Disorders of the stomach- KS's notes

Question 1

Peptic ulcer disease presents as

Answer 1

epigastric pain exacerbated by fasting, improved by eating

Question 2

Peptic ulcer disease is a result of

Answer 2

H. pylori, gastric ulcer, stress gastritis, or Zollinger-Ellison syndrome

Question 3

H. pylori is virtually always

Answer 3

associated with peptic ulcer disease

-induces acid secretion through proinflammatory cytokines

Question 4

The most common cause of Gastric ulcer is

Answer 4

NSAID use

1/3rd are duodenal ulcers

Question 5

Stress gastritis is associated with

Answer 5

shock, sepsis, respiratory failure, burns, hemorrhage, massive transfusions, or head injury
CNS injury, intracranial HTN, thermal injury–> particularly prevalent

Question 6

Stress gastritis will cause gastric bleeding if

Answer 6

coagulopathy, thrombocytopenia, INR >1.5, and aPTT >2x normal

Question 7

Zollinger-Ellison syndrome is a disease of the

Answer 7

gastroduodenal and intestinal ulceration, increased gastrin secretion and non-beta islet cell tumor of the pancreas

Question 8

Zollinger-Ellison syndrome is associated with

Answer 8

MEN 1 (multiple endocrine neoplasia)

Question 9

Complications of peptic ulcer disease include

Answer 9

bleeding, perforation, & obstruction

Question 10

Describe the complication of bleeding in peptic ulcer disease.

Answer 10

hemorrhage is leading cause of death associated with PUD

SBP <100, melena, syncope/altered mentation, renal/liver/cardiac disease= significant risk factors for rebleeding

Question 11

Describe the complication of perforation in peptic ulcer disease.

Answer 11

risk is approximately 10%

usually signaled by severe epigastric pain caused by highly acidic gastric contents into the peritoneum

Question 12

Describe the complication of obstruction in peptic ulcer disease.

Answer 12

gastric outlet obstruction
can be acute or slow
RSI
caused by edema and inflammation in the pyloric channel and first portion of duodenum

Question 13

Describe treatment of peptic ulcer disease.

Answer 13

antacids- -don't use in patients with chronic renal failure
H2 receptor antagonists
proton pump inhibitors 
prostaglandin analogues 
cytoprotective agents
anticholinergics

Question 14

Dumping syndrome can be

Answer 14

early or late
early- symptoms 15-30 minutes after a meal
late- symptoms 1-3 hours post meal- vasomotor symptoms secondary to hypoglycemia d/t excessive insulin release

Question 15

Dumping syndrome is caused by entry of

Answer 15

hyperosmolar gastric contents into the proximal small bowel, fluid shifts into small bowel lumen
results in plasma volume contraction and acute intestinal distension

Question 16

Symptoms of early dumping syndrome include

Answer 16

nausea, epigastric discomfort, diaphoresis, crampy abdominal pain, diarrhea, tachycardia, palpitations, dizziness, syncope

Question 17

Treatment for dumping syndrome is

Answer 17

dietary modifications (fewer simple sugars) and less fluid consumption during meal 
octreotide therapy

Question 18

The clinical triad of alkaline reflux gastritis is

Answer 18

postprandial epigastric pain associated with n/v, evidence of bile reflux into the stomach, histologic evidence of gastritis

Question 19

The treatment for alkaline reflux gastritis is

Answer 19

only proven treatment is operative diversion of intestinal contents from contact with gastric mucosa
most common surgical procedure is Roux en Y gastrojejunectomy

Question 20

Inflammatory bowel disease includes

Answer 20

ulcerative colitis

Crohn’s disease

Question 21

Ulcerative colitis involves

Answer 21

the rectum and extends proximally to involve part or all of the colon
mucosal disease

Question 22

In severe disease of ulcerative colitis, the

Answer 22

mucosa is hemorrhagic, edematous, or ulcerative

Question 23

Major symptoms of ulcerative colitis include

Answer 23

diarrhea, rectal bleeding, tenesmus (feeling of incomplete bowel emptying), passage mucus and crampy abdominal pain
-anorexia, n/v, fever, & weight loss
severely low: low serum albumin & leukocytosis

Question 24

Complications of ulcerative colitis include

Answer 24

hemicolectomy is performed if pt requires 6-8 L of blood in 24 hours
toxic megacolon- dilated transverse colon with loss of haustrations
perforation of colon–> peritonitis
obstruction caused by benign stricture formation
can be cured by total proctocolectomy