Gastritis (diffuse)
What is erosive Acute Gastritis?
- Superficial - Deep - Hemorrhagic
How do you diagnose Acute Gastritis?
- CBC - Upper Endoscopy - Stool sample for presence of blood - Pregnancy test
What is a recommendation by chiropractor for Acute Gastritis?
Avoid alcohol, caffeine, tobacco, hydrate, and check subluxation in neck and dorsal spine
What is Chronic Gastritis?
Chronic mucosal inflammatory changes in the stomach wall that eventually result in mucosal atrophy and mucosal (intestinal) metaplasia
What is the etiology of Chronic Gastritis?
- Helicobacter Pylori (90% !!) - Bile reflux
What does Helicobacter Pylori affect in the stomach?
The Antral Part of the stomach
What is an important predisposing factor for Intestinal type Adenocarcinoma (Stomach cancer) ?
Intestinal (mucosal) metaplasia
What are the less common etiologies of Chronic Gastritis ?
- NSAIDs - Autoimmune Diseases (autoimmune chronic gastritis, SLE) - Allergic Response
What do etiological factors do for Chronic Gastritis?
Cause multiple focal damages of stomach mucosa
What are the forms of Chronic Gastritis?
- Hypertrophic - Hyperplastic - Erosive - Antral - Atrophic
What are the signs and symptoms of Chronic Gastritis?
- Vague, not severe, non-specific, and do not push a patient to attend physician ** DEPENDS ON FORM
What are the signs and symptoms of Hypertrophic, Erosive, and Antral forms of chronic gastritis ?
- Acute pain in epigastrium and left upper abdominal area - This pain is local, without radiation - Usually this pain develops in 30-60 minutes after the meal
What are the common symptoms of Hypertrophic, erosive and Antral forms of Chronic Gastritis?
- Heartburn - Belching - COnstipation
What are the signs and symptoms of the Atrophic form of Chronic Gastritis ?
- Heaviness in epigastrium and left upper abdominal area - Fullness in the stomach after SMALL amount of meal - Diarrhea - Signs of megaloblastic/pernicious anemia
What can Atrophic form of chronic gastritis be ?
Asymptomatic
What do ALL forms have of chronic Gastritis?
- Cramping - Nausea, vomiting - Weakness - Intolerance of spicy food
How do you diagnose Chronic Gastritis?
- CLinical manifestations - Upper endoscopy with biopsy
What is a peptic ulcer defined as?
A breach in the mucosa of the alimentary tract that extends into the submucosa and deeper
Where do peptic ulcers develop?
Only in organs which have exposure to the stomach pepsin and stomach acidity - Stomach duodenum and esophagus
What % of peptic ulcers develop in duodenum, what about stomach?
80% Duodenum 20% Stomach
In Peptic Ulcer, there is a strong causal association with ______
Helicobacter Pylori infection
Where is Helicobacter Pylori found in?
100% of duodenal peptic ulcer And 70% of stomach peptic ulcer
What is a common Etiology of Peptic Ulcer?
Corticosteroid Hormones and Nonsteroidal antiinflammatory drugs (They suppress the production of PG’s which inhibit secretion of Gastrin)
What is the sequence of Gastrin?
Gastrin -> Parietal cells -> Increased production of HCl
What can Cigarette smoke lead to?
Peptic Ulcer (Leads to impairment of stomach mucosal blood flow, thus weakening the mucous barrier)
What is Zollinger-Ellison Syndrome an etiology of?
Peptic Ulcer
What is Zollinger Ellison Syndrome also known as?
Gastrinoma with overproduction of Gastrin
Can stressful lifestyle have an effect on the Stomach or Duodenum?
Yes! It can cause peptic ulcer
How can a stressful lifestyle cause a peptic ulcer?
Hyper production of Catecholamines leads to vasoconstriction of the stomach wall arteries. It affects stomach mucosal blood flow, thus weakens the mucous barrier
Is there a Genetic predisposition to Peptic Ulcer?
YES, but it’s more common in children
What are the risk factors for genetic predisposition for peptic ulcer?
- Type O blood (30% risk of duodenal ulcer) - Hypersecretion of hydrochloric acid, pepsinogen - Familial tendencies
What is the pathogenesis of Peptic Ulcer?
Aggressive forces -> Weaken the mucus barrier (defense forces) -> Peptic Ulcers
How does pain normally distribute with Peptic Ulcers?
It can be diffuse, achy, acute, dull, and is associated with mealtime
What are the 2 types of pain for peptic ulcers?
- Early (30 min - 1 hour after the meal) typical for stomach peptic ulcer - Late (1.5 - 2 hours after the meal) - typical for duodenal peptic ulcer
“Starving” pain (6-7 hours after the meal) is characteristic for ________ peptic ulcer?
Duodenal
Night pain (at 4-5 am) is characteristic for ______ Peptic Ulcer
Duodenal
What are the “Seasonal” characteristic of Peptic Ulcers?
Usually in spring or fall for BOTH stomach and duodenal peptic ulcer
What does pain distribution tell you about pain With peptic ulcer?
Lesser curvature or Pylorus and Duodenum
What kind of pain will you have with peptic ulcer in the lesser curvature?
Epigastric area, without radiation
What kind of pain do you see with Pylorus and Duodenum with peptic ulcers?
Epigastric area and RUQ
If there is pain in the area of cardia with a peptic ulcer, where will you feel this?
LUQ and retrosternal area
If there is pain with a peptic ulcer in the Postbulbar area, where will you feel pain?
Mid back on the level of T5-T7 around right scapula
What are the signs and symptoms of Peptic Ulcer
- Pain 2. Dyspepsia 3. Constipation 4. Emotional Instability
What may be the ONLY symptom with a peptic Ulcer?
Heartburn (30-80%)
What are the signs of peptic ulcer under Dyspepsia?
- Heartburn - Nausea - Vomiting - Belching
What will vomiting do in patients with peptic ulcers?
Relieve pain
What will belching feel like with Peptic Ulcers?
Sour Taste
What are the complications of Peptic Ulcer?
- Bleeding or Hemorrhage - Perforation - Penetration - Pyloric Stenosis - Malignancy of stomach ulcer - Stomach Deformity
What is bleeding or hemorrhage of peptic ulcer manifested by?
- Hematemesis (dark color vomiting) - Melena (tarry feces)
What can bleeding or hemorrhages of peptic ulcers cause ?
- Weakness - Orthostatic hypotension - Syncope - Thirst - Sweating ** POSSIBLE ANEMIA
What is Perforation associated with Peptic Ulcer?
When the stomach or duodenal wall is perforated, the stomach or duodenal content spreads into the peritoneal cavity, resulting in peritonitis
What are the signs and symptoms of Perforation Associated with Peptic ulcer?
*** Stabbing upper abdominal pain (10/10) - Pain by radiate to the right shoulder and back - chills and tachycardia - shallow breathing
What will you see on X ray with Peptic Ulcer?
Air under diaphragm clearly visible (suggestive of perforated, duodenal ulcer)
What is Penetration, associated with Peptic Ulcer?
Same as perforation, but because the involved wall is bound to an adjacent organ (liver, pancreas, greater omenum) the stomach content does not enter the peritoneal cavity.
What are “Penetration” signs and symptoms in Peptic Ulcer?
- Pain from upper abdomen radiates to the back *** - Night pain - Pain CANNOT be relieved by ANTACIDS**
What is Pyloric Stenosis in regard to peptic ulcer?
When a peptic ulcer develops close to the pylorus, it may become Stenosis due to development of fibrous tissue causing the pylorus to undergo shrinkage and deformity
When can a peptic ulcer become malignant?
This complication develops ONLY in the stomach (stomach ulcer) and usually when peptic ulcer locates on greater curvature**
How does the stomach deform with Peptic ulcer?
Peptic ulcer HEALING, with development of scar tissue, so called, “HOURGLASS STOMACH”
How do you diagnose Peptic Ulcer?
X ray with liquid barium (ulcer crater, aka hicha) - Upper endoscopy with biopsy tests for H pylori, rapid Urease test in the tissue sample - Ultra sound
What is the main infection associated with Peptic Ulcer?
H pylori CBC, Urine analysis, PCR, liver
What is a specific diagnosis method for Peptic Ulcer?
Fecal Occult blood test FOBT
Why is CT important for Peptic Ulcer diagnosis?
For assessing a patient with acute abdominal pain, and in some settings may be able to identify the site of bleeding or perforation prior to Endoscopy
What is the differential diagnosis for Peptic Ulcer?
- Acute or chronic gastritis - Esophagitis - Pancreatitis - Cholecystitis - Angina Pectoris/Heart attack
If heart attack is a differential diagnosis with Peptic Ulcer, what would cause this diagnosis?
Heart attack could be manifested by GI symptoms called Indigestion, which also known as upset stomach or dyspepsia
In the case of a heart attack, it is very important to remember that indigestion is _______
Unrelated to eating
What is indigestion with peptic ulcer characterized by?
- Severe pain or burning feeling in the upper abdomen - May be also accompanied by: nausea, vomiting, abdominal bloating, belching
Indigestion in heart attack (associated with Peptic Ulcer) could be accompanied by:
- Shortness of breath - Pain radiating to left Jaw, Left part of neck or left arm - Chest pain
Chest pain in heart attack (unstable angina):
- Lasts for more than a few minutes - Increases in intensity - Is not relieved by rest or by taking Nitroglycerin
What’s the treatment of Peptic Ulcer?
- Physical and emotional rest - Anti Helicobacter therapy - Antacids - Diet Modification
When can chiropractic help?
Chiropractic spinal manipulation may benefit some people with uncomplicated gastric or duodenal ulcer
