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Clin Med: GI (block 3) > Disorders of the Stomach > Flashcards

Disorders of the Stomach Flashcards

1
Q

What is gastritis?

A

refers to irritation, injury, or inflammation of gastric mucosal lining

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2
Q

Types of gastritis

A
  • Erosive (leading to hemorrhagic)
  • H. Pylori
  • Pernicious anemia
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3
Q

Erosive/ Hemorrhagic Gastritis is caused by…

A
  • NSAIDS,
  • alcohol,
  • Stress: mechanical ventilation, coagulopathy, trauma, burns, shock, sepsis, CNS injury, liver failure, kidney dz, & multiorgan failure
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4
Q

Erosive/Hemorrhagic Gastritis S/S

A
  • Anorexia
  • Epigastric pain
  • N/V
  • Upper GI bleeding, which presents as hematemesis (coffee ground) or melena
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5
Q

Erosive/Hemorrhagic Gastritis PE

A

May have epigastric tenderness

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6
Q

Erosive/Hemorrhagic Gastritis Dx

A
  • Endoscopy for definitive diagnosis may try empiric tx first
  • May have IDA
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7
Q

Erosive/Hemorrhagic Gastritis Empiric Tx

A
  • NSAID: stop NSAIDS & trial of PPI’s for 2-4 weeks, if no improvement do endoscopy
  • Alcohol: stop alcohol, trial of H2-receptor antagonists, PPI, or sucralfate for 2–4 weeks, if no improvement do endoscopy
  • Stress: prophylaxis (PPI) given to critically ill patients
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8
Q

Erosive/Hemorrhagic Gastritis Acute Bleeding Tx

A
  • PPI bolus followed by infusion
  • Endoscopy ASAP
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9
Q

H. pylori causes what?

A
  • Gastritis
  • Gastric ulcers
  • Peptic ulcer
  • Gastric cancer
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10
Q

H. pylori route of transmission

A

fecal-oral
oral-oral

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11
Q

H. pylori gastritis pathophys

A
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12
Q

H. pylori gastritis S/S

A
  • acute infx
    –> may have dyspepsia, which will resolve quickly
  • Chronic infx
    –> can be asymptomatic or continue w/ GERD like symptoms
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13
Q

H. pylori gastritis PE

A
  • Usually normal
  • May have mild epigastric tenderness
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14
Q

H. pylori gastritis Dx

A
  • Serum antibody test
  • Fecal antigen immunoassay
  • Urease breath test
  • Endoscopy usually not indicated, but if performed, a biopsy can be obtained
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15
Q

H. pylori gastritis Triple therapy

A
  • PPI
  • clarithromycin
  • amoxicillin ormetronidazole (in PCN-allergic pts)
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16
Q

H. pylori gastritis Quadruple therapy

A
  • PPI
  • bismuth subsalicylate
  • tetracycline
  • metronidazole
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17
Q

Peptic ulcer dz refers to…

A

ulcers in both the stomach & duodenum

18
Q

Describe a peptic ulcer

A

a break in the gastric or duodenal mucosa, extending through the muscularis mucosa, & usually > 5 mm in diameter

19
Q

How are gastric ulcers distinguished from erosive gastritis?

A

the depth of the lesion
- gastric ulcer penetrate through the mucosa

20
Q

Most cases of peptic ulcer dz are associated with…

A

H. pylori
NSAIDs
Aspirin

21
Q

Gastric Ulcers RFs

A
  • smoking
  • stress
22
Q

Gastric Ulcer pathophys

A
23
Q

Gastric Ulcers S/S

A
  • Epigastric pain 1-2 hours after eating
  • Can cause hematemesis or melena
  • Heartburn &/or chest discomfort
24
Q

Gastric Ulcers PE

A
  • poss epigastric tenderness
  • If ulcer perforated, will have peritoneal signs
25
Q

Gastric Ulcer Dx

A
  • May have anemia
  • Fecal occult test (AKA hemoccult) may be (+)
  • H. Pylori testing
  • Endoscopy w/ biopsy may be needed to make dx
26
Q

Gastric Ulcer Tx

A

Acid-anti secretory agents (1st line)
–> PPI
–> H2 Receptor Antagonists (AKA H2 blockers)

Agents enhancing mucosal defenses (not 1st line)
—> Sucralfate
–> Antacids
–> Misoprostol

H. pylori eradication

27
Q

Gastric Ulcers Complications

A

GI hemorrhage & Perforation
- both Life threatening

28
Q

Zollinger-Ellison Syndrome aka

A

Gastrinoma

29
Q

What is a Gastrinoma?

A

Gastrin secreting neuroendocrine tumor

30
Q

Zollinger-Ellison Syndrome causes…

A

incr gastrin secretion, leading to incr gastric acid, & peptic ulcer dz

31
Q

Zollinger-Ellison Syndrome causes…

A
  • severe/atypical PUD
  • diarrhea
32
Q

Zollinger-Ellison Syndrome Labs

A

incr serum fasting gastrin

33
Q

Zollinger-Ellison Syndrome Tx

A
  • resection if possible
  • PPI
  • chemo/radiation for advanced/metastatic dz
34
Q

What is the most common type of gastric carcinoma?

A

adenocarcinoma

35
Q

Gastric Adenocarcinoma RFs

A
  • H. Pylori
  • smoking
  • alcohol
  • dietary salt & food preservation - - - male sex
36
Q

Gastric Adenocarcinoma Protective Factors

A
  • female
  • diet high in fresh fruits & veggies
37
Q

Gastric Adenocarcinoma alarm S/S

A
  • new onset dyspepsia (in pts > 55yo)
  • unintentional weight loss
  • upper or lower GI bleeding
  • progressive dysphagia
  • unexplained IDA
  • palpable mass or lymphadenopathy
  • jaundice
38
Q

Gastric Adenocarcinoma PE

A
  • Sister Mary Joseph sign: hard periumbilical lymph node
  • Virchow node: left supraclavicular node
39
Q

Gastric Adenocarcinoma Dx

A
  • Endoscopy w/ biopsy
  • CT/PET for evaluation of mets
40
Q

Gastric Adenocarcinoma Tx

A
  • Surgical resection
  • Chemo
  • Radiation
41
Q

Gastric Adenocarcinoma Outcomes

A

Overall 5-year survival is 30%, with curative resection, 5-year survival is 45%

Clin Med: GI (block 3) (8 decks)

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