GI: stomach Flashcards
Acute Gastritis
- etiologies–MCC?
- CM
Etiology:
- HP infection MCC
- NSAID/ASA
- ETOH
- smoking
- extreme phsyiologic stress–shock, sepsis, burns
- pernicious anemia
- portal HTN
CM:
- often asympto
- if symptomatic: epigastric pain, dyspepsia, n/v– NOT related to eating
Diagnosis:
- Upper endoscopy with biopsy–shows thick, edematous erosions
- HP testing
TX:
- if HP+: treat with quad therapy (metronidazole, tetracycline, pepto, PPI)
- stop the offending agent(s)
- IV PPIs and H2 blockers as prophylaxis with ICU patients
Autoimmune Metaplastic Atrophic Gastritis
- define
- MC occur where in stomach
- incr risk of developing?
- diagnosis
- management
*anti parietal and anti-IF antibodies–pernicious anemia develop
MC occurs in gastric fundus and body
INCR risk of developing gastric adenocarcinoma
Diagnosis:
- Upper endoscopy with biopsy–shows thick, edematous erosions
- HP testing
TX:
- if HP+: treat with quad therapy (metronidazole, tetracycline, pepto, PPI)
- stop the offending agent(s)
- IV PPIs and H2 blockers as prophylaxis with ICU patients
PUD
*etiologies–MC and 2nd MC
CM:
diagnosis–TOC
Etiologies:
- HP–MC
- NSAIDs/ASA–2nd MCC (esp gastric)
- Zollinger-Ellison Syndrome–acid hypersecretory states
- smoking
- ETOH
- Coffee
CM:
*Dyspepsia—HALLMARK–gnawing epigastric pain
*N/V
DUODENAL: dyspepsia relieved with food and antacids –also get +nocturnal dyspepsia
GASTRIC: dyspepsia worsened with food, wt loss
If ulcer bleeds–hematemesis, melena, hematochezia
MCC OF UGIB*
If ulcer perforates:
*sudden onset of severe abdominal pain–may radiate to the shoulder blade with + peritonitis
Diganosis:
TOC–upper endoscopy + biopsy (to r/o CA) only gastric ulcers need biopsy**
CXR–if perforated, will show air under the diaphragm
HP testing:
- Urea breath test
- HP stool antigen test–good to diganose and check for eradication
- serologic antibodies–good for diagnosis but NOT good for checking eriadication since antibodies stick around lonegr than actual dz
s/s of peritonitis
rebound tenderness, guarding and rigidity
s/s of perforated ulcer
sudden onset of severe abdominal pain–may radiate to the shoulder blade with + peritonitis s/s
CXRay shows air under the diaphgram.. suggestive of?
perforated peptic ulcer
good tests to check for HP eradication
-stool antigen test ***
NOT serologic antibody test
Treatment for PUD
- +HP
- -HP
- refractory
Pos HP:
-QUAD tx: Pepto, tetracycline, metronidazole and PPI x14 days
-concomitant tx: clarithromycin, amox, tetracycline
OR
-TRIPLE: Clarithromycin, Amoxicillin and PPI x10-14 days
- Neg HP:
- goal is to suppress acid–PPI, H2 blockers, antacids, pepto, sucralfate
Refractory:
- parietal cell vagotomy
- Bilroth II (
Zollinger-Ellison Syndrome
- CMs
- diagnosis–screening, best initial and confirmatory test
- tx
CM: can be similr to PUD and so sometimes not diagnosed for a while…. but suspect this dz in anyone who has severe, recurrent, multiple or refractory ulcers +dirrhea
+severe PUD
*diarrhea
Diagnosis:
- endoscopy to confirm PUD
- elev basal or stimulated gastrin levels
- *screening: elevated fasting gastrin levels (best initial test)
- confirmatory: Secretin test–shows persistent gastrin elevations (normally gastrin is inhibited by secretin**)
TX
- Local=tumor ressection
- Mets or unresectable= lifelong high dose PPI
MC sites for Gastrinoma mets?
liver and abdominal LNs
Gastric CA RF CM PE diagnosis--toc
RF:
- HP infection—3-6X risk
- dietary: preserved foods high in salt, nitrates, nitrites, low in veg and raw fruits
- obesity
- ETOH
- smoking
- pernicious anemia
- chronic atrophic gastritis
- type A blood
CM: mostly present later in stages MC= unexplained wt loss and abd pain *anorexia *dyspepsia *early satiety *N/V *anemia *Gauiac pos stool *melena
PE:
- palpable mass on abdomen
- signs of METS:
1. umbillical LN–>sister mary joseph’s nodule
2. LEFT supraclavicular LN–>Virchow’s node (+Troisier sign)
3. LEFT axillary LN–>Irish SIgn
4. Palpable node on rectal exam= Blumer’s shelf
Diagnosis:
TOC=endoscopy + biopsy
TX
- resection if possible
- Gastrectomy
- Chemo
* poor prognosis since PT usually presents late in the DZ*
which gastric CA is assoc with HP infection
MALT gastric lymphoma
Pyloric stenosis -dfine -MC at what age -MC in? RF CM PE Diagnosis
hypertrophy + hyperplasia* of pyloric muscles—causing functional gastric outlet obstruction— obstructs stomach from emptying into duodenum
MC at 3-12 wks of life
MC in first born male
MC cause of intestinal obstruction in infancy
RF:
*use of erythromycin in the first 2 wks of life
CM:
- projectile NONBILIOUS vomiting– hallmark
- signs of dehydration, wt loss and malnutrition
PE
*palpable pylrous– olive shaped, non tender mobile hard mass to the right of the epigastrum
Diagnosis:
- abdominal US is the inital TOC–shows elongated thickened pylorus
- upper GI series—- String Sign: thin column of barium through a narrowed pyloric channel
LABS
- hypokalemia
- hypochloremia
- metabolic alkalosis from vomiting
TX
*surgical—pyloromyotomy
Carcinoid Tumors
- deinfe
- CM–carcinoid syndrome
slow growing CA–can arise in many places throughout body
- neuroendocrine tumors–usually begin in GI tract 55%(stomach, appendix, SI, colon, rectum) and 30% lungs
- rare
- well differentiated
- arrise from ENTEROCHROMAFFIN CELLS
CM: most are asympto
Carcinoid syndrome—-periodic episodes of diarrhea (serotinin realese), flushing, taachycardia, and bronchoconstriction (histamine release) and hemodynamic instability (hypoTension)
Diangosis:
- many times its incidental finding on ednoscpy
- 24 hour urinary 5-hydroxyindolecetic acid/5HIAA excretion–>high because it is end product of serotonin
- contrast enhanced triple phase CT scan–abd and pelvis
TX:
- dep on location
- often surgicla incision
