Gastric Disorders

Question 1

gastritis ddx

Answer 1

pancreatitis, gastric/pancreatic CA, hypertrophic gastropathy, functional dyspepsia, PUD, viral/larval inf, pernicious anemia gastritis

Question 2

gastritis wu

Answer 2

urgent EGD for alarm sx (sev pain, wt loss, V, GIB, anemia)

Question 3

gastritis mgmt

Answer 3

• PPI > H2 for tx NSAID-related dyspepsia & healing ulcers
• propranolol for portal HTN
• H. pylori tx (CAP x 10-14 days)

Question 4

gastritis ddx if severe pain

Answer 4

esophageal rupture, gstric volvulus, ruptured AA

Question 5

H. pylori wu

Answer 5

fecal or urea breath test > antibody serum test

Question 6

H. pylori tx

Answer 6

CAP x 10 - 14 days (amoxicillin, tetracycline (not < 12 y.o.), metronidazole, or clarithromycin + ranitidine or PPI)

Question 7

benign gastric neoplasms

Answer 7

polyps (can become malignant - bx), lipoma, fibroma, glomus tumor, hemangioma (abnormal cluster of small blood vessels)

Question 8

malignant gastric neoplasms

Answer 8

• leiomyosarcoma (smooth muscle, rare, local resection, mets rare)
• lymphoma (MALT (mucosa-associated lymphoid tissue) or diffuse large B cell (non-Hodgskin))
• sarcoma (GIST - gastrointestinal stromal tumor)
• adenocarcinoma

Question 9

Gastric adenocarcinoma epi & RF

Answer 9

• korea/japan/china, age 60

- pickled/salted/smoked foods, H. pylori, atrophic gastritis, polyps, radiation

Question 10

Gastric adenocarcinoma s/s

Answer 10

• early: asx
• indigestion, N, early satiety, anorexia, wt loss, palpable stomach, hepatomegaly, pallor, Virchow’s nodes (L supraclav), Sister Mary Joseph nodes (umbilical)
• advanced: pleural effusions, SBO, bleeding

Question 11

gastric adenoma wu

Answer 11

EGD preferred, endoscopic US for tumor depth, barium swallow, CT pelvis/chest/abd for mets

Question 12

gastric adenoma mgmt/prog

Answer 12

• stage-dependent, resection (Billroth (low/antrum resection - greater curve/jejunum anastamosis) or roux-en-Y (stomach bypass to small intestine)), chemo, rad, adjuvants prn
• poor due to poor cure & recurrence

Question 13

PUD eti/prev

Answer 13

• H. pylori, chronic NSAIDs, cigs, CMV in transplant pts, Crohn’s
• misoprostol if NSAID = must, cox-2 inhibs (Celebrex) instead of NSAID, PPI/high-dose H2
• # 1 cz of upper GIB

Question 14

PUD RF, S/S

Answer 14

• age, anticoag, steroid, NSAID, chronic dz
• epigastric pain, non-radiating, gastric ulcers worse after meals, duodenal ulcers better after meals, pain wakes from sleep (2-3am)

Question 15

PUD WU

Answer 15

EGD w/ bx for def dx, barium upper GI less sensitive, text for H. pylori

Question 16

PUD tx

Answer 16

• bland diet NOT effective
• tx H. pylori (CAP x 10-14 d)
• quit cigs
• H2 x 6-8 wks
• PPI x 4-8 wks (preferred)

Question 17

Pyloric stenosis epi, s/s, wu, mgmt

Answer 17

• 3-6 w.o., 1st born male
• projectile/nonbilious V, hunger, palpable olive, poor wt gain, visible peristaltic waves
• US (thickened stomach muscle, preferred), KUB (caterpillar sign - distended, hypertrophic stomach)
• ref for surgical pyloromyotomy