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Clinical Medicine III > GI: PUD & Gastric CA > Flashcards

GI: PUD & Gastric CA Flashcards

1
Q

these cells secrete HCl and IF

A

parietal

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2
Q

These cells secrete pepsinogen

A

Chief

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3
Q

These cells of the GI system secrete hormones

A

enteroendocrine

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4
Q

This disease is characterized by extension of an ulcer through which layers

A

Peptic ulcer disease

ulcer thru muscularis mucosa

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5
Q

5 Risk factors for PUD?

A

smoking/EtOH/Diet
Genes
Psych/stress

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6
Q

Smoking confers increased risk for what complication of PUD?

A

perf

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7
Q

EtOH confers increased risk for what PUD complication?

A

bleed

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8
Q

What blood types are at increased risk for PUD?

A

O and A

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9
Q

Stress and psych issues increase risk of PUD via…

A

impaired tissue healing

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10
Q

2 main mechanisms that cause PUD?

A

NSAIDs and H. Pylori

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11
Q

What is the MC cause of PUD and confers increased risk of gastric CA?

A

H. Pylori

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12
Q

H. pylori is G- motile flagellated bacteria that has what four virulence factors?

A

flagella
urease
adhesins
inflammation

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13
Q

NSAIDs decrease production of ______ which confers in creased risk of PUD

A

prostaglandins

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14
Q

The below indicate what drug class should be avoided when possible due to increased PUD risk?

  1. Prior PUD hx
  2. H. pylori
  3. > 75 yo
  4. Increased dose, time, duration
  5. Use w. steroids, anticoags, ASA, SSRI, alendronate
A

NSAIDs

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15
Q

What four drugs shouldn’t be combined w. NSAIDs due to increased PUD risk?

A

steroids, anticoags, SSRI, alendronate

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16
Q

Most cases of PUD are asymptomatic… but what sxs would be most common?

A

UGI discomfort + Dyspepsia

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17
Q

Belching, bloating, distension, N/V and early satiety are signs of…

A

dyspepsia

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18
Q

What are three signs/sxs of PUD complication?

A

Bleed (hematemesis/melena)
fatigue
dyspnea

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19
Q

The below sxs should warrant…

i. Bleeding
ii. IDA
iii. early satiety
iv. Weight loss
v. Progressive dysphagia/odynophagia
vi. Acute and intense upper abd. Pain
vii. Persistent vomiting
viii. FHx of UGI CA (ask in ROS)

A

prompt PUD eval

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20
Q

Where is the ulcer located?

worse after meal
(+) vomiting
(+) hematemesis, WL/Anorexia

A

Gastric ulcer

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21
Q

Where is the ulcer located?

relieved after meal
(-) vomiting
weight gain
+/- melena/bleeding

A

Duodenal ulcer

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22
Q

4 major complications of PUD?

A

Bleeding
Perf
Penetration
Gastric Outlet Obstruction

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23
Q

A patient w. PUD p/w… this is concerning for…

Hematemesis
Melena
Hematochezia

A

bleeding

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24
Q

How is bleeding treated with PUD patients?

A

IV Fluids/PRBCs (stabilize)

IV PPI
+
EGD w.:
Thermal coag/hemoclip/injection

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25
Q

A patient w. PUD p/w… this is concerning for…

Severe/Diffuse Abd. Pain
Tachy
Weak Pulse
N/V
Abd. Rigidity
A

Perforation

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26
Q

How is perforation diagnosed w. PUD patients?

A

upright CXR + Abd. XR
(showing pneumoperitoneum)

+/- CT
( to localize)

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27
Q

How is perforation treated w. PUD patients?

A

IV Fluids + NG suction + IV PPI + broad spec abx

THEN

Surgery

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28
Q

PUD penetration is a leakage of luminal contents to peritoneum, it is most commonly effecting which organ?

A

pancreas

29
Q

A pt. w/ PUD p/w intense pain that refers to the back. This is concerning for…

A

Penetration

30
Q

A pt. w/ PUD p/w the below, which is concerning for…

Vomiting
early satiety
bloating
epigastric pain
weight loss
anorexia
A

Gastric Outlet Obstruction

31
Q

Scarring/Fibrosis or Inflammation/edema in pyloric channel can cause…

A

gastric outlet obstruction

32
Q

How is gastric outlet obstruction diagnosed

A

XR showing dilated stomach and + succession splash

33
Q

How is gastric outlet obstruction treated?

A

IV Fluids (stabilize)

NG Tube + Gastric Decompression

IV PPI

34
Q

If medical therapy for gastric outlet obstruction fails, what intervention is indicated?

A

EGD + endoscopic balloon dilation

OR

Surg.

35
Q

On physical exam, a pt. p/w

hypotension
tachycardia
epigastric/RUQ tenderness
(+) peritoneal signs
(+) succession splash
(+) hemoccult

This is concerning for…

A

PUD

36
Q

What two imaging modalities are indicated for PUD diagnosis, which is more sensitive/specific for h. pylori?

A

EGD + Bx

UGI Barium Study

37
Q

The best diagnostic for H. pylori is…

A

EGD + Bx

38
Q

This H. pylori test…

determines active or eradicated h. pylori

measures for radiolabeled CO2 during exhalation after drinking radiolabeled urea

A

Urea Breath Test

39
Q

What meds must be discontinued before urea breath tests?

A

PPI (1-2 weeks prior)

Abx/Bismuth (4 weeks prior)

40
Q

T/F: Stool antigen tests require the same meds to be discontinued

A

T

41
Q

IS serology recommended for h. pylori testing? why or why not?

A

no, high rate of false + and -

42
Q

Tx for PUD w. H. pylori infx

A

Clarithromycin + PPI + Ammoxicillin x 14 days

OR

Bismuth + PPI + metronidazole + tetracycline x 14 days

43
Q

Tx for PUD if NEG h. pylori

A

assume NSAID induced

discontinue NSAID + PPI x 6-8 weeks

44
Q

Tx for PUD if NEG NSAID induced and NEG h. pylori

A

PPI x 4-8 weeks + EGD

repeat EGD after PPI

45
Q

ZES is caused by ______ in the

A

gastrinoma in duodenum or pancreas

46
Q

Gastrinoma releases gastrin, which has what to effects?

A

increased HCl and Gastric motility

47
Q

80% of ZES gastrinomas are spontaneous, 20% are part of what type of tumor?

A

MEN1

48
Q

A pt. presents w. the below, which is concerning for…

Recurrent PUD distal to duodenal bulb

upper abd. pain

steatorrhea/diarrhea

A

ZES

49
Q

How is ZES diagnosed?

A

serum gastrin > 1000

pH < 2

Secretin stim.: gastrin increase 200

50
Q

What is CT used for in ZES?

A

tumor localization

51
Q

What is the tx for ZES?

A

PPI + resection

52
Q

MC type of gastric CA…

A

adenocarcinoma

53
Q

4 RFs for gastric CA?

A

percursor lesions (MC)
diet (smoked foods, salt)
lifestyle (TOBB/EtOH)
H. Pylori

54
Q

A patient presents w.

Wt. loss
Persistant abd. pain
Hx. gastric ulcer
GI bleed
early satiety
dysphagia
NV
(+) FHx CA
A

Gastric CA

55
Q

What are three late stage signs/sxs of gastric CA?

A

palpable mass
succession splash
paraneoplastic syndromes

56
Q

1st line diagnostic for gastric CA?

A

EGD + Bx and histo

57
Q

the below histologic findings are indicative of…

i. Subtle polypoid protrusion
ii. Superficial plaque
iii. Mucosal discoloration
iv. Depression
v. ulcer

A

Gastric CA

58
Q

What is the 2nd line Dx for Gastric CA?

A

UGI study

59
Q

Describe the staging for Gastric CA?

A

TNM (Submucosal to superficial m. to deep m. to serosa)

60
Q

A palpable left supraclavicular node is found. this is called a ___ node and is a sign of…

A

Virchow’s Node

MC sign of mets from gastric CA

61
Q

periumbilical node found in Gastric CA mets is called…

A

sister mary joseph’s node

62
Q

left axillary node found in Gastric CA mets is called…

A

Irish node

63
Q

If, however rare, gastric CA is discovered early, what is the Tx?

A

endoscopic mucosal resection

64
Q

Advanced gastric CA is tx by…

A

total or partial gastrectomy

65
Q

Unresectable gastric CA is treated palliatively with either…

A

Chemo or Radiation

66
Q

Abd. discomfort +/- bloating, belching, distension…

A

dyspepsia

67
Q

Pt. who is 60+ with dyspepsia should have what workup?

A

EGD + bx

Tx if PUD present

68
Q

If no organic dz is found to cause dyspepsia, it is considered functional dyspepsia. This requires…

A

H. pylori testing and Tx

69
Q

Pt. who is < 60 with dyspepsia should have EGD only if one of what 4 things?

A

wt. loss

bleeding

2+ alarm features

rapid progression of alarm fts

Clinical Medicine III (21 decks)

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