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10 GE > 3 STOMACH AND DUODENUM > Flashcards

3 STOMACH AND DUODENUM Flashcards

1
Q

What is Pyloric Stenosis?

A

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

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2
Q

What are the etiologies of Pyloric Stenosis?

A

Congenital and Acquired

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3
Q

What is Congenital Pyloric Stenosis?

A

Hypertrophic pyloric stenosis

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4
Q

What is the gender/prevalence in Hypertrophic Pyloric Stenosis (Congenital)?

A

Male:Female = 4:1 - Prevalence 2-4 per 1,000 newborns

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5
Q

What happens with Acquired Pyloric Stenosis?

A

Scarring of stomach peptic ulcer or duodenal bulb

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6
Q

What is the etiology of acquired Pyloric Stenosis?

A

Tumors (stomach, Pancreatic, etc.)

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7
Q

What are the signs and symptoms of Pyloric Stenosis?

A
  • Severe worsening vomiting - Weight loss - Dehydration - Constant Hunger - Visible or palpable peristaltic waves
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8
Q

In Hypertrophic Pyloric stenosis (congenital), when do symptoms appear?

A

In the first 2-6 weeks of life

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9
Q

In Hypertrophic Pyloric stenosis (congenital), what are the symptoms to appear?

A

THere is progressive vomiting with partially digested food after each or few feedings

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10
Q

How would you diagnose Pyloric Stenosis?

A

Ultrasound (visualizes the thickened pylorus) Upper Endoscopy

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11
Q

What signs do you see from imaging a Pyloric Stenosis?

A

String sign or “Railroad track sign”

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12
Q

What blood test would you do for Pyloric Stenosis?

A

Hypochloremic, metabolic alkalosis with hypokalemia

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13
Q

What is treatment for Pyloric Stenosis ?

A

Surgery

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14
Q

What is Acute Gastritis?

A

Sudden Inflammation of the lining of the stomach

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15
Q

What are the common etiologies of Acute Gastritis?

A
  • Foodpoisoning/food infection - Severe alcohol consumption - Heavy smoking - NSAIDs, especially Aspirin - Extreme stress (severe trauma, burns, surgery etc.)
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16
Q

What are the signs and symptoms of Acute Gastritis?

A
  • Constant or sporadic pain in epigastric area (achy, burning, sharp, dull) - Nausea - Vomiting - Fever, chills - Belching, bloating
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17
Q

What are the forms of Acute Gastritis, and what is it based on?

A

* Based on degree of mucosal damage * 1. Erosive (mucosal damage) 2. Non erosive 3. Focal 4. Pan Gastritis (diffuse)

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18
Q

What is erosive Acute Gastritis?

A
  • Superficial - Deep - Hemorrhagic
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19
Q

How do you diagnose Acute Gastritis?

A
  • CBC - Upper Endoscopy - Stool sample for presence of blood - Pregnancy test
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20
Q

What is a recommendation by chiropractor for Acute Gastritis?

A

Avoid alcohol, caffeine, tobacco, hydrate, and check subluxation in neck and dorsal spine

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21
Q

What is Chronic Gastritis?

A

Chronic mucosal inflammatory changes in the stomach wall that eventually result in mucosal atrophy and mucosal (intestinal) metaplasia

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22
Q

What is the etiology of Chronic Gastritis?

A
  • Helicobacter Pylori (90% !!) - Bile reflux
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23
Q

What does Helicobacter Pylori affect in the stomach?

A

The Antral Part of the stomach

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24
Q

What is an important predisposing factor for Intestinal type Adenocarcinoma (Stomach cancer) ?

A

Intestinal (mucosal) metaplasia

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25
Q

What are the less common etiologies of Chronic Gastritis ?

A
  • NSAIDs - Autoimmune Diseases (autoimmune chronic gastritis, SLE) - Allergic Response
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26
Q

What do etiological factors do for Chronic Gastritis?

A

Cause multiple focal damages of stomach mucosa

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27
Q

What are the forms of Chronic Gastritis?

A
  • Hypertrophic - Hyperplastic - Erosive - Antral - Atrophic
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28
Q

What are the signs and symptoms of Chronic Gastritis?

A
  • Vague, not severe, non-specific, and do not push a patient to attend physician ** DEPENDS ON FORM
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29
Q

What are the signs and symptoms of Hypertrophic, Erosive, and Antral forms of chronic gastritis ?

A
  • 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
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30
Q

What are the common symptoms of Hypertrophic, erosive and Antral forms of Chronic Gastritis?

A
  • Heartburn - Belching - COnstipation
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31
Q

What are the signs and symptoms of the Atrophic form of Chronic Gastritis ?

A
  • Heaviness in epigastrium and left upper abdominal area - Fullness in the stomach after SMALL amount of meal - Diarrhea - Signs of megaloblastic/pernicious anemia
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32
Q

What can Atrophic form of chronic gastritis be ?

A

Asymptomatic

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33
Q

What do ALL forms have of chronic Gastritis?

A
  • Cramping - Nausea, vomiting - Weakness - Intolerance of spicy food
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34
Q

How do you diagnose Chronic Gastritis?

A
  • CLinical manifestations - Upper endoscopy with biopsy
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35
Q

What is a peptic ulcer defined as?

A

A breach in the mucosa of the alimentary tract that extends into the submucosa and deeper

36
Q

Where do peptic ulcers develop?

A

Only in organs which have exposure to the stomach pepsin and stomach acidity - Stomach duodenum and esophagus

37
Q

What % of peptic ulcers develop in duodenum, what about stomach?

A

80% Duodenum 20% Stomach

38
Q

In Peptic Ulcer, there is a strong causal association with ______

A

Helicobacter Pylori infection

39
Q

Where is Helicobacter Pylori found in?

A

100% of duodenal peptic ulcer And 70% of stomach peptic ulcer

40
Q

What is a common Etiology of Peptic Ulcer?

A

Corticosteroid Hormones and Nonsteroidal antiinflammatory drugs (They suppress the production of PG’s which inhibit secretion of Gastrin)

41
Q

What is the sequence of Gastrin?

A

Gastrin -> Parietal cells -> Increased production of HCl

42
Q

What can Cigarette smoke lead to?

A

Peptic Ulcer (Leads to impairment of stomach mucosal blood flow, thus weakening the mucous barrier)

43
Q

What is Zollinger-Ellison Syndrome an etiology of?

A

Peptic Ulcer

44
Q

What is Zollinger Ellison Syndrome also known as?

A

Gastrinoma with overproduction of Gastrin

45
Q

Can stressful lifestyle have an effect on the Stomach or Duodenum?

A

Yes! It can cause peptic ulcer

46
Q

How can a stressful lifestyle cause a peptic ulcer?

A

Hyper production of Catecholamines leads to vasoconstriction of the stomach wall arteries. It affects stomach mucosal blood flow, thus weakens the mucous barrier

47
Q

Is there a Genetic predisposition to Peptic Ulcer?

A

YES, but it’s more common in children

48
Q

What are the risk factors for genetic predisposition for peptic ulcer?

A
  • Type O blood (30% risk of duodenal ulcer) - Hypersecretion of hydrochloric acid, pepsinogen - Familial tendencies
49
Q

What is the pathogenesis of Peptic Ulcer?

A

Aggressive forces -> Weaken the mucus barrier (defense forces) -> Peptic Ulcers

50
Q

How does pain normally distribute with Peptic Ulcers?

A

It can be diffuse, achy, acute, dull, and is associated with mealtime

51
Q

What are the 2 types of pain for peptic ulcers?

A
  • 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
52
Q

“Starving” pain (6-7 hours after the meal) is characteristic for ________ peptic ulcer?

A

Duodenal

53
Q

Night pain (at 4-5 am) is characteristic for ______ Peptic Ulcer

A

Duodenal

54
Q

What are the “Seasonal” characteristic of Peptic Ulcers?

A

Usually in spring or fall for BOTH stomach and duodenal peptic ulcer

55
Q

What does pain distribution tell you about pain With peptic ulcer?

A

Lesser curvature or Pylorus and Duodenum

56
Q

What kind of pain will you have with peptic ulcer in the lesser curvature?

A

Epigastric area, without radiation

57
Q

What kind of pain do you see with Pylorus and Duodenum with peptic ulcers?

A

Epigastric area and RUQ

58
Q

If there is pain in the area of cardia with a peptic ulcer, where will you feel this?

A

LUQ and retrosternal area

59
Q

If there is pain with a peptic ulcer in the Postbulbar area, where will you feel pain?

A

Mid back on the level of T5-T7 around right scapula

60
Q

What are the signs and symptoms of Peptic Ulcer

A
  1. Pain 2. Dyspepsia 3. Constipation 4. Emotional Instability
61
Q

What may be the ONLY symptom with a peptic Ulcer?

A

Heartburn (30-80%)

62
Q

What are the signs of peptic ulcer under Dyspepsia?

A
  • Heartburn - Nausea - Vomiting - Belching
63
Q

What will vomiting do in patients with peptic ulcers?

A

Relieve pain

64
Q

What will belching feel like with Peptic Ulcers?

A

Sour Taste

65
Q

What are the complications of Peptic Ulcer?

A
  • Bleeding or Hemorrhage - Perforation - Penetration - Pyloric Stenosis - Malignancy of stomach ulcer - Stomach Deformity
66
Q

What is bleeding or hemorrhage of peptic ulcer manifested by?

A
  • Hematemesis (dark color vomiting) - Melena (tarry feces)
67
Q

What can bleeding or hemorrhages of peptic ulcers cause ?

A
  • Weakness - Orthostatic hypotension - Syncope - Thirst - Sweating ** POSSIBLE ANEMIA
68
Q

What is Perforation associated with Peptic Ulcer?

A

When the stomach or duodenal wall is perforated, the stomach or duodenal content spreads into the peritoneal cavity, resulting in peritonitis

69
Q

What are the signs and symptoms of Perforation Associated with Peptic ulcer?

A

*** Stabbing upper abdominal pain (10/10) - Pain by radiate to the right shoulder and back - chills and tachycardia - shallow breathing

70
Q

What will you see on X ray with Peptic Ulcer?

A

Air under diaphragm clearly visible (suggestive of perforated, duodenal ulcer)

71
Q

What is Penetration, associated with Peptic Ulcer?

A

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.

72
Q

What are “Penetration” signs and symptoms in Peptic Ulcer?

A
  • Pain from upper abdomen radiates to the back *** - Night pain - Pain CANNOT be relieved by ANTACIDS**
73
Q

What is Pyloric Stenosis in regard to peptic ulcer?

A

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

74
Q

When can a peptic ulcer become malignant?

A

This complication develops ONLY in the stomach (stomach ulcer) and usually when peptic ulcer locates on greater curvature**

75
Q

How does the stomach deform with Peptic ulcer?

A

Peptic ulcer HEALING, with development of scar tissue, so called, “HOURGLASS STOMACH”

76
Q

How do you diagnose Peptic Ulcer?

A

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

77
Q

What is the main infection associated with Peptic Ulcer?

A

H pylori CBC, Urine analysis, PCR, liver

78
Q

What is a specific diagnosis method for Peptic Ulcer?

A

Fecal Occult blood test FOBT

79
Q

Why is CT important for Peptic Ulcer diagnosis?

A

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

80
Q

What is the differential diagnosis for Peptic Ulcer?

A
  • Acute or chronic gastritis - Esophagitis - Pancreatitis - Cholecystitis - Angina Pectoris/Heart attack
81
Q

If heart attack is a differential diagnosis with Peptic Ulcer, what would cause this diagnosis?

A

Heart attack could be manifested by GI symptoms called Indigestion, which also known as upset stomach or dyspepsia

82
Q

In the case of a heart attack, it is very important to remember that indigestion is _______

A

Unrelated to eating

83
Q

What is indigestion with peptic ulcer characterized by?

A
  • Severe pain or burning feeling in the upper abdomen - May be also accompanied by: nausea, vomiting, abdominal bloating, belching
84
Q

Indigestion in heart attack (associated with Peptic Ulcer) could be accompanied by:

A
  • Shortness of breath - Pain radiating to left Jaw, Left part of neck or left arm - Chest pain
85
Q

Chest pain in heart attack (unstable angina):

A
  • Lasts for more than a few minutes - Increases in intensity - Is not relieved by rest or by taking Nitroglycerin
86
Q

What’s the treatment of Peptic Ulcer?

A
  • Physical and emotional rest - Anti Helicobacter therapy - Antacids - Diet Modification
87
Q

When can chiropractic help?

A

Chiropractic spinal manipulation may benefit some people with uncomplicated gastric or duodenal ulcer

10 GE (6 decks)

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