Gastric disorders Flashcards
Dyspepsia- Eti
- 15% adult population
- 3% office visits
- Functional dyspepsia is most common
- Ulcers in 5%
Dyspepsia- Sx
- Epigastric pain/ burning
- Postprandial fullness
- Hx- chronic, location, qualatiy
- N/V
Dyspepsia- Dx
- Endoscopy
- Test for H pylori
- Imaging if complicated
Dyspepsia- Tx
- PPI
- Reduce offending foods/ medications
Zollinger-Ellison syndrome- Eti
- Gastrin- secreting neuroendocrine tumors (gastrinoma)
- Hypergastrinemia & acid hyper secretion
- Arise in pancreas duodenal wall, lymph or other locations
Zollinger-Ellison syndrome- Sx
- Soliatry peptic ulcer in proximal duodenal bulb
- GE reflux symptoms
- Diarrhea, steatorrhea, wt loss
- Metastases to liver
Zollinger-Ellison syndrome- Dx
- Somatostatin receptor scintigraphy
- Endoscopic ultrasonography
- Secretin stimulation
Zollinger-Ellison syndrome- Tx
- PPI
- Surgical removal of gastrinoma
Peptic ulcer disease- Risks
- NSAIDs (steroids)
- H. pylori
- genetics
- Renal failure, cirrhosis, & COPD
Peptic ulcer disease- Eti
5-10% population
- Increase with age
- 45% NSAIDs
- 45% H. pylori
- M>W
- Smokers
- 500,000 new cases/ year
Peptic ulcer disease- Sx
- Sharp burning in upper quadrants, epigastric
- Nausea
- Hunger or fullness
- Gastric- worse after eating
- Duodenal- 2-3 hrs after eating, awaken from sleep
H. pylori- Risks
- Developed countries
- low socioeconomic
- Acquired in first 10 yrs
- Infected parents
Diabetic gastroparesis- Eti
- Gastric obstruction due to endocrine dysfunction
Diabetic gastroparesis- Sx
- Chronic or intermittent gastroparesis
- Early satiety, bloating, N/V 1-3 hrs after meals
Diabetic gastroparesis- Dx
- Exclude mechanical obstruction
- Abd xray: dilation of stomach investing or colon resembling mechanical obstruction
Diabetic gastroparesis-
- Maintina glucose < 200
- Small, frequent meals low in fiber, daily, & fat
Erosive gastritis- Eti
- Common in alcoholic, critically ill or NSAIDs
Erosive gastritis- Sx
- Asymptomatic
- Coffee ground emesis, bloody aspirate, melena
- Dyspepsia, anorexia, epigastric pain
Erosive gastritis- Dx
- Endoscopy
Erosive gastritis- Tx
- PPI
- Discontinue offending organism
Pernicious Anemia Gastritis- Eti
- Autoimmune disorder involving fundic gland
- Achlorhydria, intrinsic factor secretion, and B12 malabsorption
Pernicious Anemia Gastritis- Sx
- Hypergastremia
- Gland atrophy and interstitial metaplasia
Pernicious Anemia Gastritis- Dx
- Endoscopy biopsy
- Anti-intrinsic factor
- Macrocytic anemia
Pernicious Anemia Gastritis- Tx
- Screen for adenocarcinoma & carcinoids
- Vit B12
H, pylori- Sx
- Transient illness of nausea, abd pain and gastritis
- Diffuse mucosal inflammation
H. Pylori- Dx
- Fecal antigen assay
- Urea breath test
- Must discontinue PPI
H. pylori- Tx
- Triple tx: Omeprazole, calrithromycin and amox
- Quad tx: resistant disease
Gastric malignancy- Eti
- Adenocarcinoma most common
- Gastric lymphoma due to H. pylori
- M> W
- Intestinal= envt, older 70-80%
- Diffuse = hereditary, younger
Gastric malignancy- Sx
- Asymptomatic until advanced
- Dyspepsia, epigastric pain
- Anorexia, early satiety
- Postprandial vomitin
Gastric malignancy- Dx
Endoscopy
Gastric malignancy- Tx
Surgical resection
Hiatal hernia- Eti
- Assoc with GERD, Barett esophagus
- Stomach protrusion through LES
Hiatal hernia- Tx
Surgically tighten sphincter
Nonspecific gastritis- Eti
- H. pylori & associated with pernicious anemia
- Eosinophilia
- Diffuse mucosal inflammation
