GI #7 Flashcards by Tyler Cichowski

What is the difference between gastritis and gastropathy?

Gastritis: superficial inflammation or irritation of the stomach mucosa without mucosal injury

Gastropathy: mucosal injury without evidence of inflammation

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MCC of gastritis

H. Pylori

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Diagnostic of choice for gastritis

Upper endoscopy with biopsy

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What is a gastrinoma?

-Gastrin-secreting neuroendocrine tumor leading to severe PUD and diarrhea

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Gastrinomas are MC in what location?

Duodenal wall (45%

-Other areas: Pancreas, lymph nodes

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When should you suspect a gastrinoma in a patient?

If the patient has severe, recurrent, multiple, or refractory ulcers + diarrhea

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What is the best initial test for a gastrinoma?

-Elevated fasting gastrin levels ( >1,000 pg/mL + gastric pH < 2)

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However, for a gastrinoma, what is the confirmatory test?

Secretin test: persistent gastrin elevations. Normally, gastrin release is inhibited by secretin.

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What is the most sensitive test for a gastrinoma localization?

Somatostatin receptor scintigraphy (increased somatostatin receptors in gastrinomas)

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Treatment for gastrinomas

Local: Tumor Resection

- Metastatic, Unresectable: Lifelong high-dose PPI’s

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Where are the MC sites for mets for a gastrinoma?

-The liver and abdominal lymph nodes

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55% of carcinoid tumors arise in the GI tract. What are Carcinoid tumors?

-Rare, well-differentiated neuroendocrine tumors that arise from enterochromaffin cells

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What are the symptoms of carcinoid syndrome?

Periodic episodes of diarrhea (serotonin release), flushing, tachycardia, and bronchoconstriction (histamine release) and hemodynamic instability (hypotension)

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What are some diagnostics that can be done to diagnose a carcinoid tumor?

Many are asymptomatic (incidental finding on endoscopy)
24 hour urinary 5-hydroxyindolacetic acid/5-HIAA excretion
Radiolabeled somatostatin analogs for localization
Contrast, triple-phase CT or abdomen and pelvis

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MC type of gastric carcinoma

Adenocarcinoma

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Biggest risk factor for gastric carcinoma?

H. Pylori

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Other risk factors for gastric carcinoma

Males
> 40 years old
Preserved foods
Obesity
Smoking
Blood Type A
Non-Hodgkin Lymphoma

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What are some things that have been proven to decrease risk of gastric carcinoma?

Chronic Aspirin and NSAID use
Fruits and vegetables
Wine consumption

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Symptoms of gastric carcinoma

Most patients are advanced at time of presentation
Weight loss, persistent abdominal pain
Early satiety
Dysphagia
Melena
Hematemesis
Iron deficiency anemia (chronic blood loss)

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What are some things that have been proven to decrease risk of gastric carcinoma?

Chronic Aspirin and NSAID use
Fruits and vegetables
Wine consumption

What are some things that have been proven to decrease risk of gastric carcinoma?

Chronic Aspirin and NSAID use
Fruits and vegetables
Wine consumption

There are numerous physical exam findings that can be found with a gastric carcinoma. Name some of them.

Supraclavicular lymph nodes: Virchow’s Node
Umbilical LN: Sister Mary Joseph’s Node
Ovarian Mets: Krukenburg Tumor
Palpable Nodule on Rectal Exam: Blumer’s Shelf
Left axillary lymph node: Irish Sign

Initial test of choice for most gastric cancers is

-Upper endoscopy with biopsy

Even though gastric carcinoma has a poor prognosis, because it presents late in disease, what are some treatment options?

Gastrectomy, chemotherapy, radiation for lymphona

Pyloric Stenosis is due to hypertrophy of pyloric muscles, causing a functional gastric outlet obstruction and prevents what?

Gastric emptying into the duodenum

Risk factors for pyloric stenosis

- Most common in first 3-12 weeks of life - Erythromycin use (within first 2 weeks of life) - Caucasians - Males - First-borns

Symptoms of pyloric stenosis

- Nonbilious, projectile vomiting after feeding - Weight loss, dehydration, malnutrition - Palpable pylorus (olive shaped, mobile hard mass to right of epigastrium)

Initial diagnostic of choice for pyloric stenosis

-Abdominal US

What does an upper GI series show for pyloric stenosis?

- String sign: thin column of barium through narrowed pyloric channel - Railroad track sign: excess mucosa in pyloric lumen

Labs for pyloric stenosis shows

-Hypokalemia and hypochloremic metabolic alkalosis from vomiting

Treatment for pyloric stenosis

- Rehydration (IVF) and electrolyte repletion (potassium replacement) - Definitive: Pyloromyotomy

What is autoimmune hepatitis?

Idiopathic chronic inflammation of the liver due to circulating autoantibodies

Autoimmune hepatitis is MC In

Young women

Diagnostics for autoimmune hepatitis

- Type I: Positive ANA, smooth muscle antibodies | - Type II: Anti-liver/kidney microsomal antibodies

What do labs show for autoimmune hepatitis?

-LFTs: Increased ALT > 1,000

Definitive diagnostic for autoimmune hepatitis?

Liver biopsy

Treatment for autoimmune hepatitis

-Corticosteroids +Azathioprine

Hepatitis A is transmitted via

Fecal-oral -Associated with international travel, day care workers, MSM, homelessness, shellfish, and IVDU

Symptoms of Hepatitis A

- Most are asymptomatic - May be associated with spiking fever - Malaise, anorexia, nausea, vomiting - Jaundice, hepatomegaly

Diagnostics/Labs for Hepatitis A

- LFT: elevated ALT, AST, bilirubin - Acute: IgM anti-HAV - Past Exposure: IgG HAV with negative IgM

Explain the IgM and IgG antibodies

IgM means you have it right now (right meow) | IgG means you got it a while ago

Treatment for Hepatitis A

-No treatment needed (self-limited like HEV)

Prevention of Hepatitis A

- Handwashing - Food safety - Immunization

If a patient has an increased risk of Hepatitis A infection, what should you do?

2 doses given 6 months apart of the vaccination

Explain the post-exposure prophylaxis for Hepatitis A (there are three and depends on ages and immunocompromised or not)

- Healthy individuals 1-40 years old: HAV vaccine (within 2 weeks of exposure) - Healthy individuals > 40 years old: HAV vaccine (with or w/o immunoglobulin) within 2 weeks of exposure - Immunocompromised or chronic liver disease > 1 year old: HAV vaccine + HAV immunoglobulin within 2 weeks of exposure

What is fulminant hepatitis?

Acute hepatic failure in patients with hepatitis

What are the most common etiologies of fulminant hepatitis?

Acetaminophen toxicity: MCC in US Viral hepatitis, drug reactions, sepsis Reye syndrome: if children are given aspirin after viral infection

Symptoms of fulminant hepatitis

- Encephalopathy: asterixis, coma, AMS, seizures, cerebral edema - Coagulopathy: increased PT, increased PTT - Hepatomegaly - Jaundice - Reye Syndrome: rash (hands and feet), vomiting, liver damage, dilated pupils with minimal response to light, multi-organ failure

Treatment for fulminant hepatitis

- Supportive: IVF, electrolyte repletion, Blood products | - Liver transplant is definitive