Diseases of the Stomach and Duodenum Flashcards
Common complaint with disorders of the stomach
Dyspepsia
inflammatory changes in the gastric mucosa
gastritis
Common causes for erosive and hemorrhagic gastritis conditions
stress, NSAIDs, and alcohol, portal hypertension
What are contributors for nonerosive, nonspecific gastritis?
H. pylori, pernicious anemia, eosinophilic gastritis
Symptoms include: anorexia, epigastric pain, N/V, and upper GI bleeding
erosive or hemorrhagic gastritis
What symptoms are associated with upper GI bleeding?
melena, coffee ground emesis, blood w/nasogastric suction
What is included in the work-up of an upper GI bleed?
CBC, serum Fe, upper endoscopy
How soon might stress gastritis occur in a critically ill patient?
within 72 hrs of admission
Treatment for GI bleeding secondary to stress induced gastritis
IV PPI bolus followed by continuous infusion
Sucralfate suspension given orally
What subtype of NSAIDs have a lower incidence of significant ulcer formation?
Cox-2 inhibitors
What should be ordered if a patient presents with dyspepsia and any of the following symptoms: severe pain, weight loss, vomiting, GI bleeding, anemia?
upper endoscopy-these are red flags
What is the treatment for a patient who presents with dyspepsia and no associated red flags?
discontinue NSAIDs, trial PPI 2-4wks. If no improvement, endoscopy referral
Due to excessive ETOH consumption. Symptoms include dyspepsia, nausea, emesis, minor hematemesis
Alcoholic Gastritis
Treatment for alcoholic gastrititis
H2 blockers or PPIs and sucralfate 2-4 weeks
Treatment for portal hypertensive gastropathy
propranolol or nadolol
Break in the gastric or duodenal mucosa >5mm in diameter and extend through muscularis mucosae. Can be caused by too much acid or pepsin
Peptic ulcer disease
Most common location for gastric ulcers
antrum
What is the difference between duodenal ulcers and gastric ulcers in terms of their age distribution at presentation?
duodenal ulcers more common btw 30-55yrs and gastric ulcers are more common btw 55-70 yrs
What are the two most common etiologies of peptic ulcers?
NSAIDs and chronic H.pylori infection
Clinical presentation includes: dyspepsia, periodic pain in epigastric region relieved w/food or antacids, sometimes nocturnal pain
peptic ulcers
Physial exam is often normal. Might be epigastric tenderness w/deep palpation. FOBT or FIT may be positive
peptic ulcers
Test of choice for the work-up of peptic ulcers
upper endoscopy
What type of imaging is needed if ulcer perforation is suspected?
abdominal CT
What are the primary pharmacological medications for peptic ulcer disease?
PPIs and H2 blockers
What are the second line agents to enhance mucosal defenses in peptic ulcer disease?
bismuth, misoprostol, and antacids
How soon are 90% of duodenal and gastric ulcers healed after PPI therapy has been initiated?
duodenal ulcers in 4 weeks.
gastric ulcers in 8 weeks.
How soon are 85-90% of duodenal ulcers and gastric ulcers healed after initiation of H2 blocker therapy?
duodenal ulcers at 6 weeks. gastric ulcers at 8 weeks
Drug that should be avoided with H2 blockers
Cimetidine
Causes 75-90% of duodenal ulcers. Associated with increased gastric acid secretion. fecal-oral spread. Increases risk of gastric cancer
h. pylori infection
Combination therapy for H.pylori eradiaction
2-3 antibiotics + PPI or bismuth (“Triple or Quadruple Therapy”)
Treatment after triple or quadruple therapy for ulcers
Small ulcer (<1 cm) no further treatment. Large or complicated ulcer continue PPI for up to 6 weeks
When should a patient be retested for H.pylori?
> 4 weeks post antibiotic therapy and > 2 weeks post discontinuation of PPI
Gastrin secreting gut neuroendocrine tumor. Causes hypergastrinemia from increase acid secretion
Zollinger-Ellison Syndrome (Gastrinoma)
Where are most tumors located in Zollinger-Ellison Syndrome (Gastrinoma)?
duodenal wall (45%)
Cinical presentation includes: dyspepsia, peptic ulcers, diarrhea/steatorrhea/weight loss if pancreas affected
Zollinger-Ellison Syndrome (Gastrinoma)
What is the best imaging study to find tumors associated with Zollinger-Ellison Syndrome (Gastrinoma)?
SPECT: Somatostatin receptor scintigraphy (SRS)
Delayed gastric emptying in the absence of a mechanical obstruction
gastroparesis
Common causes of gastroparesis
1-idiopathic (~50%), post-op, DM
Which type of DM patient is more likely to experience gastroparesis?
type 1
What are two viruses that may cause gastroparesis?
norwalk and rotavirus
Symptoms include: N/V, early satiety, bloating, upper abdominal pain
gastroparesis
What are the dietary modifications to help treat gastroparesis?
small meals 4-5x, low fat, avoid insoluble fiber/ETOH/carbonation/tobacco
Name the prokinetics used to treat gastroparesis
Metaclopramide and Macrolide antibiotics
Prokinetic that is used as a liquid formulation 15 min prior to eating. serious drug interactions that can lead to irreversible tardive dyskinesia. 12 week prescription with 2 week holiday
Metoclopramide
Prokinetic that induces gastric contraction and stimulates fundic contractility. Liquid formulation 40-250mg TID. Use no longer than 4 weeks
Erythromycin
First line antiemetic for persistant N/V caused by gastroparesis
Diphenhydramine 12.5mg po q 6-8 hrs
Surgical treatment for refractory cases of gastroparesis
Gastrostomy tube for decompression and jejunostomy for feeding
