Gastro #2 Flashcards
Etiology of gastritis (4)
H. Plylori
Alcohol
Aspirin
Food
Peptic Ulcer disease
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
Where do we see defects in Peptic Ulcer Disease (2)
Stomach (gastric ulcers)
Duodenum (duodenal Ulcers)
Most common cause of duodenal ulcer vs gastric ulcer (peptic ulcer disease)
duodenal- h. pylori
Gastic- NSAIDs
does alcohol cause ulcers
Alcohol impairs healing but doesnt cause ulcers
PUD facts in red for clincal features
70% of peptic ulcers are asymptomatic
5-7% of lower GI bleeds are from an upper GI source
Clinical Features of Duodenal Ulcers
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)
Gastric Ulcers symptoms
more atypical symptoms
biopsy required to exclude malignancy! (duodenal rarely malignant)
gastric vs peptic ulcer - meals
gastric ulcer will feel WORSE, while duodenal ulcer pain will be relieved while eating
most accurate test for PUD, and what else do we need to do
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.
Zollinger-Ellison (ZE) Syndrome (Gastrinoma)
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
Zollinger-Ellison syndrome is assocaited with Multiple Endocrine Neoplasm (MEN1) syndrome - what is this related to
3 P’s= pancreatic, putuitary and parathyroid tumors
why do we need to scope suspected peptic ulcer disease in people above 45
to exclude gastric cancer
Whats H.Pylori’s shape and stuff as it relates to Peptic Ulcertaion + route of infection
gram-negative flagellated rod
most commonly acquried by fecal-oral route
H pylori is found in what % of canadians
20%
Gold standard invasive test for H pylori
Endoscopic biopsy
NSAIDS mc cause what
Gastric mucosal petechia, erosions and ulcers
NSAID ulcers usually present w these symptoms
Bleeding, perforation and obstruction
definition and loc of stress induced ulceration
ulceration or erosion in the upper GI tract of ill pts
-lesions mc in the fundus of stomach
Unclear etiology
Complication of Duodenal ulcertaion - perforated ulcer and symptoms
surgical emergency
sudden pain w/ acute abdomen: rigid, diffuse guarding
Duodenal ulceration - posterior penetration (investigation + symptom)
elevated amylase/lipase if penetration into pancreas
constant mid-epigastric pain burrowing into back
Duodenal ulcertaion - hemorrhage, what happens?
gastroduodenal artery involvement
duodenal ulceration - gastric outlet obstruction major sign
succussion splash (splashing noise heard with stethoscope over the stomach when patient is shaken)
gastric polyps - removal facts (size that should be removed)
all polyps > 1cm should be removed for biopsy
types of gastric poylps (4)
- fundic gland poylp
- Hyperplastic poylps
- Adenomatous poylps
- Multiple poylps are sus for familial polyposis syndrome
Epidemiology of gastric carcinoma (age, gender, risks)
95% gastric adenocarcinoma
m:f 3:2
50-60years old
5 signs of gastric carcinoma
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
Gastroparesis- def and symptoms
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
condiitons celic is associated with
Sjogrens, thyroid disease, T1DM
most common clinical feature of celiac??
iron deficiency anemia (pallor and fatigue)
celiac clinical features that arent anemia
improves with gluten free diet
dermatitis herptiformis (pruritic papules and vesicles on elbows, knees, buttocks, neck, scalp)
investigations for serological
serum anti-tTG iGa (anti tissue transglutaminase)
Antiendomesial antibodies
small b owel mucosal (mostly duodenum) biopsy is DIAGNOSITIC
2 major types of IBD
chrons and ulcerative colitis
chrons disease definition
Chronic transmural inflammatory disorder potentially affecting the entire gut from mouth to perianal region “gum to bum”
chron’s disease pathology terms to know + loc
ileum + ascneding colon
cobblestone appearence
granulomas
Young age, perianal disease, and need for corticosteroids have been associated with poor prognosis
clinical features of chron’s
Recurrent episodes of abdominal cramps, non-bloody diarrhea (KEY), and weight loss
Ulceritive Colitis def
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?
hallmark symptom of lcerative colitis
rectal bleeding
though it starts as non bloody diarrhea, then progresses
common complications with ulverative colitis
greater risk of colorectal cancer
toxic megacolon (colon diameter > 6cm on)
histology - chrons vs ulcerative colitis
chrons has skip lesions and granulomas
UC only mucosal, no skip lesions or granumolas
complications of chrons vs UC
CHRONS- strictures, fistuales, perianal disease
vs
US- toxic megacolon
IBS def
A disorder of chronic pain that is relieved by a bowel movement
idiopathic, diagnosis of exclusion
Rome IV criteria for diagnosing IBS
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:
- Related to defecation
- Associated with a change in frequency of stool
- 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
appendicits clinical features
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
more clinical features of appendicitis
mcburney’s sign, rovsing’s sign, psoas sign, obturator sign
appendicitis lab test for women
beta-hCG to rule out ectopic pregnancy
Hereditary Non-Polyposis Colorectal Cancer - LYNCH Syndrome (HNPCC) - but why
utosomal dominant inheritance
Mutation in a DNA mismatch repair gene
MC risk factor for colorectal carcinoma
Inflammaotry bowel disease
clinical picture of colorectal cancer
aften asymp
weakness and anemia
weight loss
imvestigastions for colorectal cancer
colonoscopy
staging
screening for colorectal cancer at 50-59 and 60-74
50-59= either gFOBT or FIT, q2 year or flexible sigmoidoscopy q10
60-74= either gFOBT, fecal immunochemical testing q2 or flexible sigmoidoscopy q10year
Diverticular disease def
abnormal outpoiching from wall of hallow organ
65% by age 85
Clinical features of diverticular disease
Episodic left lower quadrent pain
Dyspepsia def
predominant epigastric pain/buring lasting at least one month
one or more of following symptoms:
- Postprandial fullness
- early satiation
- epigartric pain or burning
