GI #7 Flashcards
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
MCC of gastritis
H. Pylori
Diagnostic of choice for gastritis
Upper endoscopy with biopsy
What is a gastrinoma?
-Gastrin-secreting neuroendocrine tumor leading to severe PUD and diarrhea
Gastrinomas are MC in what location?
Duodenal wall (45%
-Other areas: Pancreas, lymph nodes
When should you suspect a gastrinoma in a patient?
If the patient has severe, recurrent, multiple, or refractory ulcers + diarrhea
What is the best initial test for a gastrinoma?
-Elevated fasting gastrin levels ( >1,000 pg/mL + gastric pH < 2)
However, for a gastrinoma, what is the confirmatory test?
Secretin test: persistent gastrin elevations. Normally, gastrin release is inhibited by secretin.
What is the most sensitive test for a gastrinoma localization?
Somatostatin receptor scintigraphy (increased somatostatin receptors in gastrinomas)
Treatment for gastrinomas
- Local: Tumor Resection
- Metastatic, Unresectable: Lifelong high-dose PPI’s
Where are the MC sites for mets for a gastrinoma?
-The liver and abdominal lymph nodes
55% of carcinoid tumors arise in the GI tract. What are Carcinoid tumors?
-Rare, well-differentiated neuroendocrine tumors that arise from enterochromaffin cells
What are the symptoms of carcinoid syndrome?
Periodic episodes of diarrhea (serotonin release), flushing, tachycardia, and bronchoconstriction (histamine release) and hemodynamic instability (hypotension)
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
MC type of gastric carcinoma
Adenocarcinoma
Biggest risk factor for gastric carcinoma?
H. Pylori
Other risk factors for gastric carcinoma
- Males
- > 40 years old
- Preserved foods
- Obesity
- Smoking
- Blood Type A
- Non-Hodgkin Lymphoma
What are some things that have been proven to decrease risk of gastric carcinoma?
- Chronic Aspirin and NSAID use
- Fruits and vegetables
- Wine consumption
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)
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
