Disorders of the stomach- KS's notes Flashcards
Peptic ulcer disease presents as
epigastric pain exacerbated by fasting, improved by eating
Peptic ulcer disease is a result of
H. pylori, gastric ulcer, stress gastritis, or Zollinger-Ellison syndrome
H. pylori is virtually always
associated with peptic ulcer disease
-induces acid secretion through proinflammatory cytokines
The most common cause of Gastric ulcer is
NSAID use
1/3rd are duodenal ulcers
Stress gastritis is associated with
shock, sepsis, respiratory failure, burns, hemorrhage, massive transfusions, or head injury
CNS injury, intracranial HTN, thermal injury–> particularly prevalent
Stress gastritis will cause gastric bleeding if
coagulopathy, thrombocytopenia, INR >1.5, and aPTT >2x normal
Zollinger-Ellison syndrome is a disease of the
gastroduodenal and intestinal ulceration, increased gastrin secretion and non-beta islet cell tumor of the pancreas
Zollinger-Ellison syndrome is associated with
MEN 1 (multiple endocrine neoplasia)
Complications of peptic ulcer disease include
bleeding, perforation, & obstruction
Describe the complication of bleeding in peptic ulcer disease.
hemorrhage is leading cause of death associated with PUD
SBP <100, melena, syncope/altered mentation, renal/liver/cardiac disease= significant risk factors for rebleeding
Describe the complication of perforation in peptic ulcer disease.
risk is approximately 10%
usually signaled by severe epigastric pain caused by highly acidic gastric contents into the peritoneum
Describe the complication of obstruction in peptic ulcer disease.
gastric outlet obstruction
can be acute or slow
RSI
caused by edema and inflammation in the pyloric channel and first portion of duodenum
Describe treatment of peptic ulcer disease.
antacids- -don't use in patients with chronic renal failure H2 receptor antagonists proton pump inhibitors prostaglandin analogues cytoprotective agents anticholinergics
Dumping syndrome can be
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
Dumping syndrome is caused by entry of
hyperosmolar gastric contents into the proximal small bowel, fluid shifts into small bowel lumen
results in plasma volume contraction and acute intestinal distension
Symptoms of early dumping syndrome include
nausea, epigastric discomfort, diaphoresis, crampy abdominal pain, diarrhea, tachycardia, palpitations, dizziness, syncope
Treatment for dumping syndrome is
dietary modifications (fewer simple sugars) and less fluid consumption during meal octreotide therapy
The clinical triad of alkaline reflux gastritis is
postprandial epigastric pain associated with n/v, evidence of bile reflux into the stomach, histologic evidence of gastritis
The treatment for alkaline reflux gastritis is
only proven treatment is operative diversion of intestinal contents from contact with gastric mucosa
most common surgical procedure is Roux en Y gastrojejunectomy
Inflammatory bowel disease includes
ulcerative colitis
Crohn’s disease
Ulcerative colitis involves
the rectum and extends proximally to involve part or all of the colon
mucosal disease
In severe disease of ulcerative colitis, the
mucosa is hemorrhagic, edematous, or ulcerative
Major symptoms of ulcerative colitis include
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
Complications of ulcerative colitis include
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
