Gastritis & Peptic Ulcer Disease Flashcards
inflammation, infection, or damage to the stomach’s mucosal lining
gastritis
gastric irritation and atrophy caused by cellular changes or weakened host mechanisms
nonerosive gastritis
what are the 2 most common causes of nonerosive gastritis?
pernicious anemia
H. pylori
auto-immune disease resulting in B12 malabsorption due to decreased intrinsic factor
pernicious anemia
what is the treatment for nonerosive gastritis caused by pernicious anemia? (2)
parenteral B12
PPI
how does H. pylori cause nonerosive gastritis?
H. pylori secretes ammonia which breaks down the mucosal layer
nonerosive gastritis caused by H. pylori in the body of the stomach would result in what?
gastric atrophy and irritation
nonerosive gastritis caused by H. pylori in the atrum of the stomach would result in what?
erosions and ulcers
a patient presents with anorexia, mid-epigastric pain and tenderness, and nausea. Dx?
nonerosive gastritis caused by H. pylori
what are 3 non-invasive diagnostics that can be used for nonerosive gastritis caused by H. pylori?
fecal antigen immunoassay
urea breath test
serological ELISA
what do fecal and breath tests both require?
D/C of PPI for 7-14 days and antibiotics for 28 days
what is an invasive diagnostic that can be used for nonerosive gastritis caused by H. pylori?
upper endoscopy with biopsy
what is the treatment for nonerosive and erosive gastritis caused by H. pylori?
standard triple therapy
PPI + clarithromycin + amoxicillin (metronidazole if PCN allergy)
when should we test for eradication after completing the standard triple therapy?
> 4 weeks after completing treatment
when should we expect for symptoms to improve after starting treatment for erosive and nonerosive gastritis caused by H. pylori?
7-14 days from starting therapy
gastric mucosal erosion either due to inhibition of normal mucosal defenses allowing gastric fluids to damage tissues OR due to local damage from ingested items
erosive and hemorrhagic gastritis
what are the 2 most common causes of erosive and hemorrhagic gastritis?
NSAIDs
H. pylori antral infection
a patient presents with loss of appetite (anorexia), mid-epigastric pain and tenderness, nausea, nasogastric suction with coffee-ground or bright red blood, and possible melena on digital rectal exam. Dx?
erosive and hemorrhagic gastritis
what is the diagnostic of choice for erosive and hemorrhagic gastritis?
upper endoscopy (EGD)
what is the treatment for stress-induced erosive and hemorrhagic gastritis? (3)
continuous PPI infusion
PO sucralfate
+/- endoscopic repair
what should all severely ill/injured patients with erosive/hemorrhagic gastritis be treated with?
prophylactic PPI PO/IV
what is the treatment for NSAID-induced erosive and hemorrhagic gastritis? (4)
D/C NSAID / reduce to minimal dose / switch to selective COX-2 inhibitor
take NSAID with food
PPI for 2-4 weeks
+/- endoscopy if symptoms don’t improve
what are the treatment options for alcohol or irritant foods-induced erosive and hemorrhagic gastritis? (3)
D/C offending agent
PPI
H2 blocker
sucralfate
all for 2-4 weeks
what is the treatment for portal hypertension-induced erosive and hemorrhagic gastritis? (3)
propranolol
treat liver disease
PPI / sucralfate
destruction of the gastric or duodenal mucosa by digestive factors, like acid and pepsin, due to impaired or overwhelmed mucosal defense mechanisms
peptic ulcer disease
where do ulcers usually extend to and how big are they?
through muscularis mucosae
> 5mm in diameter
in which structure is PUD most commonly found?
duodenum
what are the 2 most common causes of PUD?
H. pylori (#1)
NSAID usage (#2)
a patient presents with anorexia, nausea, mid-epigastric pain and tenderness, hunger-like/gnawing pain, and pain that worsens 2-5 hours after a meal that is improved with food buffers. Dx? Tx?
peptic ulcer disease
standard triple therapy
PPI (omeprazole) + clarithromycin + amoxicillin (metronidazole)
a patient suspicious for PUD; physical exam shows rigid abdomen, guarding, and peritoneal sigs. what is the Dx?
PUD + perforated ulcer
in a patient with PUD, free air on upright x-ray indicates _____
perforation
what is the definitive diagnostic for PUD?
upper endoscopy
what do red flags with ulcer or gastritis symptoms require?
EGD
what are the ulcer and gastritis red flags? (9)
onset of sx > 50 yo
progressive dysphagia
odynophagia
recurrent vomiting
Sx despite appropriate treatment
+ FOBT, melena, hematemesis, anemia
severe abdominal pain
weight loss
FHx of GI cancer in 1st degree relative
