Gastritis and PUD

Question 0

Antrum vs. fundus

Answer 0

Antrum = near the outlet
Fundus = near the inlet (esophagus)

Question 1

Types of gastritis and their causes

Answer 1

Acute: rapidly developing, superficial lesions that are often 2/2 NSAIDs, alcohol, H. pylori, and stress from severe illness

Chronic:

• Type A: occurs in the fundus 2/2 autoantibodies to parietal cells; causes pernicious anemia (lack of IF). a/w other autoimmune disorders
• Type B: occurs in the antrum 2/2 NSAIDs or H. pylori. much more common

Question 2

Types of stress ulcers

Answer 2

Curling ulcers: stress ulcers a/w burn injuries

Cushing ulcers: stress ulcers a/w TBI

Question 3

Dx of gastritis

Answer 3

Upper endoscopy: visualize gastric mucosa

Double-contrast upper GI series is less sensitive than EGD

Question 4

H. pylori diagnosis

Answer 4

Urease breath test: active infection
IgG antibodies against H. pylori: past infection
Stool antigen test: active infection
Endoscopic biopsy: active infection

Question 5

Triple therapy

Answer 5

Amoxicillin, clarithromycin, omeprazole
Used to treat H pylori infections
-if allergic to PCN, use metronidazole instead of amoxicillin

Question 6

Gastritis vs PUD

Answer 6

Gastritis: irritation of the gastric lining, no erosion
Ulcer: erosion past the muscularis mucosa

Clinical:

• Gastritis will be dyspepsia (functionally indistinguishable from GERD)
• PUD will be dyspepsia with pain on eating, pain radiating to the back, and maybe some weight loss.

Question 7

Signet ring cells

Answer 7

Found on biopsy in diffuse type gastric cancer (two types of gastric cancer, intestinal and diffuse)

Question 8

Krukenberg tumor

Answer 8

Gastric adenocarcinoma that metastasize to the ovary

Question 9

MALT lymphoma

-what is it, what causes it, how to treat it

Answer 9

Rare gastric tumor that presents in patients w/ chronic H pylori infection
Only malignancy that can be cured with triple therapy

Question 10

Types of gastric cancer

Answer 10

Intestinal vs diffuse

• intestinal: differentiated cancer that originates from gastric mucosal cells; a/w H. pylori
• diffuse: undifferentiated cancer not a/w H. pylori or chronic gastritis; biopsy shows signet ring cells

Question 11

Virchow node

Answer 11

Enlarged left supraclavicular LN seen with gastric cancer

Question 12

Tx for gastric cancer

Answer 12

MALT lymphoma: triple therapy (amp + clarithro + omeprazole)

Others: gastric resection if detected early

Question 13

What percentage of PUD is caused by H pylori?

Answer 13

90% of duodenal ulcers, 70% of gastric ulcers

Question 14

Meal dependent pain and PUD

Answer 14

Pain after a meal: gastric ulcer

Pain resolves with meal: duodenal ulcer

Question 15

Diagnostic steps for suspected PUD

Answer 15

First rule out perforation:

• for gastric ulcers: AXR can rule out perforation (would see free air under diaphragm)
• for duodenal ulcers: get a CT scan with contrast to see if there is retroperitoneal air

Then upper endoscopy with biopsy: all gastric ulcers need to be biopsied to rule out gastric cancer

H pylori testing

Question 16

How to diagnose Zollinger Ellison syndrome?

Answer 16

Increased fasting gastrin levels
Increased gastrin levels with administration of secretin
These are diagnostic tests

Localize tumor with CT or octreotide scan and resect

Question 17

Acute management of PUD

Answer 17

If perforation suspected: get a CT w/ contrast to check
If +, then laparotomy required

Rule out active bleeding: rectal vault exam, NG lavage, serial hct
Tx w/ IVF, blood transfusions, IV PPI
Urgent EGD to control suspected bleeding

Question 18

Long-term management of PUD

Answer 18

Medical therapy:

• antacids, PPI, or H2 blockers for mild dz
• triple therapy for H pylori infection

Question 19

What drug to give patients with PUD who need NSAIDs?

Answer 19

Misoprostol

Question 20

Gastroparesis: what is it, how to treat it

Answer 20

Low motility of the GI tract likely 2/2 diabetic neuropathy of GI tract
Tx: metoclopramide, erythromycin, or bethanacol