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Clin Med 3 > E1: PUD And Gastric CA > Flashcards

E1: PUD And Gastric CA Flashcards

1
Q

What do parietal cells do?

A

Produce HCL and intrinsic factor

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2
Q

What cells secrete pepsinogen?

A

Chief cells

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3
Q

What do mucous neck cells do?

A

Secrete a thin, acidic mucous

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4
Q

What do enteroendocrine cells do?

A

Secrete various hormones, enteroendocrine G cells secrete gastrin

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5
Q

What are the protective features of the stomach mucosa?

A
  • Bicarb rich mucus coating
  • tight junctions
  • stem cells where gastric glands joint gastric puts replace damaged mucosal cells
  • Stomach mucosa produces prostaglandins
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6
Q

What is it called when there is a defect in the gastric or duodenal mucosa that extends through the muscularis mucosa into the deeper laters of the wall?

A

Peptic ulcer disease

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7
Q

What are the risk factors for PUD?

A
  • Smoking
  • alcohol use
  • genetic
  • diet
  • psychological factors
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8
Q

What is the pathophysiology of PUD?

A

Not ulcers occur when the normal secretory, defense, or repair mechanisms of the stomach are disrupted by superimposed processes such as H pylori and ingestion of NSAIDs

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9
Q

What are the two main etiologies of PUD?

A
  • H pylori

- NSAIDs

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10
Q

What is the most common cause of PUD worldwide?

A

H pylori

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11
Q

H pylori infection increases the risk of ***.

A

Gastric cancer

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12
Q

What is the route of transmission of H pylori?

A

Oral-oral or fecal-oral

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13
Q

What kind of bacteria is H pylori?

A

Gram negative rod

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14
Q

What are the virulence factors of H pylori?

A

1) flagella
2) Urease
3) adhesins
4) causes inflammation

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15
Q

What does the flagella of H pylori do?

A

Used to burrow into the stomach mucous to reach epithelial cells, where it is less acidic

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16
Q

What does the urease of H pylori do?

A

Hydrolyze gastric urea to form ammonia, neutralize gastric acid, and produce a neutralized area around H pylori

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17
Q

What are the factors that increase risk of PUD with the use of NSAIDs?

A
  • Prior history of PUD/ulcer complications
  • H pylori infection
  • > 75 yo
  • increased dose, time, and duration
  • concomitant use of steroids, other NSAIDs, anticoagulants, aspirin, SSRIs, or alendronate
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18
Q

What are the common symptoms of PUD?

A
  • 70% are asymptomatic
  • upper abdominal pain
  • dyspepsia
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19
Q

A patient presents with abdominal pain that is worse after meals and lasts about 30 minutes to 1 hour afterwards. Patient has vomiting, hematemesis, weight loss, and anorexia.
What kind of ulcer are you suspicious of?

A

Gastric ulcer

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20
Q

Patient has abdominal pain that is relieved by meals, but becomes worse 2-3 hours after eating. Patient does not have any vomiting, but does have melena and weight gain.
What kind of ulcer are you suspicious of?

A

Duodenal ulcer

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21
Q

What are the alarm symptoms of PUD?

A
  • Bleeding
  • Unexplained IDA
  • early satiety
  • unintentional weight loss
  • dysphagia
  • persistent vomiting
  • family hx of gastric cancer
22
Q

What are the possible complications of PUD?

A
  • Bleeding (most common)
  • Perforation
  • penetration
  • gastric outlet obstruction
23
Q

What is the diagnosis and treatment of hemorrhage caused by PUD?

A

Stabilize with IV fluids or PRBCs, Start IV PPI and perform EGD

24
Q

What is the clinical presentation of perforation caused by PUD?

A

Sever, diffuse abdominal pain, tachycardia, weak pulse, nausea and vomiting

25
Q

How is perforation caused by PUD diagnosed?

A

History and physical
upright and abdominal XR
Possibly CT

26
Q

What is the treatment of perforation caused by PUD?

A
  • Stabilize with IV fluids
  • NG tube, NG suction for gastric decompression
  • IV PPI
  • Broad spectrum abx
  • surgery
27
Q

What is contraindicated if you suspect perforation?

A

UGI with barium

28
Q

What happens in penetration caused by PUD?

A

The ulcer penetrates through the bowel wall without free perforation and leakage of luminal contents into the peritoneal cavity.
-The pancreas is the most common adjacent structure affected

29
Q

What is the clinical presentation of gastric outlet obstruction caused by PUD?

A

-Vomiting, early satiety, bloating, epigastric pain, weight loss, anorexia

30
Q

What will you see on imaging in a patient with gastric outlet obstruction?
What will you hear on abdominal auscultation?

A

Imaging: dilated bowel

Auscultation: succussion splash

31
Q

How is H pylori diagnosed? Which is most sensitive and specific?

A
  • Biopsy for histology during EGD (most sensitive and specific!)
  • urea breath test
  • stool antigen test
  • serology
32
Q

If a patient tests positive for H pylori, what should you do?

A

Treat and confirm eradication 4 weeks after completion of treatment.
-Consider long term acid suppression with daily PPI

33
Q

What is the clarithromycin triple therapy for h pylori?

A
  • PPI BID
  • Clarithryomycin 500mg BID
  • Amoxicillin 1000mg BID

All for 14 days

34
Q

What is the Bismuth Quadruple therapy for H pylori?

A
  • PPI BID
  • Bismuth subsalicylate 300mg QID
  • Metronidazole 250mg QID
  • Tetracycline 500mg QID
35
Q

What is Zollinger -Ellison syndrome?

A

A syndrome in which gastrinomas, typically arising in the duodenum or pancreas, hypersecrete gastrin

36
Q

What is the clinical presentation of ZES?

A
  • Recurrent PUD, often distal to duodenal bulb
  • Upper abdominal pain
  • Diarrhea/steatorrhea
37
Q

How is ZES diagnosed?

A
  • fasting serum gastrin >1000 pg/mL and gastric pH <2
  • secretion stimulation test
  • CT abdomen to localize tumor
38
Q

What is a positive secretion stimulation test?

A

After IV secretin, gastrin levels increase by >200 pg/mL

39
Q

What is the treatment of ZES?

A

PPIs and surgical resection if possible

40
Q

What is the clinical presentation of gastric cancer, and what is the most common?

A
  • Most patients are asymptomatic
  • weight loss
  • persistent abdominal pain
  • gastric ulcer history
41
Q

90-95% of gastric cancers are ***.

A

Adenocarcinomas

42
Q

How is gastric cancer diagnosed?

A
  • EGD biopsy
  • UGI (second line)
  • staging
43
Q

What may you see on EDG of a patient with gastric cancer?

A

-Subtle polypoid protrusion, a superficial plaque, mucosal discoloration, a depression, or an ulcer

44
Q

What is Virchows node?

A

Enlarged supraclavicular lymph node associated with gastric cancer

45
Q

What are the 3 lymph nodes associated with gastric cancer?

A
  • Virchows node (most common)
  • Sister Mary Josephs node (periumbilical node)
  • Left axillary node (Irish node)
46
Q

What is the treatment for early gastric cancer?

A

Endoscopic mucosal resection

47
Q

What is the treatment for advanced gastric cancer?

A

Total or partial gastrectomy

48
Q

What is the treatment for unresectable gastric cancers?

A

Chemotherapy vs chemoradiotherapy

49
Q

What is dyspepsia?

A

Abdominal discomfort sometimes accompanied by bloating, belching, or abdominal distention

50
Q

How should you work up a patient with dyspepsia who is >60 years old?

A

-EDG with biopsy. If PUD is present, treat accordingly. If no evidence of organic disease, consider functional dyspepsia and test for H pylori

51
Q

How should you work up a patient with dyspepsia who is <60 years old?

A

Perform an EGD in patients with any of the following indications

  • significant weight loss
  • over GI bleeding
  • 3 or more alarm features
  • rapidly progressive alarm features
52
Q

What are some of the dyspepsia alarm features?

A

Unintentional weight loss, progressive dysphagia, odynophagia, unexplained IDA, persistent vomiting, fhx of upper GI cancer

Clin Med 3 (17 decks)

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