Brainscape's Knowledge GenomeTM

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


See full index

clin med > Gastric Disorders > Flashcards

Gastric Disorders Flashcards

1
Q

Injury of gastric mucosa is ________

irritation of esophageal mucosa is ____________

A

injury of gastric mucosa: gastritis/peptic ulcer disease (PUD)
injury of esophageal mucosa: GERD

*these are separate diseases, they do NOT cause each other!

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

where is HCl produced in the stomach and how does this occur? (weeds)

A

H+/K+ ATPase (proton pump)
Cl– follows H+ into lumen
Sodium bicarbonate transported to blood as counter ion

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

parietal cells of the gastric lumen secrete HCl and ____

weeds

A

Also secrete Instrinsic Factor, which protects vitamin B12 in acid environment

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

prostoglandins help do what in the gut?

A

protect mucus lining

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

what is the one main difference between gastritis and peptic ulcer disease (otherwise they are similar)

A

Gastritis is inflammation of gastric mucosa

Ulcer is penetration of the mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

reflux- heartburn is felt where?

A

substernal

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

gastritis/PUD pain is where? how it described?

A

epigastric pain, often described as “gnawing”

vs. burning, chest pain, acidic pain of GERD

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

Gastric vs. duodenal ulcer pain response to food is …?

A

unreliable, may be relieved or exacerbated by eating

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

N/V may indicate____

A

obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

sudden, severe pain w/ peritoneal signs may indicate _______

A

perforation

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

hematemesis, melena suggest ______

A

hemorrhage, GI bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

blood acted on by acids looks like ?

A

coffee grounds

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

for any dyspepsia, what are the alarm signs? (7)

A 
onset at > 45 yo
wt. loss
recurrent vomiting
dysphagia
heme-pos. stools/ severe anemia
strong FH of GI cancers
epigastric mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

any alarm signs need what for Dx ?

A

Urgent endoscopy in these patients to rule out perforation, gastric cancer or obstruction

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

non-alarm sign but not getting better? …what will you do?

A

now is a good time to endoscope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

gallbladder inflammation is a Ddx for gastritis/PUD but this presents more with what?

A

post-prandial cramping and murphy’s sign pain

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

PE for gastritis/PUD?

A

not very helpful, possible epigastric tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what do we need for Dx of gastritis/PUD?

A

UGI/Ba++ swallow or EGD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

barium sticks to _____ or ______

A

ulcerated or inflamed tissue (makes it a good Dx test for these)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

noninvasive Dx tests for H pylori: which is a very good one? which is the most common one?

A

best: stool antigen test
common: Breath test 13C released by urease activity (must be off PPI for one month prior to this test)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the CLO test?

A

Campylobacter-like organism (CLO) test: Tissue biopsy and test for urease activity

*-Campylobactor is a Hpylori-like organism, these hydrolyze (split) the urea so that its detection means positive for these

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

EGD endoscopy asses _______, _______ and _______

A

bleeding, reflux and dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

erosive gastritis vs NSAID gastritis on EGD?

A

erosive: looks like mucosal inflammation
NSAID: “shotgun” pattern - little black spots of NSAIDs seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is atrophic gastritis?

A

chronic inflammation of the gastric mucosa with loss of the gastric glandular cells and replacement by intestinal-type epithelium and fibrous tissue.
-decrease in glandular cells = loss of secretory mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

atrophic gastritis may be related to _____, _____ or _______

A

alcohol, Hpylori, or Vit B12 deficiency (from decrease in intrinsic factor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

atrophic gastritis may progress to _____

A

adenocarinoma (b/c it is a chronic inflammation issue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the risk factors for developing a perforation?

A

Age >45, H. pylori, NSAID/steroid use, smoking, known Hx of PUD

28
Q

how does a bowel perforation present?

A

Sudden, severe epigastric pain, peritoneal signs (guarding, rigidity, etc.), N/V
Low grade fever, leukocytosis

29
Q

Xray of perforation shows what?

A

FREE AIR UNDER DIAPHRAGM

30
Q

why can’t we use barium contrast if there is a possible bowel perforation? what can we use instead?

A

barium will stay in the gastric cavity for a while

- use water-soluble gastrograffin instead!

31
Q

Txt for gastritis/PUD?

A 
Treat H. pylori (if that was the cause) 
H2 blockers
Proton pump inhibitors
Avoidance of NSAIDs and ETOH
surgery
32
Q

what is a vagotomy and why does it work for gastritis/PUD?

A

removal of vagus nerve branch (to get rid of the Ach input that is causing the gastritis/PUD)

33
Q

what are the two surgery options for gastritis/PUD?

A

Surgery– antrectomy (antrum of stomach), vagotomy (vagus nerve branch)

34
Q

heliobacter pylori formerly known as ________

A

campylobacter

35
Q

H. Pylori: colonizes….

hydrolyzes…

A

Colonizes gastric type mucosa. Is extremely sensitive to acid
Hydrolyzes urea to create a neutral pH for itself

36
Q

what is the cause of “garden variety” PUD? (the major etiological factor)

A

H pylori

37
Q

H Pylori causes direct cell damage, increases permeability of free radical and increases ______

A

inflammation

38
Q

how is H pylori transmitted?

A

close human contact through oral-oral in industrialized world and fecal-oral in developing world, we think

39
Q

Recurrence of ulcer after eradication is 2-4%, compared to ___% when infection persists. what does this mean?

A

80% so eradication works; i.e. there is a cure for ulcers

40
Q

H. Pylori is NOT related to _____ or ______

A

Is NOT related to nonulcer dyspepsia or GERD

41
Q

best non-invasive Dx test for H pylori

A

urea breath testing
Relies on 13C labeling of orally digesting urea and checking the lungs for excretion (as 13CO2)
Positive test indicates active infection.

second: stool antigen test

42
Q

hadley’s favorite test for H pylori

A

CLO test : Rapid Urease Test: (aka CLO test, Hp-fast, HUT test)
Tissue placed in medium, change in pH with urease activity

43
Q

what is the “gold standard” test for H pylori

A

invasive test: Histologic and culture testing: Gold Standard; cost is a factor, though, and it is slow

44
Q

what are the noninvasive tests for H pylori? (weeds maybe)

A

urea breath
stool antigen
serum whole blood antibody
salivary and urinary assays

45
Q

It is reasonable in the patient who has positive test for H. pylori and no alarm signs, to treat the presumed infection and follow up for resolution of symptoms. what is the significance of this?

A

EGD not necessary for everyone

46
Q

test for eradication of H. Pylori? do we have to do this for everyone?

A

urea breath or stool antigen

- dont need to do if symptoms have gone away

47
Q

Standard Txt for H pylori?

A

triple therapy (or quadruple) - but 3 components change frequently
-Any PPI BID, Amoxicillin 1 g BID, Clarithromycin 500 mg BID
Treat for 2 wk
Can add bismuth (Pepto-Bismol)- (for quadruple)

can also do metronidazole (in place of Clarithromycin)

48
Q

who do we test for H pylori (4 groups) ?

A
  1. Evidence of active ulcer/gastritis
  2. Asymptomatic pts w/documented H/O disease and are on anti-secretory meds (hides symptoms)
  3. F/H of gastric cancer
  4. MALT lymphomas (mucus assoc. lymphoid tissue)
49
Q

who do we NOT test for H pylori?

A

Non-chronic symptoms suggestive of GERD

50
Q

PPIs for H pylori, you must dose with what?

A

meal! (prior to meal)

51
Q

which are the worst offenders of NSAID-induced- ulcers? which one spares most prostaglandin production (and therefore is less likely a cause of this? )

A

worst: ASA

least offender: Cox2 inhibitors

52
Q

4 part Txt of NSAID ulcer

A
  1. Stop the NSAID; use lowest possible dose for shortest possible time
  2. Give: misoprostol, PPI, H-2 blocker
  3. Switch to acetaminophen/COX-2 specific
  4. Warn patients of the risk, Caution the use of combination products (e.g. Goody or B.C. powders, others)
53
Q

do NOT use acetaminophen if the pt has _______

A

liver disease

54
Q

NSAIDs can cause an issue to what other organ system?

A

kidneys!

55
Q

avoid NSAIDS for people older than ___ yo

A

70

56
Q

what is zolinger-ellison syndrome?

A

Gastrinoma (in pancreas “asking” stomach to make more acid) causing hyperplasia of the gastric glands
Causes serious ulcers
(Acid hypersecretion)

57
Q

Txt for zollinger-ellison syndrome: surgical option if there is no _____, ______ or _________. Symptomatic treatment?

A

Surgical option if no:
metastases
MEN I (multiple endocrine neoplasms)
short life expectancy

Symptomatic treatment otherwise:
PPI, possible antrectomy/vagotomy

58
Q

gastroparesis

A

an autonomic neuropathy (usually mediated in walls of GI). You’re not getting the big contractions that you need for digestion.

59
Q

normal emptying time for the stomach?

A

20 min

60
Q

gastrpoparesis is common in what pts? what are the signs?

A

DM; early satiety or post-prandial nausea

61
Q

non-ulcerative dyspepsia is a _______ disorder, similar to IBS.

A

functional

62
Q

non-ulcerative dyspepsia Dx

A

Dx of exclusion– no ulcer/gastritis, no GERD

63
Q

non-ulcerative dyspepsia may be caused by what?

A

H pylori infection

64
Q

PUD surgery: for ________, _______ or ______. And what are the two surgical options for these patients?

A

For bleeders, perforation, obstruction

  • ->Selective vagotomy
  • ->Excision of ulcer
65
Q

Relapse rates for treated ulcers are ______; suspect ________ if relapse occurs

A

low

NSAIDS/OTC meds

clin med (88 decks)

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