Gastro - Online MedEd - misc gastric

Question 1

Gastroparesis - what is it?

Answer 1

Gastric paralysis

Stomach fails to empty

Question 2

Causes of gastroparesis

Answer 2

Idiopathic

Diabetes

Question 3

Presentation of gastroparesis

Answer 3

Delayed gastric emptying: chronic N/V, abdominal pain especially with eating
-Diabetic - peripheral neuropathy, but diabetic gastroparesis is peripheral neuropathy of vagus nerve!

Question 4

Diabetic neuropathy

Answer 4

Nerves to feet are longer than nerves to stomach

So in order for diabetic gastroparesis to occur –> must have damage to feet already

Question 5

Diagnosis of gastroparesis

Answer 5

Rule out PUD, cancers, gastric outlet obstruction
Scope negative –> go to next step, scope cannot make definitive diagnosis of gastroparesis, but might still see food in someone who has fasted
Definitive diagnosis: emptying study

Question 6

What is emptying study

Answer 6

Radiotracer with scrambled eggs
Picture at 0, 2, 4 hours
>60% at 2 hours, >10% at 4 hours = this is positive test
-Must be off opiates, off anticholinergics and have good blood glucose control

Question 7

Treatment of gastroparesis

Answer 7

Avoid opiates, avoid anticholinergics, maintain good blood glucose control

• Best agent: pro kinetic agents - metachlopramide (for stable disease, PO), arithromycin (acute flare, IV), domperidone (cardiac side effects)
• Low fiber and small volume meals

Question 8

Diabetic gastroparesis - brittle diabetics - what is there picture?

Answer 8

Really high sugars preprandially and really low post prandially
Challenging to control blood sugars

Question 9

Cyclic vomiting syndrome - what is it?

Answer 9

Linked to THC

This is not a withdrawal/dependent thing

Question 10

Presentation of cyclic vomiting

Answer 10

Habitual MJ
MJ multiple times/day
Cyclical vomiting x weeks - when get symptoms, MJ makes them feel better

Question 11

Diagnosis of cyclic vomiting

Answer 11

Clinical dx
Likely do EGD and biopsy to rule out other causes
Might even get emptying study

Question 12

Treatment of cyclic vomiting

Answer 12

Stop MJ
Metochlopramide
Azithryomycin
Control N/V - ondansetron

Question 13

Gastric carcinoma - what is it?

Answer 13

Increased incidence in east Asia

Linked to nitrites - preservatives, diet related

Question 14

Gastric carcinoma - presentation

Answer 14

Early satiety - taking up space
Unintentional weight loss
Gastric outlet obstruction
*Usually late

Question 15

Gastric carcinoma - dx

Answer 15

EGD and biopsy (sigma ring cells)

PET scan/Pan scan CT for staging (90% are already spread)

Question 16

Treatment of gastric carcinoma

Answer 16

Resection, chemo