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CD 3305 > Gastro #2 > Flashcards

Gastro #2 Flashcards

1
Q

Etiology of gastritis (4)

A

H. Plylori
Alcohol
Aspirin
Food

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2
Q

Peptic Ulcer disease

A

Damage to the gastric or duodenal mucosa cause by imapired mucosal defense and/or increased acidic gastric contents

Defects superficial to the muscularis mucosa are EROSIONS and do not cause scarring

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3
Q

Where do we see defects in Peptic Ulcer Disease (2)

A

Stomach (gastric ulcers)

Duodenum (duodenal Ulcers)

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4
Q

Most common cause of duodenal ulcer vs gastric ulcer (peptic ulcer disease)

A

duodenal- h. pylori

Gastic- NSAIDs

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5
Q

does alcohol cause ulcers

A

Alcohol impairs healing but doesnt cause ulcers

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6
Q

PUD facts in red for clincal features

A

70% of peptic ulcers are asymptomatic

5-7% of lower GI bleeds are from an upper GI source

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7
Q

Clinical Features of Duodenal Ulcers

A

epigastric pain (may be localized to tip of xiphoid or radiating to t5-t8)

Burning

Develops 1-3h after meals (food intake actually relieves pain)

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8
Q

Gastric Ulcers symptoms

A

more atypical symptoms

biopsy required to exclude malignancy! (duodenal rarely malignant)

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9
Q

gastric vs peptic ulcer - meals

A

gastric ulcer will feel WORSE, while duodenal ulcer pain will be relieved while eating

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10
Q

most accurate test for PUD, and what else do we need to do

A

Endoscopy with biopsy

Zollinger-ellison syndrome needs to be ruled out with serum gastrin levels in cases of GERD and PUD that are refractory to medical management.

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11
Q

Zollinger-Ellison (ZE) Syndrome (Gastrinoma)

A

tumor of pacnreas or duodenum causes increase production of gastin

leads to ulcers, may see steathorrhea (excess fat in feces).

usually part of multiple endocrine neoplasm (MEN1) syndrome which includes pancreatic, pituitary, and parathyroid tumours

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12
Q

Zollinger-Ellison syndrome is assocaited with Multiple Endocrine Neoplasm (MEN1) syndrome - what is this related to

A

3 P’s= pancreatic, putuitary and parathyroid tumors

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13
Q

why do we need to scope suspected peptic ulcer disease in people above 45

A

to exclude gastric cancer

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14
Q

Whats H.Pylori’s shape and stuff as it relates to Peptic Ulcertaion + route of infection

A

gram-negative flagellated rod

most commonly acquried by fecal-oral route

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15
Q

H pylori is found in what % of canadians

A

20%

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16
Q

Gold standard invasive test for H pylori

A

Endoscopic biopsy

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17
Q

NSAIDS mc cause what

A

Gastric mucosal petechia, erosions and ulcers

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18
Q

NSAID ulcers usually present w these symptoms

A

Bleeding, perforation and obstruction

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19
Q

definition and loc of stress induced ulceration

A

ulceration or erosion in the upper GI tract of ill pts
-lesions mc in the fundus of stomach

Unclear etiology

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20
Q

Complication of Duodenal ulcertaion - perforated ulcer and symptoms

A

surgical emergency

sudden pain w/ acute abdomen: rigid, diffuse guarding

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21
Q

Duodenal ulceration - posterior penetration (investigation + symptom)

A

elevated amylase/lipase if penetration into pancreas

constant mid-epigastric pain burrowing into back

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22
Q

Duodenal ulcertaion - hemorrhage, what happens?

A

gastroduodenal artery involvement

23
Q

duodenal ulceration - gastric outlet obstruction major sign

A

succussion splash (splashing noise heard with stethoscope over the stomach when patient is shaken)

24
Q

gastric polyps - removal facts (size that should be removed)

A

all polyps > 1cm should be removed for biopsy

25
Q

types of gastric poylps (4)

A
  1. fundic gland poylp
  2. Hyperplastic poylps
  3. Adenomatous poylps
  4. Multiple poylps are sus for familial polyposis syndrome
26
Q

Epidemiology of gastric carcinoma (age, gender, risks)

A

95% gastric adenocarcinoma
m:f 3:2
50-60years old

27
Q

5 signs of gastric carcinoma

A

Virchows node- enlarged left supraclavicular node

Blumbers shelf- Mass in the rectouterine pouch

Krukenbergs tumor- Metastasis to ovary

Sister mary josephs nodule- Periumbilical lesion

Irish nodes- Left axillary node

28
Q

Gastroparesis- def and symptoms

A

due to neuropathy (of vagus n) caused by uncontrolled diabetes mellitus affecting the motility of stomach and beyond

ss- post prandial epigastric pain, bloating, vomiting

29
Q

condiitons celic is associated with

A

Sjogrens, thyroid disease, T1DM

30
Q

most common clinical feature of celiac??

A

iron deficiency anemia (pallor and fatigue)

31
Q

celiac clinical features that arent anemia

A

improves with gluten free diet

dermatitis herptiformis (pruritic papules and vesicles on elbows, knees, buttocks, neck, scalp)

32
Q

investigations for serological

A

serum anti-tTG iGa (anti tissue transglutaminase)
Antiendomesial antibodies

small b owel mucosal (mostly duodenum) biopsy is DIAGNOSITIC

33
Q

2 major types of IBD

A

chrons and ulcerative colitis

34
Q

chrons disease definition

A

Chronic transmural inflammatory disorder potentially affecting the entire gut from mouth to perianal region “gum to bum”

35
Q

chron’s disease pathology terms to know + loc

A

ileum + ascneding colon
cobblestone appearence
granulomas

Young age, perianal disease, and need for corticosteroids have been associated with poor prognosis

36
Q

clinical features of chron’s

A

Recurrent episodes of abdominal cramps, non-bloody diarrhea (KEY), and weight loss

37
Q

Ulceritive Colitis def

A

Inflammatory disease affecting colonic mucosa anywhere from rectum (always involved) to cecum

confined to mucosa, confined from colon to rectum

risk is less in smokers?

38
Q

hallmark symptom of lcerative colitis

A

rectal bleeding

though it starts as non bloody diarrhea, then progresses

39
Q

common complications with ulverative colitis

A

greater risk of colorectal cancer

toxic megacolon (colon diameter > 6cm on)

40
Q

histology - chrons vs ulcerative colitis

A

chrons has skip lesions and granulomas

UC only mucosal, no skip lesions or granumolas

41
Q

complications of chrons vs UC

A

CHRONS- strictures, fistuales, perianal disease

vs

US- toxic megacolon

42
Q

IBS def

A

A disorder of chronic pain that is relieved by a bowel movement

idiopathic, diagnosis of exclusion

43
Q

Rome IV criteria for diagnosing IBS

A

Recurrent abdominal pain for more than 6 mo, of at least 1/d/wk in the last 3 mo, associated with 2 or more of the following:

  1. Related to defecation
  2. Associated with a change in frequency of stool
  3. Associated with a change in form (appearance) of stool

Symptom onset at least 6 mo before diagnosis and criteria present during the last 3 mo

44
Q

appendicits clinical features

A

Abdominal pain (classic pattern: pain initially periumbilical; constant, dull, poorly localized, then well localized pain over McBurney’s point)

Flexed knee and hip in severe pain

45
Q

more clinical features of appendicitis

A

mcburney’s sign, rovsing’s sign, psoas sign, obturator sign

46
Q

appendicitis lab test for women

A

beta-hCG to rule out ectopic pregnancy

47
Q

Hereditary Non-Polyposis Colorectal Cancer - LYNCH Syndrome (HNPCC) - but why

A

utosomal dominant inheritance

Mutation in a DNA mismatch repair gene

48
Q

MC risk factor for colorectal carcinoma

A

Inflammaotry bowel disease

49
Q

clinical picture of colorectal cancer

A

aften asymp
weakness and anemia
weight loss

50
Q

imvestigastions for colorectal cancer

A

colonoscopy

staging

51
Q

screening for colorectal cancer at 50-59 and 60-74

A

50-59= either gFOBT or FIT, q2 year or flexible sigmoidoscopy q10

60-74= either gFOBT, fecal immunochemical testing q2 or flexible sigmoidoscopy q10year

52
Q

Diverticular disease def

A

abnormal outpoiching from wall of hallow organ

65% by age 85

53
Q

Clinical features of diverticular disease

A

Episodic left lower quadrent pain

54
Q

Dyspepsia def

A

predominant epigastric pain/buring lasting at least one month

one or more of following symptoms:

  • Postprandial fullness
  • early satiation
  • epigartric pain or burning

CD 3305 (15 decks)

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