GI: PUD & Gastric CA Flashcards
these cells secrete HCl and IF
parietal
These cells secrete pepsinogen
Chief
These cells of the GI system secrete hormones
enteroendocrine
This disease is characterized by extension of an ulcer through which layers
Peptic ulcer disease
ulcer thru muscularis mucosa
5 Risk factors for PUD?
smoking/EtOH/Diet
Genes
Psych/stress
Smoking confers increased risk for what complication of PUD?
perf
EtOH confers increased risk for what PUD complication?
bleed
What blood types are at increased risk for PUD?
O and A
Stress and psych issues increase risk of PUD via…
impaired tissue healing
2 main mechanisms that cause PUD?
NSAIDs and H. Pylori
What is the MC cause of PUD and confers increased risk of gastric CA?
H. Pylori
H. pylori is G- motile flagellated bacteria that has what four virulence factors?
flagella
urease
adhesins
inflammation
NSAIDs decrease production of ______ which confers in creased risk of PUD
prostaglandins
The below indicate what drug class should be avoided when possible due to increased PUD risk?
- Prior PUD hx
- H. pylori
- > 75 yo
- Increased dose, time, duration
- Use w. steroids, anticoags, ASA, SSRI, alendronate
NSAIDs
What four drugs shouldn’t be combined w. NSAIDs due to increased PUD risk?
steroids, anticoags, SSRI, alendronate
Most cases of PUD are asymptomatic… but what sxs would be most common?
UGI discomfort + Dyspepsia
Belching, bloating, distension, N/V and early satiety are signs of…
dyspepsia
What are three signs/sxs of PUD complication?
Bleed (hematemesis/melena)
fatigue
dyspnea
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)
prompt PUD eval
Where is the ulcer located?
worse after meal
(+) vomiting
(+) hematemesis, WL/Anorexia
Gastric ulcer
Where is the ulcer located?
relieved after meal
(-) vomiting
weight gain
+/- melena/bleeding
Duodenal ulcer
4 major complications of PUD?
Bleeding
Perf
Penetration
Gastric Outlet Obstruction
A patient w. PUD p/w… this is concerning for…
Hematemesis
Melena
Hematochezia
bleeding
How is bleeding treated with PUD patients?
IV Fluids/PRBCs (stabilize)
IV PPI
+
EGD w.:
Thermal coag/hemoclip/injection
A patient w. PUD p/w… this is concerning for…
Severe/Diffuse Abd. Pain Tachy Weak Pulse N/V Abd. Rigidity
Perforation
How is perforation diagnosed w. PUD patients?
upright CXR + Abd. XR
(showing pneumoperitoneum)
+/- CT
( to localize)
How is perforation treated w. PUD patients?
IV Fluids + NG suction + IV PPI + broad spec abx
THEN
Surgery
PUD penetration is a leakage of luminal contents to peritoneum, it is most commonly effecting which organ?
pancreas
A pt. w/ PUD p/w intense pain that refers to the back. This is concerning for…
Penetration
A pt. w/ PUD p/w the below, which is concerning for…
Vomiting early satiety bloating epigastric pain weight loss anorexia
Gastric Outlet Obstruction
Scarring/Fibrosis or Inflammation/edema in pyloric channel can cause…
gastric outlet obstruction
How is gastric outlet obstruction diagnosed
XR showing dilated stomach and + succession splash
How is gastric outlet obstruction treated?
IV Fluids (stabilize)
NG Tube + Gastric Decompression
IV PPI
If medical therapy for gastric outlet obstruction fails, what intervention is indicated?
EGD + endoscopic balloon dilation
OR
Surg.
On physical exam, a pt. p/w
hypotension tachycardia epigastric/RUQ tenderness (+) peritoneal signs (+) succession splash (+) hemoccult
This is concerning for…
PUD
What two imaging modalities are indicated for PUD diagnosis, which is more sensitive/specific for h. pylori?
EGD + Bx
UGI Barium Study
The best diagnostic for H. pylori is…
EGD + Bx
This H. pylori test…
determines active or eradicated h. pylori
measures for radiolabeled CO2 during exhalation after drinking radiolabeled urea
Urea Breath Test
What meds must be discontinued before urea breath tests?
PPI (1-2 weeks prior)
Abx/Bismuth (4 weeks prior)
T/F: Stool antigen tests require the same meds to be discontinued
T
IS serology recommended for h. pylori testing? why or why not?
no, high rate of false + and -
Tx for PUD w. H. pylori infx
Clarithromycin + PPI + Ammoxicillin x 14 days
OR
Bismuth + PPI + metronidazole + tetracycline x 14 days
Tx for PUD if NEG h. pylori
assume NSAID induced
discontinue NSAID + PPI x 6-8 weeks
Tx for PUD if NEG NSAID induced and NEG h. pylori
PPI x 4-8 weeks + EGD
repeat EGD after PPI
ZES is caused by ______ in the
gastrinoma in duodenum or pancreas
Gastrinoma releases gastrin, which has what to effects?
increased HCl and Gastric motility
80% of ZES gastrinomas are spontaneous, 20% are part of what type of tumor?
MEN1
A pt. presents w. the below, which is concerning for…
Recurrent PUD distal to duodenal bulb
upper abd. pain
steatorrhea/diarrhea
ZES
How is ZES diagnosed?
serum gastrin > 1000
pH < 2
Secretin stim.: gastrin increase 200
What is CT used for in ZES?
tumor localization
What is the tx for ZES?
PPI + resection
MC type of gastric CA…
adenocarcinoma
4 RFs for gastric CA?
percursor lesions (MC)
diet (smoked foods, salt)
lifestyle (TOBB/EtOH)
H. Pylori
A patient presents w.
Wt. loss Persistant abd. pain Hx. gastric ulcer GI bleed early satiety dysphagia NV (+) FHx CA
Gastric CA
What are three late stage signs/sxs of gastric CA?
palpable mass
succession splash
paraneoplastic syndromes
1st line diagnostic for gastric CA?
EGD + Bx and histo
the below histologic findings are indicative of…
i. Subtle polypoid protrusion
ii. Superficial plaque
iii. Mucosal discoloration
iv. Depression
v. ulcer
Gastric CA
What is the 2nd line Dx for Gastric CA?
UGI study
Describe the staging for Gastric CA?
TNM (Submucosal to superficial m. to deep m. to serosa)
A palpable left supraclavicular node is found. this is called a ___ node and is a sign of…
Virchow’s Node
MC sign of mets from gastric CA
periumbilical node found in Gastric CA mets is called…
sister mary joseph’s node
left axillary node found in Gastric CA mets is called…
Irish node
If, however rare, gastric CA is discovered early, what is the Tx?
endoscopic mucosal resection
Advanced gastric CA is tx by…
total or partial gastrectomy
Unresectable gastric CA is treated palliatively with either…
Chemo or Radiation
Abd. discomfort +/- bloating, belching, distension…
dyspepsia
Pt. who is 60+ with dyspepsia should have what workup?
EGD + bx
Tx if PUD present
If no organic dz is found to cause dyspepsia, it is considered functional dyspepsia. This requires…
H. pylori testing and Tx
Pt. who is < 60 with dyspepsia should have EGD only if one of what 4 things?
wt. loss
bleeding
2+ alarm features
rapid progression of alarm fts
