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Gastro Exam 1 > Gastric Disorders > Flashcards

Gastric Disorders Flashcards

1
Q

What does the stomach secrete in response to its expansion during digestion?

A

hydrochloric acid, pepsin, gastrin

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2
Q

Why do you need the stomach to have a low pH

A

kill ingested bacteria and promote proteolysis and activation of pepsin

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3
Q

What type of cell does gastrin originate from

A

G cells

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4
Q

What are the 2 purposes of gastrin

A

stimulate gastric juice (acidic - -.9-1.5) (hydrochloric acid, pepsin, and intrinsic factor

stimulate stomach motor function

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5
Q

what is the pathway that leads to gastrin and its effect?

A

When food enters the stomach, the protein component stimulates G cells situated in the antral region of the stomach to release the hormone gastrin, which stimulates the cells to release histamine and stimulates parietal cells to secrete acid.

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6
Q

As the acidity of the stomach and duodenum increases, protective feedback pathways are activated to inhibit further___ ___________.

A

acid secretion

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7
Q

The release of what is a mechanism of acid-mediated inhibitory control

A

somatostatin by D cells

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8
Q

Gastritis and gastritis related disease (gastric bcell lymphoma, peptic ulcer disease, and stomach cancer) are associated with what?

A

H. pylori

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9
Q

when are you most likely to acquire H pylori

A

in childhood

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10
Q

How do you contract H pylori

A

transmission via fecal/oral or oral/oral routes

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11
Q

H pylori burrows and attaches to the gastric epithelium where pH is closer to what

A

4.5 to 6.5

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12
Q

H pylori burrowing through mucus layer to gastric epithelium leads to inflammation resulting in histologic changes. This makes this cascade the _____ leading cause of cancer death worldwide

A

fifth

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13
Q

Gold standard testing for H pylori

A

endoscopy with 4 biopsies along the stomach lining

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14
Q

3 non invasive testing for H pylori

A

antibody test - not helpful in acute cases
Urea breath test - most widely used
Fecal antigen test

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15
Q

How many times do you get a urea breath test

A

1st time: + –> treat –> 2nd time –> improvement?

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16
Q

Symptoms of gastritis/dyspepsia

A

epigastric pain, discomfort, burning

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17
Q

causes of acute gastritis

A

NSAIDs/Aspirin
Smoking and alcohol use
Physiological stress (burns, trauma, shock)

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18
Q

Types of Chronic Gastritis

A

A (fundal) - autoimmune (atrophic gastritis or pernicious anemia)
B (astral) - helicobacter pylori infection

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19
Q

What type of eating disorder can you often see gastritis with

A

Bulimia due to chronic vomiting

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20
Q

What else besides vomiting can trigger gastritis

A

Excessive alcohol use and anti-inflammatory drugs

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21
Q

What 4 things are most gastric and duodenal ulcers attributed

A

H pylori
NSAIDs
Severe physiologic stress
Hypersecretory conditions (Zollinger-Ellison)

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22
Q

Why are NSAIDs implicated with Gastritis

A

They decrease prostaglandins which decreases mucus production resulting in gastric ulcers

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23
Q

Patients with gastritis due to hypersecretory conditions present typically have what? and what do labs reveal?

A

a gastroma located in the pancreas or duodenum
present with diarrhea
labs reveal increased gastrin level

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24
Q

What are gastronomas (gastrin secreting neuroendocrine tumor) associated with besides gastritis

A

Multiple endocrine neoplasia (MEN) type 1

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25
Q

Treatment of Gastritis

A

PPI and removal of tumor

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26
Q

What two mechanisms contribute to the pathophysiology of gastritis?

A

H pylori
Decrease in number of somatostatin secreting astral D cells

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27
Q

Is H pylori gram positive or gram negative

A

Gram negative

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28
Q

What does H pylori Produce

A

Ammonia which is toxic to epithelial cells, causing gastritis

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29
Q

How do you differentiate gastritis from peptic ulcer disease with patient presentations

A

patients with peptic ulcer disease tend to have symptoms more pronounced with food intake

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30
Q

What must you rule out on physical examination to make sure patient is not having complications (perforation) of peptic ulcer disease

A

rigid abdomen, rebound tenderness, or guarding

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31
Q

What type of patient presentations would you consider GERD until proven otherwise

A

complaint of heart burn or abdominal pain with heartburn more than once per week

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32
Q

If patient has any symptoms of dyspnea or chest pressure what should that make you think

A

cardiac etiology

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33
Q

Where does biliary pain often radiate and what type of food is it associated with

A

right shoulder
fatty/greasy foods

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34
Q

If a patient describes a severe boring type of pain in epigastrium that is relieved when they bend over what should you be thinking?

A

pancreatitis

35
Q

What are the alarm signs of dyspepsia

A

> 55 y/o
bleeding
anemia
unintentional weight loss
dysphagia
odynophagia
early satiety
previous malignancy
Lymphadenopathy
abdominal mass
previous ulcer

36
Q

What alarm signs should be recognized in patients > 55 yo

A

unintended weight loss
progressive dysphagia
persistent vomiting
evidence of GI bleeding
family Hx of cancer

37
Q

What 2 signs are patients with gastro ulcers always going to present with

A

dyspepsia and abdominal pain

38
Q

What are other symptoms of gastro ulcers

A

pain in upper belly
feeling bloated or early satiety
decreased appetite
nausea/vomiting
vomiting blood or black colored stool
more tired than usual - anemia

39
Q

What is the most common cause of upper GI bleed

A

peptic ulcer disease

40
Q

What will you see with Duodenal Ulcers

A

most common
well nourished
Pain 2-3 hours after meals
EATING DECREASES PAIN

41
Q

What will you see with Gastric Ulcers

A

Weight loss
Pain 30 min-1hr after eating
vomiting
EATING INCREASES PAIN

42
Q

How do you approach treatment and diagnosis for Peptic Ulcer Disease

A

Test then Treat (H Pylori Prevalence High)
OR
Empiric (H Pylori Prevalence Low)

43
Q

How are you going to treat PUD if H Pylori prevalence is low

A

Empirically - PPI for 4-8 WEEKS
no improvement? test for H Pylori

44
Q

How are you going to treat PUD if H Pylori prevalence is high

A

Test for H Pylori then Treat

Triple therapy (first line) - PPI, clarithromycin, amoxicillin for 14 d
Quadruple Therapy (2nd line) - PPI, Bismuth, tetracycline, metronidazole

45
Q

What are the most significant complications of PUD

A

gastric bleeding, perforation, or outlet obstruction

46
Q

What is the most common cause of death in patients with PUD

A

Gastrointestinal bleeding… usually artery so bright red

47
Q

What percentage of peptic ulcers cause perforation?

A

5%

48
Q

Where does perforation due to peptic ulcers usually occur

A

anteriorly through the duodenum or lesser curve of the stomach

49
Q

How will patients present if they have a perforation due to peptic ulcer

A

fever, tachy, dehydration… the thorax will appear distended, tight, hyper resonant, and the patient does not want to be touched

50
Q

What may you see on CXRay

A

Pneumoperitoneum
free air under the diaphragm

51
Q

What is another acute or chronic complication you can see with PUD

A

Gastric Outlet Obstruction

52
Q

How will patients present with a Gastric Outlet Obstruction

A

Severe hypochloremic hypokalemic alkalosis

this must be corrected prior to sx

53
Q

motility disorder characterized by heartburn and caused by the reflux of gastric contents into the esophagus

A

Gastroesophageal reflux disease (GERD)

54
Q

Patient presents with heartburn, generally worse after meals or lying down. Often already taken antacids … they may also have regurgitation and dysphagia
what are you thinking?

A

GERD

55
Q

What is GERD caused by?

A

LES not closing allowing for reflux of gastric contents into esophagus causing burning pain

56
Q

If you hear these 3 words in a vinet I immediately want you to think what

Heartburn, dysphagia, regurgitation

A

GERD!!!!!

57
Q

Exacerbating factors

A

Obesity or increased weight
Fatty foods
caffeine
carbonated beverages
ETOH
tobacco
drugs
peppermints
chocolate

58
Q

How do you diagnose GERD

A

You can diagnose it with history alone usually

59
Q

What will you hear in clinic from GERD patients

A

nongastro symptoms
wheezing
asthma exacerbation
nocturnal cough or choking
hoarseness
Anemia
enamel erosion
halitosis

60
Q

What must you also exclude if patient has chest pain before gastro evaluation

A

cardiac causes

61
Q

If patient has ALARM symptoms or if they haven’t improved on PPIs, what are you going to do

A

Endoscopy

62
Q

What are you going to start GERD patients on

A

PPI

63
Q

What are lifestyle modifications you can recommend to GERD patients

A

stop smoking
lose weight
avoid fatty foods, alcohol, coffee, chocolate
elevate head of bed
dont lie down after meal

64
Q

What are pharmacological treatment options

A

PPI
H2 blockers (tidine)
Vitamin B12 and calcium supplementations if taking PPIs prolonged

65
Q

What is the surgery option for treatment of GERD

A

Fundoplication

66
Q

How should you treat GERD in pregnancy

A

antacid therapy, lifestyle modification, or sucralfate

67
Q

History of chronic GERD which causes metaplastic change in the lining of the distal esophagus

A

Barrett Esophagus

68
Q

What is Barrett esophagus associated with a risk for

A

adenocarcinoma of the esophagus

69
Q

What population is Barrett Esophagus predominantly found in?

A

Middle aged white males

70
Q

What are the risk factors for Barrett esophagus

A

long standing frequent reflux, smoking, male, older, central obesity

71
Q

What do almost all Barrett Esophagus patients have

A

hiatal hernia

72
Q

What is diagnostics for Barrett Esophagus

A

endoscopy

73
Q

Treatment for Barrett Esophagus

A

PPIs, lifestyle modifications

74
Q

Management of Barrett Esophagus with no Dysplasia and cancer risk

A

upper endoscopy every 3-5 years
0.2% per year

75
Q

Management of Barrett Esophagus with LOW grade dysplasia and cancer risk

A

upper endoscopy annually OR endoscopic treatment with radio frequency ablation

0.7% per year, but may be as high as 8%

76
Q

Management of Barrett Esophagus with HIGH grade dysplasia and cancer risk

A

radio frequency ablation

7-19% per year

77
Q

What is the most common cancer/ gastric neoplasm of the stomach?

A

ADENOCARCINOMA

78
Q

patient present with weight loss, early safety abdominal pain/fullness and dyspepsia
what are you thinking

A

Adenocarcinoma of stomach

79
Q

Are adenocarcinoma of the stomach patients usually asymptomatic

A

yes

80
Q

Are males or females more likely to get adenocarcinoma

A

2x more common in males

81
Q

What is the most important risk factor for gastric neoplasms

A

H pylori

you may also see Virchow’s node (above clavicle) or sister Mary joseph’s node (belly button)

82
Q

Projectile vomiting that occurs shortly after feeding an infant <3mo old

A

Pyloric Stenosis

83
Q

What is the buzz word for the PANCE with Pyloric Stenosis

A

Olive like mass

84
Q

Diagnostics for pyloric stenosis

A

ultrasound and/or barium studies

Gastro Exam 1 (2 decks)

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