GI - 4 Stomach pt 2

Question 1

List 3 risk factors/ causes of peptic ulcers

Answer 1

Smoking
NSAIDS (mainly aspirin)
H. Pylori

Question 2

Where do Gastric Ulcers develop? What is it associated with?

Answer 2

In btwn body and antrum

Associated with decreased acid production (gastritis overwhelms mucosal defense mechanisms)

Question 3

What do NSAIDs increase the risk of?

Answer 3

GU (40x), Complications with ulcers (bleeding, perforation, death)

Question 4

Epigastric pain (hallmark) 80%
20% with complications (ie bleeding) are asymptomatic
Pain is a “gnawing, dull ache, hunger like”
50% report relief with food (esp DU) and recurrence 2-4hrs after

Answer 4

PUD

Question 5

What is the main symptom of PUD?

Answer 5

Epigastric pain

Question 6

Epigastric pain relieved by eating food is a sign of:

Answer 6

PUD (DU)

Question 7

____ is procedure of choice for an Ulcer.

Also do what?

Answer 7

Endoscopy

Also Bx for H. Pylori

Question 8

What is the treatment for DU? GU?

Answer 8

PPI
GU 4 weeks
DU 8 weeks

Question 9

What are 3 Meds to eradicate H. pylori?

Answer 9

PPI 2 x day, Clarithromycin 500mg bid, Amoxicillin 1g BID

Question 10

List 4 complications of PUD

Answer 10

GI hemorrhage
Ulcer perforation
Ulcer penetration
Gastric outlet obstruction

Question 11

Melena, hematemesis, hematochezia

Nasogastric lavage shows “coffee grounds” or red blood

Answer 11

GI hemorrhage

Question 12

Sudden, severe abdominal pain

Appear ill, rigid abd, no bowel sounds, rebound tenderness

Answer 12

Ulcer perforation

Question 13

What is the treatment for Ulcer perforation?

Answer 13

40% seal on own
Surgery
H. pylori tx, fluids, IV PPI, abx

Question 14

Located along posterior wall of duodenum or stomach may penetrate into pancreas, liver or biliary tree
Change in pattern/intensity of their pain
Severe constant pain, radiates to back, unresponsive to antacids, food
increased amylase. How is it diagnosed? Treated?

Answer 14

Ulcer Penetration
Endoscopy and barium studies confirm it’s an ulcer, but don’t show penetration
Treat: IV PPI (no surgical tx)

Question 15

Edema or narrowing of pylorus or duodenal bulb
Most with known history of ulcers
Fullness and heaviness with meals progresses to early satiety, vomiting, wt loss
Chronic obstruction: dilated atonic stomach, severe wt loss, malnutrition
Dehydration, metabolic alkalosis, hypokalemia.
What is it? What’s the treatment?

Answer 15

Gastric Outlet Obstruction
Tx: Correct fluid and electrolytes
IV PPI
Nasogastric decompression of stomach
Endoscopy in 24-72 hrs to define nature of obstruction, R/o gastric cancer, and Dilatation of obstruction

Question 16

Name 3 ways Gastric Outlet Obstruction is identified

Answer 16

Physical: Succussion splash may be heard in epigastrum
Nasogastric aspiration: >200cc foul smelling fluid is diagnostic
More subtle obstructions are diagnosed with a saline load test or nuclear gastric emptying study

Question 17

80% of gastrinomas arise:

Answer 17

within gastrinoma triangle: porta hepatis, neck of pancreas, and 3rd portion of duodenum

Question 18

PUD with similar symptoms
Ulcers are usually solitary in duodenum, may be multiple
GERD common
Diarrhea in 1/3, steatorrhea (presence of excess fat in feces), wt loss

Answer 18

Zollinger-Ellison Syndrome

Question 19

Laboratory findings in ____
Fasting gastrin > 150 pg/ml
Median level is 500-700 pg/ml, 60%> 1000pg/ml
Gastrin>1000 and acid hypersecretion is diagnostic
For others can do a secretin stimulation test

Answer 19

Zollinger-Ellison Syndrome

Question 20

What is a more common cause of Hypergastrinemia than Gastrinoma? What must you do to check?

Answer 20

Hypochlorhydria
must measure gastric pH in pt with hypergastrinemia
if pH>3 implies hypochlorhydia

Question 21

Imaging in Z-E Syndrome

Answer 21

Somatostatin Receptor Scintigraphy with SPECT scan >80% sensitive