Clinical-Stomach Disorders Flashcards
What is Portal hypertension gastropathy
Congestion of the capillaries and venules of the gastric mucosal and submucosal layers
What can be given in the case of portal hypertensive gastropathy to reduce recurrent bleeding
Propranolol or nadolol
What is the most common clinical manifestation of erosive gastritis
Upper GI bleeding, resulting in hematemesis, “coffee ground” emesis, or bloody aspirate during nasogastric suction
*Usually not hemodynamically significant bleeding
During hemorrhagic gastritis, what is the method of diagnosis and what is the state of inflammation
Upper endoscopy, which will not show significant inflammation on histology
What is the location of Type A gastritis
Body predominant
In Type A gastritis, what are the autoimmune mechanisms associated with
- achlorhydria
- pernicious anemia
- gastric cancer risk
What antibodies are present in the majority of type A gastritis
Antibodies to parietal cells
What is the process of Achlorhydria
- Hypergastrinemia due to loss of regulation on G cells
- Hyperplasia of ECF cells (due to increased gastrin)
What can achlorydia lead to
Small multi centric carcinoid tumors
What population is more common for pernicious anemia gastritis
Females
What are the effects of pernicious anemia gastritis
- Megablastic anemia (due to decrease IF secretion and B12 absorption)
- Autoimmune destruction of gastric fundic mucosa
- Increased risk for gastric adenocarcinoma
What is the cause of Type A gastritis
Rare autoimmune disorder involving the fundic glands
What is the location and cause of type B gastritis
Antral dominated infection with H. Pylori
H pylori is associated with an increased risk of which condition
Gastric cancer
What is the characteristic morphology associated with Menetrier disease
Giant thickened gastric folds in the body of the stomach
What are the symptoms of Menetrier disease
-Chronic protein loss, leading to anasarca (general swelling throughout the body)
Where does peptic ulcer disease most commonly occur
Duodenal bulb and stomach
What are the typical descriptions given by the patient for peptic ulcer disease
- gnawing
- dull
- aching
- “hunger like”
What are the signs of peptic ulcer bleeding
“Coffee grounds” emesis
- hematemesis
- melena
- hematochezia
What is the rule of thumb for exclusion of nasogastric lavage fluid without blood with regards to active bleeding of a duodenal ulcer
Does not rule it out
What is the prevalence of H pylori in duodenal bleeds, and what is the cause
70-90% and due to increased gastric acid secretion
What is the prevalence of H. Pylori in gastric ulcers and what is the cause
Infection of the gastric body decreased acid secretion
What are the factors that can cause ulcers and are not H pylor related
NSAIDs, corticosteroids, anticoagulants, smoking
What are the tests that can be preformed to test for H. Pylori
Urea breath test
Fecal antigen test
What is the protocol for being able to test for H. Pylori without a false negative
Stop the PPI for 14 days, as well as 4 weeks after completing antibiotic treatment
What is the stain used to see H pylori
Warthin-Starry silver stain
What is the complication with an ulcer in the posterior wall of the duodenum or stomach
Perforation into the pancreas, liver, or biliary tree
What is the treatment for an active GI bleed due to ulcer
-Continuous infusion with PPI via IV starting with a bolus
What are some complication of surgery for peptic ulcer disease
- Obstruction
- Bile reflex gastritis
- Bezoar (GI mass)
- anemia
- malabsorption
- osteomalacia
How does H pylori cause a duodenal ulcer
-Causes the hyper secretion of gastric acid, which stimulated the antral G cells and increased activity of parietal cells
How does H pylori cause a gastric ulcer
In the lesser curvature of the antrum, but infects the cells celled, causing a decrease in the protective mechanisms
What is the clinical feature with regards to timing in duodenal ulcers
Gets better with food
What is the clinical feature with regards to timing in a gastric ulcer
Gets worse with food
What is the process of treatment for gastric ulcers
Eradication of H. Pylori
Followed up with EGD to rule out malignancy
What are the histological findings in gastric adenoma
Signet ring cells
Linitis plastica
What are the physical exam findings that are consistent with gastric adenocarcinomas
Virchow sentinel node (left supraclavicular node)
Krukenberg tumor
What are the clinical findings that may lead to the diagnosis of Zollinger-Ellison (ZE syndrome)
Ulcer disease is:
- Severe
- Refractory to therapy
- diarrhea, yet NGT section stops it
What is the common location of a gastrinoma
Aka ZE tumor
- Duodenum (45%)
- Pancreas (Pancreatic)
Which condition is Zollinger Ellison associated with
MEN-1
What are the conditions commonly seen in MEN1
Gastrinoma, hyperPTH (and calcium), pituitary neoplasms
What finding on endoscopy would suggest diagnosis of Zollinger Ellison
Large mucosal folds
Which diagnosis can be made with a positive secretin test
Zollinger ellison, because it is the only gastrinoma that will respond
What is the level of gastrin that must present for the diagnosis of Zollinger-ellison
> 1000 ng/L
What are the levels in the blood that are checked for Zollinger ellison syndrome
- Serum PTH
- Prolactin
- LH-FSH
- GH
In patients with MEN1, what is the usual prognosis of Zollinger Ellison
Not good, as they are usually multifocal and unresectable
What is the endocrine cause of gastroparesis
Diabetes mellitus
What are the 3 general conditions that can cause gastroparesis
Endocrine
Neurological
Postsurgical
What is the ideal method for assessing gastric emptying
Gastric scinigrapy with a low fat solid meal
What is the condition of gastric paresis
Chronic condition of intermittent, waxing and waning symptoms and signs of gastric obstruction in the absence of mechanical lesions
What is the treatment of gastroparesis
No specific therapy, but acute cases can be helped with NG suction and IV fluids
What is the recommended meal for those patients with gastroparesis
-Low in fiber, milk, gas forming, and fat
Which agents in gastroparesis should be avoided
-Opiods and others that reduce GI motility
In the treatment of gastroparesis with metocloparmide, what is the risk of tar dive dyskinesia
Less than 1% and defined as involuntary motions such as eye blinking and smacking of the lips
What is the characteristic of food or foreign body impaction
Inability to swallow liquids, including their own saliva
What is the condition of postvagotmy
Aka dumping syndrome
-rapid food passage into the small intestine, leading to distention as a result of the osmotic flow into the lumen, resulting in reactive hypoglycemia
