Gastric Disorders Flashcards
2 disorders that cause injury of gastric mucosa are ________
disorder that causes injury 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!
parietal cells of the gastric lumen secrete HCl and ____
Intrinsic Factor, which protects vitamin B12 in acid environment
prostoglandins help do what in the gut?
protect mucus lining
what is the difference between gastritis and peptic ulcer disease and gastropathy
Gastritis is superficial inflammation of gastric mucosa with mucosal injury
Ulcer is penetration of the mucosa
Gastropathy: mucosal injury without inflammation
most common cause of gastritis + other causes. common clinical presentation
#1 is H. pylori, other causes = NSAIDS, ASA, acute stress, alcohol CP = most commonly AS if sxs, epigastric pain, often described as “gnawing” and other similar sxs as PUD (vs acidic, burning, reflux pain like GERD)
Gastric vs. duodenal ulcer pain response to food is …?
gastric usually pain with eating and duodenal is pain after eating
hematemesis, melena suggest ______
hemorrhage, GI bleed
any alarm signs need what for Dx ?
Urgent endoscopy in these patients to rule out perforation, gastric cancer or obstruction
non-alarm sign but not getting better? …what will you do?
now is a good time to endoscope
barium sticks to _____ or ______
ulcerated or inflamed tissue (makes it a good Dx test for these)
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
EGD endoscopy assesses _______, _______ and _______
bleeding, reflux and dysphagia
erosive gastritis vs NSAID gastritis on EGD?
erosive: looks like mucosal inflammation
NSAID: “shotgun” pattern - little black spots of NSAIDs seen
what is atrophic gastritis and where does it normally occur?
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
normally occurs in fundus and body
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)
Xray of bowel 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!
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)
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
how is H pylori transmitted?
close human contact through oral-oral in industrialized world and fecal-oral in developing world, we think
H. Pylori is NOT related to _____ or ______
Is NOT related to nonulcer dyspepsia or GERD
what three tests will test for active H. pylori infection?
Non-invasive tests:
1). urea breath testing: 13C labeling of orally digesting urea and checking the lungs for excretion (as 13CO2)
2). stool antigen test
Invasive test is endoscopic tests where you take a biopsy sample and test it for H. pylori
*can use all three of these tests to confirm eradication after tx but stool antigen/urea breath prob more common
Standard Txt for H pylori?
Quadruple therapy is best PPI Tetracycline Flagyl Bismuth subsalicylate for 14 days
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
- Stop the NSAID; use lowest possible dose for shortest possible time
- Give: misoprostol, PPI, H-2 blocker
- Switch to acetaminophen/COX-2 specific
- Warn patients of the risk, Caution the use of combination products (e.g. Goody or B.C. powders, others)
what is zollinger-ellison syndrome? MC site (and others). Common CP or index of suspicion
gastrin-secreting neuroendocrine tumor which leads to severe PUD and diarrhea, MC in duodenum (also seen in pancreas, lymph nodes)
CP: pts with severe, multiple, recurrent ulcers + diarrhea
how to dx and txt zollinger-ellison syndrome. what is the most common site of metastasis?
Dx:
Best screening = elevated fasting gastrin levels (>1000) and confirm this with a secretin test (which causes severe increase in gastrin after administration)
Tx: Surgery to locally resect, if metastatic or unable to resect then med management with lifelong high dose PPIs
*MC site of metastasis is liver and associated lymph nodes
what is gastroparesis
an autonomic neuropathy (usually mediated in walls of GI). You’re not getting the big contractions that you need for digestion.
gastroparesis is common in what pts? what are the signs?
DM; early satiety or post-prandial nausea
Relapse rates for treated ulcers are ______; suspect ________ if relapse occurs
low
NSAIDS/OTC meds
how to diagnose and tx gastritis?
dx: H. pylori testing, UGD with biopsy is test of choice
tx: eradicate h. pylori with quad therapy if needed, PPI or H2 blocker to suppress acid or prophylaxis for stress gastritis, prevention of cause (like meds)
which type of ulcer is more common in PUD? which ulcer type is more likely to progress into malignancy?
duodenum more common and often younger pts, while gastric is more likely to become malignant (4% turn to gastric adenocarcinoma) and usually presents in older pts
PP behind duodenal vs gastric ulcers. what are the most common causes for PUD?
duodenal: increase in aggressive factors (H. Pylori, HCl)
gastric: decrease in protective factors (mucus, bicarbonate, prostaglandins)
* causes SAME as as gastritis: H. pylori (MC), NSAIDS/ASA more likely gastric ulcers, ETOH, smoking, stress PLUS zollinger-ellison syndrome
CP for PUD and perforated ulcer
dyspepsia (burning, gnawing epigastric pain), N/V, duodenal (pain after eating) vs gastric (pain with eating), bleeding ulcer presents with hematemesis or melena
Perforated ulcer: sudden onset severe abd pain plus peritoneal signs (rebound tenderness, guarding and rigidity)
what is the most common cause of GI bleed?
PUD
how do you dx PUD?
UGD with biopsy is TOC (best to diagnose H. pylori infection as well)
tx for PUD? what does this depend on?
tx depends on H. Pylori status
if +, then tx infection
refractory to medical therapy, can do surgical approaches of vagotomy or Bilroth II (partial gastrectomy)
when do you use EGD vs non-invasive tests to diagnose H. pylori?
if a patient doesn’t need an EGD (more likely gastritis) then do one of the other two tests first
all gastric ulcers need what repeat imaging to confirm healing?
repeat EGD, even if AS
what is pyloric stenosis, what does it lead to, and it is the MC cause of what in infants?
hypertrophy and hyperplasia of pyloric sphincter which causes functional outlet obstruction
MC cause of intestinal obstruction in infants
CP and PE for pyloric stenosis
CP: non-bilious projectile vomiting especially after feeding, maybe dehydration or weight loss
PE: olive shaped nontender abdominal pass
Dx, labs and Tx for pyloric stenosis
Dx: US shows enlongated, thickened pylorus (initial test), Upper GI series shows “string sign” (barium passing through thickened pylorus)
Labs: hypokalemic and hypochloremic metabolic alkalosis
Tx: rehydration (IV fluids) and electrolyte repletion first, pyloromyotomy definitive
MC type of gastric carcinoma, MC risk factor and others
MC type: adenocarcinoma (90%)
H. pylori is biggest RF, also smoking, preserved foods, chronic atrophic gastritis, and NHL
CP of gastric carcinoma
- Most are advanced at presentation*
- weight loss and persistent abdominal pain , early satiety, hematemesis/melena
how to dx and tc gastric carcinoma
dx: EGD with biopsy is initial test of choice
tx: endoscopic resection for early local dz, +/- chemo/radiation
which lymph node is commonly enlarged or should be examined if gastric cancer is suspected?
left supraclavicular node (virchow’s node)
what is the triple therapy tx of H pylori?
PPI, clarithromycin, and amoxicillin
