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GI Goljan stomach disorders Flashcards

1
Q

What are the signs and Sx of stomach disease?

A

hematmesis;

melena

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2
Q

most common cause of hematemesis w/ stomach disorder?

A

PUD (most common);

esophageal varices and hemorrhagic gastritis

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3
Q

What mechanism causes melena? what does this signify?

A

Hb is converted into hematin (black pigment) by acid;

signifies bleed proximal to duodenojejunal jxn (90%)

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4
Q

Gastric analysis is included when stomach disease is suspected?

A

measurement of basal acid output (BAO), maximal acid output (MAO) and the BAO: MAO ratio

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5
Q

define basal acid output

A

acid output of gastric juice collected via NG tube over 1hr period on empty stomach => normally less than 5mEq/hr

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6
Q

define maximal acid output

A

acid output of gastric juice that is collected over 1hr after pentagastrin stimulation normally 5-20mEq/hr

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7
Q

what is normal BAO:MAO ratio?

A

0.2 : 1

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8
Q

Epidemiology congenital pyloric stenosis

A

probable genetic basis w/ parent having disease increases risk for child w/ CPS
males > females;

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9
Q

How does acquired pyloric obstruction occur?

A

complication of chronic duodenal ulcer disease w/ pyloric scarring

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10
Q

Pathophys of congenital pyloric stenosis

A

progressive hypertrophy of circular muscles in pyloric sphincter;
Deficiency of NO synthase precipitates CPS

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11
Q

when does congenital pyloric stenosis present?

A

not at birth but occurs over 3-5wks

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12
Q

clinical findings of congenital pyloric stenosis

A

projectile vomit of NON-BILE stained fluid;
hypertrophied pylorus palpated in epigastrium (70%) => “olive mass”;
visible hyperperistalsis

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13
Q

Tx for congenital pyloric stenosis

A

myotomy IF it does not resolve

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14
Q

Define gastroparesis and what may cause it

A 
decreased stomach motility => 
autonomic neuropathy (diabetes mellitus);
previous vagotomy
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15
Q

clinical findings in gastroparesis

A

early satiety and bloating;

vomiting of undigested food a few hrs after eating

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16
Q

Tx for gastroparesis

A

small volume frequent feeding;

metoclopramide

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17
Q

What 2 pathologies are associated w/ acute hemorrhagic (erosive) gastritis?

A

erosions => breach in epithelium of mucosa;

ulcers => breach in mucosa w/ extension into submucosa or deeper

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18
Q

What are the causes of acute hemorrhagic (erosive) gastritis?

A 
NSAIDs; 
alcohol, H. pylori;
CMV (AIDS), smoking;
Burns (Curling ulcers);
CNS injury (Cushing ulcer); 
Uremia;
anisakis
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19
Q

How does anisakis cause acute hemorrhagic gastritis?

A

worm associated w/ eating raw fish

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20
Q

clinical findings of acute hemorrhagic gastritis?

A

hematemesis;
melena;
Fe deficiency

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21
Q

Non pharm Tx for acute hemorrhagic gastritis excluding H. pylori?

A

avoid mucosal irritants (NSAIDs, alcohol);

cessation of smoking

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22
Q

pharm Tx for acute hemorrhagic gastritis excluding H. pylori?

A

misoprostol;

proton pump inhibitors

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23
Q

Differentiate 2 types of chronic atrophic gastritis

A

Type A=> body and fundus

Type B=> antrum and pylorus

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24
Q

What is the most often cause of type A chronic atrophic gastritis?

A

pernicious anemia

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25
complications of type A chronic atrophic gastritis
Achlorhydria w/ hypergastrinemia (loss of - cycle); macrocytic anemia due to vit B12 deficiency; increased risk for gastric adenocarcinoma
26
most common cause of type B chronic atrophic gastritis
H. pylori (gram neg, curved rod)
27
Epidemiology of type B chronic atrophic gastritis
30-50% population in US; increases w/ age; transmitted by fecal-oral/ oral-oral route usually in poor sanitation areas
28
pathophys of type B chronic atrophic gastritis
gram neg, curved rod; produces urease, proteases, cytotoxins; colonizes mucus layer lining
29
What does H. pylori attach to? does it invade?
attaches to blood group O receptors on mucosal cells; | NOT invasive
30
microscopic findings in type B chronic atrophic gastritis
``` chronic inflammatory infiltrate in lamina propria; intestinal metaplasia (precursor lesion for adenoCA) ```
31
Tests for H. pylori ID
Urea breath test > 90%; stool antigen test (pos when active, neg when not); detect urease in gastric Bx; Serologic tests (only 1st infection)
32
Tx for type B chronic atrophic gastritis
sequential therapy => 1) Rabeprazole and amoxicillin; 2) Rabeprazole + clarithromycin + tinidazole
33
What is the test of cure for type B chronic atrophic gastritis?
stool antigen test => neg 8wks after Tx
34
Other than type B chronic atrophic gastritis, what other diseases are associated w/ H. pylori?
duodenal and gastric ulcers; gastric adenoCA; low grade B cell malignant lymphoma
35
Other than type A and B chronic atrophic gastritis, what other disease is associated w/ chronic atrophic gastritis?
Menetrier's disease (hypertrophic gastropathy)
36
What is associated w/ Menetrier's disease?
- Giant rugal folds => hyperplasia of mucus secreting cells causing hypoproteinemia (protein losing enteropathy) - Atrophy of parietal cells (achlorhydria) => increase risk for adenoCA
37
Epidemiology of PUD
H. pylori (70% in US) => duodenal ulcers more common than gastric ulcers; increased recurrence rate for untreated PUD
38
Gross appearance of PUD ulcers
clean, sharply demarcated and slightly elevated around edges
39
Which PUD ulcers should always be Bx?
gastric ulcers as can rarely become malignant; | duodenal ulcers NEVER malignant
40
What may be found in the histo section of ulcers?
necrotic debris; inflammation w/ predominance of neutrophils; granulation tissue (repair tissue); fibrosis
41
Epidemiology and pathogen of ZE syndrome
majority are malignant pancreatic islet cell tumors; secrete excess gastrin causing hyperacidity; sporadic 2/3; usually single ulcers but can be multiple; MEN type I association (20-30% cases)
42
What would give suspicion of ZE syndrome?
``` multiple ulcers in usual places; ulcers resistant to Tx; ulcers distal to 1st part of duodenum; PUD plus diarrhea; fam Hx of PTH or pituitary tumors; PUD w/o H. pylori or NSAIDs ```
43
clinical findings of ZE syndrome?
epigastric pain w/ weight loss; heartburn from GERD; peptic ulceration (usually solitary duodenal ulcers); acid hypersecretion w/ diarrhea; maldigestion of food (acid interferes w/ pancreatic enzyme activity
44
Lab findings in ZE syndrome
increased BAO, MAO and BAO:MAO ratio; | increased gastrin > 1000pg/mL
45
Tx for ZE syndrome
CTX and PPI
46
What are gastric polyps typically complications of?
chronic gastritis and achlorhydria
47
What is the most common type of gastric polyp? malignant potential?
hyperplastic polyp; | hamartoma w/ no malignant potential
48
What is a neoplastic gastric polyp?
adenomatous polyp w/ potential for malignant transformation
49
name the 3 gastric tumors
leiomyoma; primary stomach adenoCA; primary gastric malignant lymphoma
50
most common site of leiomyoma? what is a common complication?
stomach; | may ulcerate or bleed
51
primary stomach adenoCA epidemiology
decreasing incidence in US; increasing incidence in Japan; increased incidence in blood group A ppl
52
What are the 2 types of primary stomach adenoCA? which is most common
intestinal >> diffuse
53
Risk factors for intestinal type of gastric adenoCA
``` intestinal metaplasia due to H. pylori (important); nitrosamines; smoked foods (japan); diets lacking fruit/veggies; type A chronic atrophic gastritis; Menetrier's disease ```
54
What are the 2 types of intestinal type of gastric adenoCA?
polypoid or ulcerated
55
locations of intestinal type of gastric adenoCA
lesser curvature of pylorus and antrum (50-60%); cardia (25%); body and fundus
56
T/F diffuse type of gastric adenoCA is NOT associated w/ H. pylori
true
57
What characterizes diffuse type of gastric adenoCA?
diffuse infiltration of malignant cells in stomach wall
58
What malignant cells infiltrate in diffuse type of gastric adenoCA?
linitis plastica; does NOT peristalse; Signet ring cells ; produces Krukenberg tumor of ovaries
59
How signifies a krukenberg tumor has spread to ovaries?
hematogenous spread of signet ring cells
60
clinical findings of gastric adenoCA
cachexia and weight loss; epigastric pain; vomiting often w/ melena; mets to left supraclavicular node => Virchow's node; paraneoplastic skin lesions; mets to umbilicus (Sister Mary joseph sign)
61
What are paraneoplastic skin lesions associated w/ gastric adenoCA?
acanthosis nigricans; | multiple outcroppings of seborrheic keratosses => Leser Trelat sign
62
where are common mets of gastric adenoCA?
liver, lung, ovaries
63
Tx for gastric adenoCA?
surgery; local radiation; CTX
64
Px of overall 5yr survival rate
10-15%
65
what is the most common site for extranodal malignant lymphoma
stomach (primary gastric malignant lymphoma)
66
What are the types of primary gastric malignant lymphoma
low grade B cell lymphoma; | High grade B or T cell lymphoma
67
What is the pathogenesis of low grade B cell lymphoma?
H. pylori related; | MALToma (mucosa assoc lymphiod tissue)
68
Tx for primary gastric malignant lymphoma
H. pylori produces 50% cure rate
69
What is the most common GI ulcer?
Duodenal >> Gastric
70
epidemiology of gastric ulcers
male = female; | smoking does NOT cause PUD but delays healing
71
epidemiology of duodenal ulcers and what causes increases risk?
male > female; risk increased w/ MEN I; increased risk in cirrhosis, COPD, renal failure, hyperparathyroidism
72
H. pylori frequency in gastric and duodenal ulcers
gastric => 80%; duodenal=> 90-95%
73
Pathogenesis for gastric ulcers
defective mucosal barrier due to H. pylori leading to mucosal ischemia (reduced PGE), bile reflux, delayed gastric emptying
74
How is the gastric analysis for gastric ulcers?
BAO and MAO normal to decreased
75
Pathogenesis for duodenal ulcers
defective mucosal barrier due to H. pylori but causing increased acid production so increased parietal cell mass
76
gastric analysis for duodenal ulcers?
BAO and MAO both increased
77
Location of gastric ulcers. how does this relate to cancer?
single ulcer on lesser curvature of antrum; | sam location for cancer
78
location for duodenal ulcers
single ulcer on anterior portion of 1st part of duodenum followed by single ulcer on posterior portion
79
what risk does a duodenal ulcer on the posterior portion have?
danger of perforation into pancreas and pancreatitis
80
Complications of gastric ulcers
bleeding (MC is left gastric artery); | perforation
81
complications of duodenal ulcers
bleeding (MC is gastroduodenal artery); perforation (air under diaphragm, pain radiates to left or right shoulder); gastric outlet obstruction; pancreatitis
82
Clinical findings in gastric ulcers
epigastric pain made worse by eating
83
Clinical findings in duodenal ulcers
epigastric pain relieved by eating
84
How is gastric ulcer Dx?
Endoscopy (90-95% accurate) and MUST BIOPSY; | upper GI barium study: ID's 70-80% PUD
85
Why must gastric ulcers be biopsied?
potential for malignancy is 1-4%
86
How are duodenal ulcers Dx?
endoscopy (90-95%); | upper GI barium study to ID 70-80% of PUD
87
should duodenal ulcers be biopsied?
no bc they are never malignant
88
Nonphram Tx for gastric ulcers
stop smoking; avoid NSAIDs and alcohol; avoid foods causing Sx Surgery=> antrectomy or hemigastrectomy w/o vagotomy
89
Pharm Tx for gastric ulcers
eradicate H. pylori; H2 receptor antagonists; PPI; antacids
90
Nonpharm Tx of duodenal ulcers
stop smoking; avoid NSAIDs and alcohol; avoid foods causing Sx Surgery=> highly selective vagotomy
91
Pharm Tx for duodenal ulcers
eradicate H. pylori; H2 receptor antagonists; PPI; antacids

GI block (11 decks)

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