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Gastro > Diseases of the Stomach and Duodenum > Flashcards

Diseases of the Stomach and Duodenum Flashcards

1
Q

Describe the two types of hiatal hernias 1 and 2-4

A

1: Displacement of the gastroesophageal junction above the diaphragm. Fundus below

2-4: True hernia with a hernia sac. *Fundus through defect in the phrenoesophageal membrane

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2
Q

How does a Hiatal hernia present? How do we diagnose? What is the treatment?

A

Present: GERD symptoms

Diagnosis: Barium Swallow

Tx: Small –> Gerd mgmt
Large –> Surgical repair

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3
Q

Muscosal biopsy is necessary to differentiate what?

A

Gastritis and gastropathy

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4
Q

What are the most common etiologies of Erosive and hemorrhagic gastropathy?

A

*NSAID
*Alcohol
Physical stress
Portal hypertension

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5
Q

What are the general symptoms and signs of erosive and hemorrhagic gastropathy?

A

Anorexia, Epigastric pain, *could be asymptomatic

Can have Upper GI bleed.

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6
Q

Gastroprotective prostaglandings are derived from what? What are the functions of Gastric prostaglandins?

A

COX-1

  1. Release more bicarb and mucus ( dec perm and dec acid back-diffusion)
  2. Vasodilators (increase res to injury)
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7
Q

Describe S/Sx of NSAID gastropathy, Tx, and further evaluation

A

S/Sx - mainly Dyspepsia

Tx - discontinue NSAID or reduce to lowest dose. Switch to COX 2.

  • If NSAID must be continued, take with milk of food and **Add daily PPI

If stuff doesnt resolve or + alarm signs, Upper endoscopy

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8
Q

Ethanol has direct toxic effect on gastric mucosa. Also, it impairs ______ leading to ______ gastric emptying.

A

Gastric motility

delayed

**Leads to prolonged contact w/ gastric mucosa –> injury

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9
Q

How does Alcoholic Gastropathy present? How do we treat?

A

S/Sx: Dyspepsia, nausea, vomit, minor hematemesis

Tx= no alcohol. H2 or PPI for 2-4 weeks.

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10
Q

Stress gastropathy is often seen in ________ patients. Highest risk of signifigant bleeding is associated with what 2 conditions?

A

Critically ill

Coagulopathy, Resp failure w/ mech vent

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11
Q

Critically ill patients should prophylactically recieve what medication for stress gastropathy? How do you treat an active bleed?

A

IV PPI

IV PPI

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12
Q

Portal hypertensive gastropathy leads to congestion which increases gastric blood flow pathalogically. How do we tx this?

A

Beta blocker for portal hyper

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13
Q

H. Pylori is the most common cause of what?

A

Peptic ulcer disease

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14
Q

Who gets tested for H Pylori (generally)

A

Dyspeptic pts
Chronic GERD patients
PUD patients

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15
Q

Pts should discontinue what for how long prior to H pylori testing?

A

Anti-secretory therapy x 2 weeks

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16
Q

Look at “Other types of gastritis”

Pernicious, infectious, eosinophil, menetrier

A

Pernicious - b12
Infectious - infectious usually immunocomp
Eosinophil - rare, post eat vomit
Menetrier - ideopathic hypertrophic

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17
Q

Define peptic ulcer disease. Where is it most common? What age groups alter this?

A

A break in the gastric or duodenal mucosa due to impaired mucosal defense mechanisms.

5x more common in the **Duodenum

Young = duodenum
55+ = gastric
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18
Q

What are the 2 main etiologies of peptic ulcers? List the “others”

A

**NSAID and H pylori (#1)

Hypersecretion
CMV
Chronic diseases
Crohns
Lymphoma
19
Q

Up to ______% of peptic ulcers are asymptomatic. This means patients usually present with what complications/S/Sx?

A

70%

Bleeding or perforation

20
Q

What are the S/Sx of PUD?

A

Dyspepsia (#1) *gnawing, aching, hunger. Cyclic (immed after eating w/ gastric. 2-4 hours w/ duodenal)

May complain of nocturnal pain (mainly duodenal)

Often report relief w/ food or antacids*

21
Q

Gastric ulcer =_______ pain with eating

Duodenal ulcer = ______ pain with eating

A

Increase

Decrease

22
Q

Any Alarm signs with PUD warrant what?

A

Immediate endoscopy and referral

23
Q

How do we work up a PUD patient?

A

EGD
Labs - CBC (anemia) FOBT
H pylori biopsy if PUD found on endoscopy

24
Q

How do we treat peptic ulcers?

A

NSAID related - stop, titrate or swtich to COX2

H Pylori - Triple or quad x 14 days

General - PPI (antisecretory), Mucosal defense w/ Sucralfate (protective coating) or Misoprostol (NSAID prophylaxis)

25
Q

Peptic ulcers have a high incidence of _______. But this carries a low mortality

A

Bleeding.

26
Q

PUD can cause ulcer perforation. What can this result in, what are the S/Sx?

A

Chemical peritonits due to spilling of gastric contents.

Sudden, severe ABD pain
Rigid abd, reduced bowel sounds
Pneumoperitoneum (air under diaphragm)

27
Q

Up to 40% of _______ seal spontaneously. How do we treat the other ones?

A

Ulcer perforations (adhered omentum)

Tx

Admit for fluid, ng suction, IV PPI, ABX

Surgical repair if –> free air or peritonitis
Pt deterioration

Look @ CT

28
Q

How is an Ulcer Penetration different from a perforation?

A

Penetration goes through bowel wall but has **no leakage into peritoneal cavity.

Pens to pancreas, liver and biliary tree

29
Q

What will a patient tell you they feel like with a ulcer penetration?

A

Change in typical PUD symptoms.
Change in frequency of dyspepsia (more… rad to the back)
No relief w/ food or antacid

Look @ CT

30
Q

Gastric Outlet Obstruction is a complication of _________. Describe it including s/sx and Tx

A

PUD

Chronic edema of pylorus of duodenal bulb

S/Sx
Early satiety, Postprandial vom(undigested), weight loss

Tx

IV -> liquid -> PO PPI**
Endoscopic dilation of gastric outlet

31
Q

What Zollinger-Ellison Syndrome

A

Gastrin secreting neuroendocrine tumor

32
Q

Where is the gastrinoma triangle?

A

Porta hepatis, Pancreatic neck, 3rd portion dudenum

33
Q

What are common gastrinoma locations? what patients are they common in?

A

Pancreas
Duodenal Wall
Lymph nodes

MEN-1

34
Q

90% of ZES patients develop what?

How do we screen patients for ZES?

A

PUD

Fasting Gastrin levels

  1. Ulcers/PUD w/ fam Hx MEN1
  2. PUD w/ no NSAID or H Pylori
35
Q

If we find gastrinoma/ZES what do we do?

A

Refer to GI

36
Q

What is Gastroparesis? What two things is it generally linked with?

A

Delayed gastric emptying w/ no Mech obstruction **

Most common = Idiopathic
Linked w/ DM 15%**
Otherwise could be injury to vagus

37
Q

What are cardinal symptoms of Gastroparesis? How do we actually detect this? What do we do?

A

NV, Early satiety, bloating, weight loss

Pt hx. Rule out mechanical obstruction via CT or EGD. **

Refer for GI/EGD**

38
Q

How is gastroparesis managed?

A

Acute bad = NG decompress and IV fluid/electro

General = small meals, low fat food, no soda/alcohol.

Optimize glycemic control in diabetics**

Prokinetic meds -
Metoclopramide **
Domperidone
Erythromycin

39
Q

Gastric Adenocarcinoma is one of the most _______ cancers worldwide. Its highest rates are in _______, ________, and __________

A

common

Eastern asia, europe, S. America

** Men&raquo_space; women

40
Q

Symptoms of Gastric Adenocarcinoma include:

A 
Dyspepsia
Epigastric pain
Anorexia
Early Satiety
Weight loss
Dysphagia

**General, vague symptoms = increased mortality due to late presentation.

41
Q

What are the typical physical exam signs of Gastric adenocarcinoma

A

Usually nothing

Sometimes Virchow node or Sister Mary Joseph Nodule **

42
Q

What would diagnostic studies show in gastric adenocarcinoma?

A

CBC = Anemia
LFT = elevated
Endoscopy confirms

CT PET can find mets once cancer is found.

43
Q

What is Gastric lymphoma? Where do primary tumors arise from? What is this associated with?

A

Secondary tumors from spread of non-hodgkin lymphoma.

MALT

Chronic H Pylori infection

Tx/workup same way as Gastric Adenocarcinoma*****

44
Q

What is carcinoid syndrome?

A

Carcinoid tumor (digestive tract/lungs) causing myriad symptoms.

Super flushed for 30 mins…. Might burn **
Venous telaniectasias
Diarrhea (non bloody)

Gastro (9 decks)

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