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Gastroenterology > Disorders of the Stomach and Duodenum > Flashcards

Disorders of the Stomach and Duodenum Flashcards

1
Q

Inflammation of the lining of the stomach

Seen with endoscopic or radiologic evaluation

Multiple variety of causes

A

Gastritis

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1
Q

Why can gastritis be worrisome?

A

erosions can progress to ulcers

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2
Q

What are some signs/symptoms of gastritis?

A

Epigastric abdominal pain – gnawing or aching
Nausea
Indigestion
Loss of appetite
Vomiting (+/- hematemesis)

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3
Q

How is gastritis diagnosed?

A

History and PE

endoscopy

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4
Q

What are some treatment options for gastritis?

A

Treat the underlying cause

Mostly symptomatic:
H2 blockers
PPIs
carafate

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5
Q

List some causes of gastritis

A

H. pylori
NSAIDs/ASA
Alcohol
Caffeinated beverages
Medical or surgical stress
Autoimmune gastritis (Pernicious anemia)
Viral
Duodenogastric reflux
Fungal
Granulomatous (Crohns disease, Tuberculosis, Syphilis, sarcoid)
Hypersensitivity reactions
Eosinophilic Lymphocytic
Infection
Hyperplastic (Zollinger-Ellison syndrome, Menetrier’s disease)

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6
Q

Caused due to the inhibition of prostaglandin synthesis (Prostaglandins are needed for mucosal protection and healing)

Stomach lining constantly being turned over- prostaglandins are vital

Affects approximately 2/3 of patients on this medication chronically

A

NSAID Gastritis

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7
Q

Important to eradicate

Associated with chronic gastritis, PUD, gastric carcinoma

Transmission uncertain

Creates persistent inflammation

A

H. Pylori Infection

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8
Q

spiral, gram negative urease producing bacterium

A

H. pylori

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9
Q

Recurrence rate of ulcer is what percentage if patient is infected with H. pylori and not treated?

A

85%

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10
Q

If patient has PUD and not on NSAID/ASA, assume or test for what?

A

H. pylori

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11
Q

What are some non-invasive methods used to diagnose H. pylori infections?

A

Non-invasive:

Urea breath test - Must be off PPI, bismuth, antibiotics; Detects active infection – 90% PPV (Only for 18+ year olds)

Serology IgG antibody - Not useful for confirming eradication

Stool testing – H. pylori antigen; Useful for confirmation eradication

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12
Q

What are some invasive methods used to diagnose H. pylori infections?

A

Invasive:

Endoscopy with biopsy

Rapid urease test (Biopsies added to urea solution containing phenol red)

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13
Q

What is the treatment and follow up for H. pylori infections?

A

Treatment: triple therapy (abx and anti-ulcer)

Follow up with urea breath test or stool 1-3 months after completion (still need to be off PPI for accurate test)

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14
Q

Confined to the rugae in the gastric body and fundus

Associated with an excessive number of mucosal epithelial cells

Two major types

A

Hyperplastic Gastritis

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15
Q

What are the two major types of hyperplastic gastritis?

A

Menetrier’s disease

Zollinger-Ellison syndrome

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16
Q

Which type of hyperplastic gastritis is described below?

Large gastric folds

Decreased gastric acid secretion

Enhanced protein loss into the stomach

A

Menetrier’s disease

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17
Q

Which type of hyperplastic gastritis is described below?

Increased number of parietal cells with no change in surface and mucous cells

Caused by a gastrin-secreting neuroendocrine tumors (gastrinomas)

<1% of PUD

A

Zollinger-Ellison Syndrome

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18
Q

What amount of gastrinomas are malignant?

A

2/3 of gastrinomas are malignant

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19
Q

When a gastrinoma is diagnosed, what amount of cases have already metastasized to liver?

A

1/3 have already metastasized to liver at time of diagnosis

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20
Q

In patients with Zollinger-Ellison Syndrome, what percentage of patients will develop PUD?

A

90% of patients will develop PUD

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21
Q

How is Zollinger-Ellison Syndrome diagnosed?

A

Fasting serum gastrin

In the presence of gastric pH <4.0, a serum gastrin value >1000 pg/mL is virtually diagnostic of ZES

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22
Q

What is a test you can use to differentiate gastrinomas from other causes of hypergastrinemia?

A

Secretin stimulation test

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23
Q

What is the treatment for Zollinger-Ellison Syndrome?

A

PPIs (90-100% ulcer healing within 4 weeks)
Surgery
chemotherapy

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24
Q

Consider this gastritis if you have a younger person who comes in with asthma and trouble eating

A

Eosinophilic Gastritis

25
Q

What are the most common causes of gastric ulcers?

A

NSAIDs and H. pylori are the most common causes of ulcers

26
Q

Loss of surface epithelium that extends to penetrate muscularis mucosae

A

Ulcer: >5mm in diameter
Erosions: <5mm in diameter

27
Q

Which type of ulcer is described below?

Pain worse at night or in a fasting state

Occurs 2-3 hours after eating

Relieved by food ingestion

Have to rule out ZE with duodenal ulcers

Majority secondary to H. pylori

A

Duodenal ulcer

28
Q

Which type of ulcer is described below?

Worsened with food

A

Gastric Ulcer

29
Q

Which type of ulcer is the most common?

A

Duodenal ulcers are 5x more common than gastric ulcers

30
Q

Stress- related mucosal erosions that lead to upper GI hemorrhage

Develop within 72 hours in critically ill patients

Pathogenesis poorly understood

Bleeding is associated with a HIGH mortality

A

Stress Ulcers

31
Q

Stress ulcers are associated with what conditions?

A

Sepsis
Multiorgan failure
Hypotension
Trauma
Major surgery
Severe burns
Prolonged mechanical ventilation

32
Q

Caused when normal mucosal defenses are impaired or overwhelmed by acid or pepsin

Loss of surface epithelium that extends to penetrate muscularis mucosae (Ulcer >5mm in diameter; Erosions <5mm in diameter)

Many upper GI bleeds are due to this

Lifetime prevalence 10%

Slight male propensity (1.3:1)

A

Peptic Ulcer Disease

33
Q

delay healing of ulcer

A

EtOH, smoking

34
Q

Which ulcers have a higher incidence of recurrence throughout life?

A

Duodenal ulcers

35
Q

Describe the clinical presentation of peptic ulcer disease?

A

May be asymptomatic

Dyspepsia - 80-90% of patients (But <25% of patients with dyspepsia will have PUD)
Frequently relieved by food – duodenal
Worse after eating - gastric

Mild epigastric pain - Gnawing, aching feeling

Anemia

Occult blood in stool

Hematemesis

Melena

Coffee-ground emesis

36
Q

What is the procedure of choice to diagnose PUD?

A

Endoscopy

37
Q

What are some red flags with peptic ulcer disease?

A

Anemia
Weight loss
Positive hemoccult
Hematemesis/melena
Persistent vomiting
Hepatomegaly/abdominal mass
Dysphagia
Progressive symptoms

38
Q

What are some complications with peptic ulcer disease?

A

GI hemorrhage
Ulcer perforation/penetration
Gastric outlet obstruction

39
Q

Abdominal xray: free air under the diaphragm suggests what?

A

Ulcer perforation/penetration

40
Q

In an otherwise healthy infant aged 2-3 months; seems to be in pain
and cries for >3 hours a day, >3 days a week, for more than 3 weeks
(rule of threes)

Most common cause is GERD

A

Colic

41
Q

What is the clinical presentation of infants with colic?

A

Severe and paroxysmal crying that occurs mainly in the late afternoon
Knees drawn up into chest
Fists are clenched
Flatus is expelled
Faces are pained in appearance
Minimal response to soothing techniques

42
Q

Olive shaped mass right of midline

Projectile vomiting – sometimes can see visible peristalsis after feeding
Post-prandial, projectile, non-bilious vomiting

Begins between the ages of 2-4 weeks (Rare at birth or over 6 months of age)

More prevalent in males

A

Pyloric Stenosis

43
Q

What is the pathophysiology of pyloric stenosis?

A

Caused by hypertrophy of muscles of the pylorus with elongation and
thickening leading to obstruction

44
Q

Avoid giving Zithromax in kids under 3 because it can cause what?

A

pyloric stenosis

45
Q

How is pyloric stenosis diagnosed?

A

Ultrasound – highly sensitive and specific; Can see hypertrophied pyloric valve (stenosis)

Barium swallow - will see tapering

46
Q

What is the treatment for pyloric stenosis?

A

Surgical repair

47
Q

The congenital absence or complete closure of a portion of the lumen
of the duodenum (during gestation)

A

Duodenal Atresia

48
Q

Duodenal atresia is also associated with what other conditions/disorders?

A

Can be associated with Down Syndrome

Associated with cardiac anomalies and GI defects: Malrotation of intestines, Imperforate anus, Annular pancreas

49
Q

How does duodenal atresia typically present?

A

Bilious emesis (vomiting bile) and epigastric distension within the first few hours of birth

50
Q

What Xray finding would you see in duodenal atresia?

A

“double bubble” sign

51
Q

What is the treatment for duodenal atresia?

A

Surgical repair

52
Q

2nd most common cancer worldwide

Uncommon in US

A

Gastric Adenocarcinoma

53
Q

What is the strongest risk factor for gastric adenocarcinoma?

A

Chronic H. pylori infection – stronger risk factor

54
Q

What are some risk factors for gastric adenocarcinoma?

A

H. pylori

High salt diets

Dietary nitrates

Smoking

First-degree relatives of patients with gastric cancer have a 2-3 fold chance of developing the disease

55
Q

In gastric adenocarcinoma, what are two signs of metastatic spread?

A

Virchow’s node - Left supraclavicular node/area

Sister Mary Joseph node - umbilical

56
Q

In gastric adenocarcinoma, what percentage will survive 5 years after
“curative” resection?

A

25-35%

57
Q

2nd most common gastric tumor

> 95% are B cell non-Hodgkins lymphoma

A

Gastric Lymphoma

58
Q

Rare (<1% of gastric tumors)

More common in the bowel - 95% present in rectum, small intestine, appendix

Sporadic or secondary to chronic gastrinemia

A

Carcinoid Tumors

59
Q

Symptomatic delay in gastric emptying of solid or liquid meals in absence of obstruction

A

Gastroparesis

60
Q

What are the most common causes of gastroparesis?

A

Diabetic autonomic neuropathy (poorly controlled diabetes)

Post-vagotomy

61
Q

What is the treatment for gastroparesis?

A

Prevention/Maintenance: Small frequent meals, Avoid agents that slow down gastric motility, Maintain good control of DM

Acute exacerbations: NG tube, IV fluids

Chronic or Subacute exacerbations: Metoclopramide (reglan), Domperidone, Erythromycin, Gastric pacemaker?

Gastroenterology (9 decks)

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