Gastric Disorders Flashcards by Jacqui Joseph

Injury of gastric mucosa is ________

irritation of esophageal mucosa is ____________

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

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

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

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

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parietal cells of the gastric lumen secrete HCl and ____

weeds

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

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prostoglandins help do what in the gut?

protect mucus lining

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

Gastritis is inflammation of gastric mucosa

Ulcer is penetration of the mucosa

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reflux- heartburn is felt where?

substernal

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gastritis/PUD pain is where? how it described?

epigastric pain, often described as “gnawing”

vs. burning, chest pain, acidic pain of GERD

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

unreliable, may be relieved or exacerbated by eating

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N/V may indicate____

obstruction

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sudden, severe pain w/ peritoneal signs may indicate _______

perforation

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hematemesis, melena suggest ______

hemorrhage, GI bleed

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blood acted on by acids looks like ?

coffee grounds

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

onset at > 45 yo
wt. loss
recurrent vomiting
dysphagia
heme-pos. stools/ severe anemia
strong FH of GI cancers
epigastric mass

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any alarm signs need what for Dx ?

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

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

now is a good time to endoscope

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

post-prandial cramping and murphy’s sign pain

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PE for gastritis/PUD?

not very helpful, possible epigastric tenderness

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what do we need for Dx of gastritis/PUD?

UGI/Ba++ swallow or EGD

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barium sticks to _____ or ______

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

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

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

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what is the CLO test?

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

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EGD endoscopy asses _______, _______ and _______

bleeding, reflux and dysphagia

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erosive gastritis vs NSAID gastritis on EGD?

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

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what is atrophic gastritis?

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

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atrophic gastritis may be related to _____, _____ or _______

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

atrophic gastritis may progress to _____

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

what are the risk factors for developing a perforation?

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

how does a bowel perforation present?

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

Xray of perforation shows what?

FREE AIR UNDER DIAPHRAGM

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

barium will stay in the gastric cavity for a while | - use water-soluble gastrograffin instead!

Txt for gastritis/PUD?

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

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

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

what are the two surgery options for gastritis/PUD?

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

heliobacter pylori formerly known as ________

campylobacter

H. Pylori: colonizes.... | hydrolyzes...

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

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

H pylori

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

inflammation

how is H pylori transmitted?

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

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

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

H. Pylori is NOT related to _____ or ______

Is NOT related to nonulcer dyspepsia or GERD

best non-invasive Dx test for H pylori

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

hadley's favorite test for H pylori

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

what is the "gold standard" test for H pylori

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

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

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

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?

EGD not necessary for everyone

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

urea breath or stool antigen | - dont need to do if symptoms have gone away

Standard Txt for H pylori?

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)

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

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)

who do we NOT test for H pylori?

Non-chronic symptoms suggestive of GERD

PPIs for H pylori, you must dose with what?

meal! (prior to meal)

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

worst: ASA | least offender: Cox2 inhibitors

4 part Txt of NSAID ulcer

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)

do NOT use acetaminophen if the pt has _______

liver disease

NSAIDs can cause an issue to what other organ system?

kidneys!

avoid NSAIDS for people older than ___ yo

what is zolinger-ellison syndrome?

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

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

Surgical option if no: metastases MEN I (multiple endocrine neoplasms) short life expectancy Symptomatic treatment otherwise: PPI, possible antrectomy/vagotomy

gastroparesis

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

normal emptying time for the stomach?

20 min

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

DM; early satiety or post-prandial nausea

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

functional

non-ulcerative dyspepsia Dx

Dx of exclusion– no ulcer/gastritis, no GERD

non-ulcerative dyspepsia may be caused by what?

H pylori infection

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

For bleeders, perforation, obstruction - ->Selective vagotomy - ->Excision of ulcer

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

low | NSAIDS/OTC meds