Disorders of the Stomach

Question 1

There are just TWO major causes of peptic ulcer disease - what are they?

Answer 1

H. pylori: more duodenal ulcers

NSAIDs: more gastric ulcers

Question 2

What symptom is the hallmark of PUD?

Answer 2

epigastric pain that is gnawing, dull, aching, or hunger-like

Question 3

What is the procedure of choice for diagnosing duodenal and gastric ulcers?

Answer 3

upper endoscopy

Question 4

You should biopsy both duodenal and gastric ulcers.

T/F

Answer 4

False
Duodenal ulcers are virtually never malignant and do not require biopsy.
3-5% of benign-appearing gastric ulcers prove to be malignant and therefore ulcer margin biopsies are almost always done.

Question 5

What could it mean if a patient’s typical rhythmic discomfort (from ulcers) changes to constant or radiating pain?

Answer 5

May reflect ulcer penetration or perforation

Question 6

What are two acid-antisecretory agents used to treat ulcers?

Answer 6

1. PPIs

2. H2-receptor antagonists

Question 7

What time of day should patients take PPIs and H2-receptor blockers?

Answer 7

PPIs: 30 minutes prior to breakfast; make sure to eat

H2-receptor blockers: once daily at bedtime

Question 8

What is the standard triple therapy for H. pylori?

Answer 8

1. PPI
2. clarithromycin
3. amoxicillin

Question 9

What is the standard quadruple therapy for H. pylori?

Answer 9

1. PPI
2. bismuth subsalicylate
3. tetracycline
4. metronidazole

Question 10

Patients with ulcers should eat only bland foods, avoid alcohol, and quit smoking.
T/F

Answer 10

False, false, true
~There is no justification for bland or restrictive diets
~Moderate alcohol intake is not harmful
~Smoking retards healing and increases recurrences!

Question 11

Erosive gastritis and hemorrhagic gastritis most commonly caused by what?

Answer 11

• drugs (NSAIDs)
• alcohol
• stress (from major medical or surgical illness)
• portal HTN

Question 12

S/s of erosive/hemorrhagic gastritis?

Answer 12

• often asymptomatic
• dyspepsia, anorexia, epigastric pain, nausea/vomiting
• hematemesis or coffee ground emesis (bleeding not usually significant)

Question 13

Patients with pernicious anemia gastritis are at increased risk for what?

Answer 13

gastric adenocarcinoma (3x increased risk)

Question 14

What are the main types of nonerosive, non specific gastritis?

Answer 14

• H. pylori
• pernicious anemia
• eosinophilic gastritis

Question 15

What is the most common cause of dyspepsia?

Answer 15

functional dyspepsia - no organic cause

Question 16

What diagnostic workup is done for dyspepsia?

Answer 16

If < 55 with uncomplicated dyspepsia: test for H. pylori or do PPI trial
If > 55 or with “alarm” symptoms (wt loss, dysphagia, recurrent vomiting, bleeding): CBC, electrolytes, liver enzymes, calcium, thyroid function, PLUS upper endoscopy

Question 17

60-90% of gastric cancers are attributable to what?

Answer 17

H. pylori

Question 18

What are four environmental risk factors for gastric cancer?

Answer 18

1. high nitrate diet
2. low vitamin C
3. hx pernicious anemia
4. hx gastric resection

Question 19

What two medications may be taken before meals by a patient with diabetic gastroparesis?

Answer 19

metoclopramide and erythromycin

both stimulate stomach contractions

Question 20

T/F: peptic ulcers are 5x more common in duodenum than in the stomach

Answer 20

TRUTH!

Question 21

Less than 1% of peptic ulcer disease is caused by what?

Answer 21

Zollinger-Ellison syndrome (gastrinoma)

Question 22

T/F over 2/3 of gastrinomas are malignant

Answer 22

TRUE!

in fact: over 1/3 have already metastasized to the LIVER at initial presentation

Question 23

what is a common s/s for gastrinoma?

Answer 23

• diarrhea
• ->fun fact: nasogastric suction of stomach acid stops the diarrhea
• gastric acid hypersecretion (leads to peptic ulcers)