Clinical Aspects of Stomach Diseases Flashcards
What is the general diagnostic workup employed with acute gastritis?
EGD - allows direct visualization of the mucosa for ulcers / erosions as well as direct biopsy
What is type A vs type B chronic gastritis?
A - autoimmune gastritis, achlorhydria / anemia (pernicious), antral sparing
B = Bacterial, Helicobacter pylori
How does the rapid urease test work?
Take a piece of biopsied antral material and place it on the indicator for 24 hours. If urease is present, the pH will be raised and the color indicator will change
-> very sensitize test for H. pylori
What two tests are considered the most reliable for the diagnosis of H. pylori?
- Urea breath test, with C13 or C14
2. Stool test - good sensitivity / specificity for picking up H. pylori antigen, and non-invasive
What separates triple therapy from quad therapy? Why is it used?
Bismuth (pepto-bismol) - Inhibits growth of the organism and may have beneficial mucosa effects
What two things can be detected in the serum in autoimmune chronic gastritis?
- Autoantibodies - could be anti-parietal or anti-IF
2. High serum gastrin levels - loss of negative feedback due to achlorhydria
What is the Schilling test? How will it read in autoimmune gastritis?
Tests for absorption of heavy B12
Abnormal part I - absorption of B12 taken orally
Normal part 2 - Will be normal excretion if you give IV
What type of peptic ulcer disease do NSAIDs cause? Which drug generates them less?
Cause more gastric ulcers than duodenal
Selective COX-2 inhibitors like celecoxib are less ulcerogenic
What is the pain pattern for gastric ulcer (GU) vs duodenal ulcer (DU) and how does this relate to presentation?
GU - made worse with food -> patient will have weight loss
DU - made better with food (protective secretin released with meals) -> patient will have weight gain
Both of these will be worse at night when they’re thinking about it
What are the “alarm” signs and symptoms for peptic ulcer disease?
Nausea / vomiting with coffee ground emesis
Melena - upper GI bleed
Anemia
Weight loss and anorexia
What test is done routinely in peptic ulcer disease? How do the alarm symptoms play into this?
EGD - need to biopsy to rule out cancer, also give urease test and histopathologic exam to show the cause.
Young patients with positive H. pylori serology and no “alarm” symptoms may be treated empirically
Older patients with “alarm” symptoms need biopsy to rule out gastric cancer
Do we routinely biopsy duodenal ulcers?
Actually no - far less likely to be malignant than gastric ulcer
What are the treatments for healing erosions / ulcers in acute gastritis / peptic ulcer disease?
PPI’s - mainstay of therapy, most effective
H2-receptor blockers - somewhat effective, better for maintenance therapy
Sucralfate - sticky resin that works in acidic conditions to bind the base of an ulcer, useless if conditions are not acidic
What are the surgical options for treating PUD? When are they done?
Vagotomy - sometimes with antrectomy
Subtotal gastrectomy - remove acid producing organ
Usually done when complications of PUD are arising, but you should rule out gastrinoma first
What are the complications of ulcers? How are they treated?
- Hemorrhage - cautery, local vasoconstriction, or hemoclips
- Perforation - surgical closing of hole
- Obstruction - Balloon dilation
Why does obstruction happen in PUD?
Ulcers cause so much edema and scarring that they block emptying of the stomach
What syndrome might Zollinger-Ellison be associated with, and where is it usually found?
Associated with MEN1
It is found in the gastrinoma triangle: usually in duodenom or pancreas.
- > one corner of triangle made by cystic duct
- > another corner made by middle of pancreas
- > last corner made by third part of duodenum
How does Zollinger-Ellison present?
Recurrent ulcers in duodenum / jejunum, with abdominal pain and diarrhea (from malabsorption because pancreatic enzymes don’t work at low pH)
What test for ZE is diagnostic?
Secretin stimulation test - IV secretin normally decreases serum gastrin levels. In patients with gastrinoma, gastrin remains elevated or even increases
Serum gastrin and acid secretion will also be elevated
What radiolabelled scan get detect ZE syndrome? What are the medical treatments of ZE syndrome then?
Radiolabeled octreotide scan -> these cells take up somatostatin due to many receptors
Medical treatments:
High dose PPis and Octreotide - somatostatin analog, in order to suppress tumor / acid activity
What are the surgical options for ZE syndrome?
Tumor resection if localized, may need local tumor ablations if metastasized
Selective vagatomy to decrease acid
Total gastrectomy if all other acid suppression attempts fail
What are the signs and symptoms of gastric cancer?
Weight loss, early satiety, pain, NVD, hematemesis, melena, edema
Palpable lymph nodes and epigastric mass may eb present
What diagnostic workup may be required for gastric carcinoma?
EGD and biopsy for tissue diagnosis
Full body CT for assessing resectability and distant metastases
