GI - 4 Stomach pt 3 Flashcards
What are benign tumors of the stomach? Whaddya do? (2)
Epithelial polyps - Fundic gland or hyperplastic polyps. Leave ‘em alone
Adenomatous polyps - Premalignant potential. Must remove
2 Malignant Tumors of the Stomach
Adenocarcinoma
Lymphoma
Most common gastric CA
Mean age is 63yo, uncommon Women
Higher incidence in Latinos, African Americans, Asian Americans
Most arise in antrum
Adenocarcinoma
Tell me 5 things about Adenocarcinoma (how common, mean age, which gender likely, races of higher incidence, and where in the body?)
Most common gastric CA
Mean age is 63yo, uncommon Women
Higher incidence in Latinos, African Americans, Asian Americans
Most arise in antrum
Asymptomatic till advanced. Nonspecific /determined by location of tumor. Dyspepsia. Epigastric pain. Anorexia, early satiety, wt loss. GI bleed (ulcerated lesions). Vomiting (pyloric obstruction). Dysphagia (lower esophageal obstruction)
Gastric Adenocarcinoma
What is the best test for Gastric Adenocarcinoma? What’s the treatment?
EUS
Tx: Curative Surgical Resection
List the 6 Tumor stages and what they mean
T1s Carcinoma in situ: intra-epithelial tumor without invasion of the lamina propia
T1 Tumor invades lamina propria or submucosa
T2a Tumor invades muscularis propria
T2b Tumor invades subserosa
T3 Tumor penetrates serosa (visceral peritoneum) without invasion of adjacent structures
T4 Tumor invades adjacent structures
List the 5 Nodal stages and what they mean
Nodal (N) stage NX Regional lymph node(s) cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in 1 to 6 regional lymph nodes
N2 Metastasis in 7 to 15 regional lymph nodes
N3 Metastasis in more than 15 regional lymph
List the 3 stages of Metastasis and what they mean
Mx Presence of distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
4 predisposing factors to gastric lymphoma
Helicobacter pylori-associated chronic gastritis
Autoimmune diseases
Immunodeficiency syndromes
Long-standing immunosuppressive therapy
Abdominal pain, wt loss , early satiety Bleeding (occult) Night sweats absent in primary lymphoma Palpable mass Peripheral lymphadenopathy
Gastric Lymphoma
What’s a good test for Gastric Lymphoma? (2)
What test stages it?
Endoscopy: shows ulcer, mass, diffusely infiltrating lesion.
Biopsy confirms diagnosis
CT for staging
5 stages of Gastric Lymphoma
IE: limited to the stomach
IIE1: stomach and contiguous lymph nodes
IIE2: stomach and noncontiguous subdiaphragmatic lymph nodes
III: stomach and lymph nodes on both sides of diaphragm
IV : Hematogenous spread (stomach and one or more extralymphatic organs or tissues)
Secondary nodal lymphomas are rarely curable.
How do you treat primary low grade gastric lymphoma? (2)
Test for H pylori in those with MALT-lymphoma and tx if +
Neg for H pylori or fail tx : radiation >90 percent long-term disease-free survival
If low grade gastric lymphoma fails, or there is recurrence. How do you treat it then?
Multi-agent chemotherapy, such as CVP or CHOP
What do ppl with Acute Upper GI Bleeding die of?
Die from complications of underlying disease not exsanguination
How does Upper GI Bleeding present? (2)
Hematemesis
Bright red blood or coffee grounds
Melena
After 50-100cc blood in GI tract
Top 4 causes of Upper GI Bleeding in order of frequency
PUD
Portal HTN
Mallory-Weiss tear
Vascular Anomalies
What qualifies as severe, moderate, and minor blood loss from Upper GI Bleeding?
Severe= Systolic BP 100beats/min Moderate= Systoloic BP>100mm Hg and HR >100beats/min Minor= Normal systolic BP and HR
How are High Risk patients for Upper GI bleeding identified? Whaddya do?
Active bleeders
Hematemesis or bright red blood on NG aspirate.
Endoscopy within 12 hours
What does aspirate mean?
remove blood by suction
ng aspirate = nasogastric aspirate
What test identifies source and risk of bleeding in Upper GI bleeds?
Upper Endoscopy
2 drugs for Upper GI bleeding
IV PPI
Octreotide
Reduces splanchnic blood flow and portal pressures
