GI - Stomach Flashcards
Functional dyspepsia?
Symptoms as described for dyspepsia persisting for at least 12 weeks without evidence of an ulcer
Dyspepsia? Associated with?
Pain associated with fullness early satiety bloating or nausea.
Gastroesophageal reflux typically occurs when? Worsens with?
After meals. Recumbency.
Biliary colic caused by? Location of pain? Precipitated by? Lasts for?
Gallstones. Right upper quadrant. Precipitated by meals, especially fatty foods. Last 30 to 60 minutes with spontaneous resolution
Irritable bowel syndrome suggested by what symptoms?
- Chronic dysmotility symptoms (up loading, cramping)
- Relieves with defecation
- no weight loss or bleeding
Duodenal ulcers caused pain how long after meals? Relieved by?
2 to 5 hours after a meal. Food or antacids.
If food worsens gastric pain - think?
Gastric ulcer
Gastric cancer can present with dysphasia if? Persistent vomiting if? Early satiety it?
In the cardiac region of the stomach. Blocking the pyloric channel. Mass effect or infiltration of the stomach wall.
When should patients undergo endoscopy for dyspepsia?
- Older than 45 years who present with new onset dyspepsia
- Patients with alarm symptoms (weight-loss, recurrent vomiting, dysphasia, bleeding, anemia)
- Symptoms have failed to respond to empiric therapy
In younger patients with no alarm features - strategy for dyspepsia?
Urea breath test or H. pylori antibody test
Problem with H. pylori antibody test?
Will remain positive for life even after successful treatment
Cancers associated with H. pylori?
Gastric carcinoma and gastric MALT lymphoma
Treatment for H. pylori?
Clarithromycin, amoxicillin and a PPI
Major cause of duodenal and gastric ulcers not caused by H. pylori? Mech?
NSAIDs. Inhibit prostaglandin synthesis resulting in reduced secretion of mucus and bicarb and decreased mucosal bloodflow
Condition that should be suspected if pt with ulcers is H. pylori negative and does not use NSAIDs? Diagnosed with?
Zollinger-Ellison syndrome. Serum gastrin levels greater than 1000
Free perforation into the abdominal cavity may cause?
Hemorrhage with severe onset of pain and development of Peritonitis
Indications for surgical intervention?
Perforation and obstruction
Symptoms of gastric outlet obstruction?
Persistent vomiting and weight loss with +/-
abdominal distention
Gastritis? Presents as? Common causes?
Information/erosion of the gastric lighting; bleeding without pain
#Alcohol #NSAIDs #H pylori #Portal hypertension #Stress (trauma, burns, sepsis, uremia)
Atrophic gastritis is associated with which vitamin deficiency?
B12
Test to diagnose erosive gastritis?
#Endoscopy to diagnose #H pylori testing
H pylori testing options?
#endoscopic biopsy – most accurate/invasive #Serology – negative test excludes infection but lacks specificity (current versus old infection?) #Urea breath testing – positive only in activity fiction # stool antigen – positive only in active infection
When to give stress ulcer prophylaxis?
#Mechanical ventilation #head trauma #burns #Coagulopathy
Role of alcohol and tobacco in PUD?
Delay healing of ulcers (do not cause ulcers)
Risk of cancer into duodenal PUD? Gastric PUD?
No risk
4%
Patient with H. pylori gastritis treated with triple therapy. How to evaluate if treatment worked?
Treatment failure usually from?
Breath test or stool antigen
Alcohol, NSAIDs, smoking, medication noncompliance
Patient with confirmed gastrinoma. CT/MRI negative for metastases. Next step?
Somatostatin receptor scintigraphy (nuclear octreotide scan) + endoscopic ultrasound to further exclude metastases
(Gastrinoma associated with increased number of somatostatin receptors)
Treatment for diabetic gastroparesis?
Erythromycin and metoclopramide
