Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Med III > Exam 1 - PUD and Gastric Cancer > Flashcards

Exam 1 - PUD and Gastric Cancer Flashcards

1
Q

What is the function of the parietal cells in the stomach?

A

Produce HCL and intrinsic factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the function of the chief cells in the stomach?

A

Secrete pepsinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the function of the mucus neck cells in the stomach?

A

Secrete a thin, acidic mucus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the function of the enteroendocrine cells in stomach?

A

Secrete various hormones. Enteroendocrine G cells secrete gastrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are 4 protective features of the stomach mucosa?

A
  1. bicarbonate-rich mucus
  2. tight junctions
  3. Stem cells
  4. prostaglandins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a defect in the gastric or duodenal mucosa that extends through the muscularis mucosa into the deeper layers of the wall?

A

Peptic ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common cause of PUD worldwide?

A

H. pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does H. pylori predispose individuals to?

A

Gastric cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does H. pylori cause disruption of the protective mechanisms of the stomach, leading to ulcers?

A
  1. Flagella - used to burrow into stomach
  2. Urease - produces neutralized area
  3. Adhesins
  4. Causes inflammation - inflammation causes G cells to secrete gastrin, therefore increasing HCL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do NSAIDs cause disruption of the protective mechanisms of the stomach, leading to ulcers?

A

NSAIDs inhibit the production of cyclooxygenase, leading to decreased production of PGE2 which is a protective factor of the mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

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

A
  • Prior hx of PUD/ulcer complications
  • Presence of H. pylori infection
  • Advanced age ( > 75 yo)
  • Increased dose, time and duration of use
  • Concomitant use of steroids, other NSAIDs, anticoagulants, aspirin, SSRI, alendronate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the common clinical presentation of PUD?

A
  • Majority are asymptomatic

- Upper abdominal pain/discomfort in those who are sympatomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Are the following symptoms more correlated with a gastric or duodenal ulcer?

  • Pain worse after meals; pain worse 30 minutes to 1 hour after meal
  • Vomiting common
  • More likely to hemorrhage which manifests as hematemesis
  • Weight loss
A

Gastric ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Are the following symptoms more correlated with a gastric or duodenal ulcer?

  • Pain relieved by meals; pain worse 2-3 hours after meal
  • Vomiting uncommon
  • Less likely to hemorrhage, but manifests as melena
  • Weight gain
A

Duodenal ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some alarm symptoms for PUD?

A
  • Bleeding
  • Unexplained iron deficiency anemia
  • Early satiety
  • Unintentional weight loss
  • Progressive dysphagia/odynophagia
  • Acute onset of intense upper abdominal pain
  • Persistent vomiting
  • Family hx of upper GI cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the most common complication of PUD?

A

Hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some possible complications one can experience from PUD?

A
  • Hemorrhage
  • Perforation
  • Penetration
  • Gastric outlet obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the clinical presentation associated with hemorrhage from PUD?

A
  • Melena
  • Hematemesis
  • Hematochezia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is hemorrhage from PUD diagnosed?

A

EGD

20
Q

What is the treatment for hemorrhage from PUD?

A
  • IV fluids or PRBCs
  • IV PPI
  • Thermal coagulation
  • Hemoclip
  • Injection therapy
21
Q

What is the clinical presentation associated with perforation from PUD?

A
  • Severe, diffuse abdominal pain
  • Tachycardia, weak pulse
  • Nausea/Vomiting
22
Q

How is perforation from PUD diagnosed?

A

Upright chest and 2-view abdominal x-rays (free air under diaphragm)

23
Q

What is the treatment for a perforation from PUD?

A
  • IV fluids
  • IV PPI
  • NG tube and suction
  • Antibiotics
  • Surgery
24
Q

What is the most common adjacent structure affected due to penetration from PUD?

A

Pancreas

25
Q

What is the clinical presentation associated with gastric outlet obstruction?

A
  • Vomiting
  • Early satiety
  • Bloating
  • Epigastric pain
  • Anorexia/Weight loss
26
Q

How is gastric outlet obstruction diagnosed?

A
  • Dilated stomach on imaging

- Succussion splash on exam

27
Q

What is the treatment for gastric outlet obstruction?

A
  • IV fluids
  • NG tube
  • Gastric decompression
  • IV PPI
  • Endoscopic balloon dilatation or surgery if failure with medical treatment
28
Q

How is H. pylori diagnosed?

A
  • Urea breath test
  • Stool Antigen test
  • Serology
  • Biopsy for histology during EGD
29
Q

What is the most sensitive and specific testing method for H. pylori?

A

Biopsy for histology during EGD

30
Q

What is the treatment for PUD due to H. pylori?

A

Clarithroymycin Triple Therapy x 14 days:

  • PPI BID
  • Clarithromycin 500 mg BID
  • Amoxicillin 1000 mg BID

Bismuth Quadruple Therapy x 14 days

  • PPI BID
  • Bismuth subsalicylate 300 mg QID
  • Metronidazole 250 mg QID
  • Tetracycline 500 mg QID
  • Confirmation eradication 4 weeks after completion of treatment
  • Consider long-term acid suppression with daily PPI
  • Discontinue exacerbating factors: NSAIDS, tobacco, alcohol
31
Q

What is the treatment for PUD likely secondary to aspirin/NSAID usage?

A
  • Discontinue aspirin/NSAID
  • 6-8 weeks of PPI
  • Consider long-term daily PPI
  • Discontinue exacerbating factors: NSAIDS, tobacco, alcohol
32
Q

What is the treatment for PUD if it is not due to H. pylori or aspirin/NSAID usage?

A
  • Discontinue exacerbating factors: NSAIDS, tobacco, alcohol
  • 4-8 weeks of PPI and evaluate for other etiologies
  • Perform repeat EGD after initial PPI therapy
  • Consider long-term daily PPI
33
Q

What is Zollinger-Ellison Syndrome

A

Syndrome in which gastrinomas typically arising from the duodenum or pancreas hypersecrete gastrin, increasing HCL secretion and gastric motility

34
Q

What is the clinical presentation associated with Zollinger-Ellison Syndrome?

A
  • Recurrent PUD that is often distal to duodenal bulb
  • Diarrhea (including steatorrhea)
  • Upper abdominal pain
35
Q

How is Zollinger-Ellison Syndrome diagnosed?

A
  • Fasting serum gastrin > 1000 pg/mL + gastric pH < 2 ***
  • Secretin stimulation test
  • CT abdomen to localize tumor
36
Q

What is the treatment for Zollinger-Ellison Syndrome?

A

PPIs and surgical resection if possible

37
Q

What is the clinical presentation associated with gastric cancer?

A
  • Most are asymptomatic
  • Weight loss
  • Persistent abdominal pain
  • Gastric ulcer history
38
Q

What is the clinical presentation if patient presents with late gastric cancer?

A

Palpable stomach mass, succussion splash, paraneoplastic syndromes

39
Q

How is gastric cancer diagnosed?

A

EGD

40
Q

What type of cancer are most gastric cancers?

A

Adenocarcinoma

41
Q

What is the most common sign of metastatic disease with gastric cancer?

A

Virchow’s Node: left supraclavicular lymph node

42
Q

What are some signs of metastatic disease with gastric cancer?

A
  • Virchow’s Node: left supraclavicular lymph node
  • Sister Mary Joseph’s Node: periumbilical nodule
  • Left axillary node (Irish node)
43
Q

What is the definition of dyspepsia?

A

Abdominal discomfort sometimes accompanied by bloating, belching or abdominal distention

44
Q

What is the workup for a patient with dyspepsia who is 60 years or older?

A
  • Perform EGD with biopsy in all patients
  • If PUD present, treat
  • If no evidence of organic disease, consider “functional dyspepsia” and test for H. pylori and treat as necessary
45
Q

What is the workup for a patient with dyspepsia who is less than 60 years old?

A

Perform EGD if patients with ANY of the following:

  • Clinically significant weight loss
  • Overt GI bleeding
  • 2 or more alarm features
  • Rapidly progressive alarm features
46
Q

What are some dyspepsia alarm features?

A
  • Unintentional weight loss
  • Progressive dysphagia
  • Odynophagia
  • Unexplained iron deficiency anemia
  • Persistent vomiting
  • Palpable mass or lymphadenopathy
  • Family hx of upper GI cancer

Clinical Med III (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions