GI - 4 Stomach pt 3

Question 1

What are benign tumors of the stomach? Whaddya do? (2)

Answer 1

Epithelial polyps - Fundic gland or hyperplastic polyps. Leave ‘em alone
Adenomatous polyps - Premalignant potential. Must remove

Question 2

2 Malignant Tumors of the Stomach

Answer 2

Adenocarcinoma

Lymphoma

Question 3

Most common gastric CA
Mean age is 63yo, uncommon Women
Higher incidence in Latinos, African Americans, Asian Americans
Most arise in antrum

Answer 3

Adenocarcinoma

Question 4

Tell me 5 things about Adenocarcinoma (how common, mean age, which gender likely, races of higher incidence, and where in the body?)

Answer 4

Most common gastric CA
Mean age is 63yo, uncommon Women
Higher incidence in Latinos, African Americans, Asian Americans
Most arise in antrum

Question 5

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)

Answer 5

Gastric Adenocarcinoma

Question 6

What is the best test for Gastric Adenocarcinoma? What’s the treatment?

Answer 6

EUS

Tx: Curative Surgical Resection

Question 7

List the 6 Tumor stages and what they mean

Answer 7

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

Question 8

List the 5 Nodal stages and what they mean

Answer 8

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

Question 9

List the 3 stages of Metastasis and what they mean

Answer 9

Mx Presence of distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis

Question 10

4 predisposing factors to gastric lymphoma

Answer 10

Helicobacter pylori-associated chronic gastritis
Autoimmune diseases
Immunodeficiency syndromes
Long-standing immunosuppressive therapy

Question 11

Abdominal pain, wt loss , early satiety
Bleeding (occult)
Night sweats absent in primary lymphoma
Palpable mass
Peripheral lymphadenopathy

Answer 11

Gastric Lymphoma

Question 12

What’s a good test for Gastric Lymphoma? (2)

What test stages it?

Answer 12

Endoscopy: shows ulcer, mass, diffusely infiltrating lesion.
Biopsy confirms diagnosis
CT for staging

Question 13

5 stages of Gastric Lymphoma

Answer 13

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)

Question 14

Secondary nodal lymphomas are rarely curable.

How do you treat primary low grade gastric lymphoma? (2)

Answer 14

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

Question 15

If low grade gastric lymphoma fails, or there is recurrence. How do you treat it then?

Answer 15

Multi-agent chemotherapy, such as CVP or CHOP

Question 16

What do ppl with Acute Upper GI Bleeding die of?

Answer 16

Die from complications of underlying disease not exsanguination

Question 17

How does Upper GI Bleeding present? (2)

Answer 17

Hematemesis
Bright red blood or coffee grounds
Melena
After 50-100cc blood in GI tract

Question 18

Top 4 causes of Upper GI Bleeding in order of frequency

Answer 18

PUD
Portal HTN
Mallory-Weiss tear
Vascular Anomalies

Question 19

What qualifies as severe, moderate, and minor blood loss from Upper GI Bleeding?

Answer 19

Severe= Systolic BP 100beats/min 
Moderate= Systoloic BP>100mm Hg and HR >100beats/min
Minor= Normal systolic BP and HR

Question 20

How are High Risk patients for Upper GI bleeding identified? Whaddya do?

Answer 20

Active bleeders
Hematemesis or bright red blood on NG aspirate.
Endoscopy within 12 hours

Question 21

What does aspirate mean?

Answer 21

remove blood by suction

ng aspirate = nasogastric aspirate

Question 22

What test identifies source and risk of bleeding in Upper GI bleeds?

Answer 22

Upper Endoscopy

Question 23

2 drugs for Upper GI bleeding

Answer 23

IV PPI
Octreotide
Reduces splanchnic blood flow and portal pressures