Diseases of the Stomach and Duodenum Flashcards
Describe the two types of hiatal hernias 1 and 2-4
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
How does a Hiatal hernia present? How do we diagnose? What is the treatment?
Present: GERD symptoms
Diagnosis: Barium Swallow
Tx: Small –> Gerd mgmt
Large –> Surgical repair
Muscosal biopsy is necessary to differentiate what?
Gastritis and gastropathy
What are the most common etiologies of Erosive and hemorrhagic gastropathy?
*NSAID
*Alcohol
Physical stress
Portal hypertension
What are the general symptoms and signs of erosive and hemorrhagic gastropathy?
Anorexia, Epigastric pain, *could be asymptomatic
Can have Upper GI bleed.
Gastroprotective prostaglandings are derived from what? What are the functions of Gastric prostaglandins?
COX-1
- Release more bicarb and mucus ( dec perm and dec acid back-diffusion)
- Vasodilators (increase res to injury)
Describe S/Sx of NSAID gastropathy, Tx, and further evaluation
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
Ethanol has direct toxic effect on gastric mucosa. Also, it impairs ______ leading to ______ gastric emptying.
Gastric motility
delayed
**Leads to prolonged contact w/ gastric mucosa –> injury
How does Alcoholic Gastropathy present? How do we treat?
S/Sx: Dyspepsia, nausea, vomit, minor hematemesis
Tx= no alcohol. H2 or PPI for 2-4 weeks.
Stress gastropathy is often seen in ________ patients. Highest risk of signifigant bleeding is associated with what 2 conditions?
Critically ill
Coagulopathy, Resp failure w/ mech vent
Critically ill patients should prophylactically recieve what medication for stress gastropathy? How do you treat an active bleed?
IV PPI
IV PPI
Portal hypertensive gastropathy leads to congestion which increases gastric blood flow pathalogically. How do we tx this?
Beta blocker for portal hyper
H. Pylori is the most common cause of what?
Peptic ulcer disease
Who gets tested for H Pylori (generally)
Dyspeptic pts
Chronic GERD patients
PUD patients
Pts should discontinue what for how long prior to H pylori testing?
Anti-secretory therapy x 2 weeks
Look at “Other types of gastritis”
Pernicious, infectious, eosinophil, menetrier
Pernicious - b12
Infectious - infectious usually immunocomp
Eosinophil - rare, post eat vomit
Menetrier - ideopathic hypertrophic
Define peptic ulcer disease. Where is it most common? What age groups alter this?
A break in the gastric or duodenal mucosa due to impaired mucosal defense mechanisms.
5x more common in the **Duodenum
Young = duodenum 55+ = gastric
What are the 2 main etiologies of peptic ulcers? List the “others”
**NSAID and H pylori (#1)
Hypersecretion CMV Chronic diseases Crohns Lymphoma
Up to ______% of peptic ulcers are asymptomatic. This means patients usually present with what complications/S/Sx?
70%
Bleeding or perforation
What are the S/Sx of PUD?
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*
Gastric ulcer =_______ pain with eating
Duodenal ulcer = ______ pain with eating
Increase
Decrease
Any Alarm signs with PUD warrant what?
Immediate endoscopy and referral
How do we work up a PUD patient?
EGD
Labs - CBC (anemia) FOBT
H pylori biopsy if PUD found on endoscopy
How do we treat peptic ulcers?
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)
Peptic ulcers have a high incidence of _______. But this carries a low mortality
Bleeding.
PUD can cause ulcer perforation. What can this result in, what are the S/Sx?
Chemical peritonits due to spilling of gastric contents.
Sudden, severe ABD pain
Rigid abd, reduced bowel sounds
Pneumoperitoneum (air under diaphragm)
Up to 40% of _______ seal spontaneously. How do we treat the other ones?
Ulcer perforations (adhered omentum)
Tx
Admit for fluid, ng suction, IV PPI, ABX
Surgical repair if –> free air or peritonitis
Pt deterioration
Look @ CT
How is an Ulcer Penetration different from a perforation?
Penetration goes through bowel wall but has **no leakage into peritoneal cavity.
Pens to pancreas, liver and biliary tree
What will a patient tell you they feel like with a ulcer penetration?
Change in typical PUD symptoms.
Change in frequency of dyspepsia (more… rad to the back)
No relief w/ food or antacid
Look @ CT
Gastric Outlet Obstruction is a complication of _________. Describe it including s/sx and Tx
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
What Zollinger-Ellison Syndrome
Gastrin secreting neuroendocrine tumor
Where is the gastrinoma triangle?
Porta hepatis, Pancreatic neck, 3rd portion dudenum
What are common gastrinoma locations? what patients are they common in?
Pancreas
Duodenal Wall
Lymph nodes
MEN-1
90% of ZES patients develop what?
How do we screen patients for ZES?
PUD
Fasting Gastrin levels
- Ulcers/PUD w/ fam Hx MEN1
- PUD w/ no NSAID or H Pylori
If we find gastrinoma/ZES what do we do?
Refer to GI
What is Gastroparesis? What two things is it generally linked with?
Delayed gastric emptying w/ no Mech obstruction **
Most common = Idiopathic
Linked w/ DM 15%**
Otherwise could be injury to vagus
What are cardinal symptoms of Gastroparesis? How do we actually detect this? What do we do?
NV, Early satiety, bloating, weight loss
Pt hx. Rule out mechanical obstruction via CT or EGD. **
Refer for GI/EGD**
How is gastroparesis managed?
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
Gastric Adenocarcinoma is one of the most _______ cancers worldwide. Its highest rates are in _______, ________, and __________
common
Eastern asia, europe, S. America
** Men»_space; women
Symptoms of Gastric Adenocarcinoma include:
Dyspepsia Epigastric pain Anorexia Early Satiety Weight loss Dysphagia
**General, vague symptoms = increased mortality due to late presentation.
What are the typical physical exam signs of Gastric adenocarcinoma
Usually nothing
Sometimes Virchow node or Sister Mary Joseph Nodule **
What would diagnostic studies show in gastric adenocarcinoma?
CBC = Anemia
LFT = elevated
Endoscopy confirms
CT PET can find mets once cancer is found.
What is Gastric lymphoma? Where do primary tumors arise from? What is this associated with?
Secondary tumors from spread of non-hodgkin lymphoma.
MALT
Chronic H Pylori infection
Tx/workup same way as Gastric Adenocarcinoma*****
What is carcinoid syndrome?
Carcinoid tumor (digestive tract/lungs) causing myriad symptoms.
Super flushed for 30 mins…. Might burn **
Venous telaniectasias
Diarrhea (non bloody)
