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P&T Block 3 Pulm & GI > L79 > Flashcards

L79 Flashcards

1
Q

Define dyspepsia

A

Stomach pain
Might also be described as indegestion
“Non-ulcer dyspepsia” = dyspepsia w/o identifiable cause after eval

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2
Q

If you feel an abdominal mass on exam, what are you thinking?

A

CANCER

Food in the stomach would present as distension

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3
Q

What is peptic erosin vs ulcer?

A

@ stomach
Due to pepsin + acid secretion
Erosion = mucosal break
Ulcer = break + DEPTH

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4
Q

What is gastritis

A

Inflammation of stomach

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5
Q

Causes of acute gastritis

A
  1. NSAIDS
  2. Alcohol
  3. Chemo // radiation
  4. Portal HTN
  5. Curling or Cushing ulcer
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6
Q

What is Curling ulcer? Cushing ulcer?

A

Curling - ulcers that occur in BURN pts

Cushing - ulcers that occur in pts w/ severe intracranial pathology

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7
Q

5 main causes of chronic gastritis

A
  1. H.pylori
  2. AI: pernicious anemia
  3. Other GI diseases: Crohn’s
  4. Systemic disease: GVHD, sarcoid, chronic granulomatous
  5. Menetrier’s disease
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8
Q

3 things gastric ulcers do

A

Bleed
Perforation -> penetrate adj structures
Obstruct

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9
Q

H. pylori
Transmission
What layer of stomach
Cause

A 
Fecal-oral
Mucous layer
**Chronic gastritis --> 
1. Ulcers
2. Increased risk MALToma
3. Less gastric acid -> other gastric cancers
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10
Q

4 ways to dx H.pylori

A
  1. Ab in serum
  2. Antigen in stool
  3. Urea breath test (b/c bacteria makes urease)
  4. Biopsy w/ UEndoscopy
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11
Q

Treat H pylori infection

A

2 Ab + PPI

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12
Q

How are NSAIDs linked to ulcers?

A

Non-selective COX 1 & 2 inhibitor

No PGs = lose GI protection

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13
Q

Describe an NSAID ulcer

A

Ulcer w/o inflammation
How distinguish from gastritis
@ antrum

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14
Q

If you add what drug to NSAID - this will increase risk of NSAID complications (ulcer)

A

Corticosteroids

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15
Q

What can you give with NSAIDs to minimize ulcer risk

A

Misoprostol = PGE1 analog

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16
Q

What is Zollinger Ellison syndrome?

A

Ectopic pancreatic tissue
Gastrinomas
= Tumors that secrete gastrin
More acid from parietal cells

17
Q

Some ZE pts don’t just have ZE alone - they have multiple endocrine neoplasia type 1. What is MEN1?

A

Adenomas in the:

  • Parathyroid -> hyperCa
  • Pancreatic islet cells -> ZE
  • Pituitary gland
18
Q

2 values to dx ZE

A

Acidic stomach
+
High gatrin in blood when fasting

19
Q

Test to dx ZE

A

Secretin provocation
+ Secretin
See jump in serum GASTRIN

20
Q

What are 3 reasons you’d have high serum gastrin w/o ZE?

A 
Conditions where you lose negative FB:
- Chronic PPI/H2 blockers
- AI -> lost parietal cells
- Antral resection (no G cells)
Look for high blood gastrin w/ high pH in stomach (basic)
21
Q

Describe how B12 gets absorbed in the diet

A

B12 + haptocorrin from saliva
Stomach makes IF
Pancreatic enzymes in SI cleave B12/hapto
B12 binds IF -> absorbed in distal ileum
B12 stored in the liver

22
Q

What type of anemia will you have if B12 def?

A

Megaloblastic

23
Q

What are 5 causes of B12 def?

A 
Pernicious anemia
Gastric surgery
Pancreatic dysfxn
Ileal resection (Crohn's)
Bacterial overgrowth
24
Q

What is pernicious anemia? Why does it result in pernicious anemia?

A

Abs vs IF + parietal cells

Lose both

25
Q

Treat B12 def

A

B12 injections!

26
Q

Is gastric adenocarinoma benign or malignant?

A

Malignant

27
Q

Where can adenocarcinoma happen in the stomach? How does location change the likely cause?

A

Proximal

Distal - associated with H pylori infection

28
Q

Treat gastric:
Adenocarcinoma
Lymphoma
MALToma

A

Adeno: surgery, bad prognosis
Lymphoma: chemo
MALToma - likely H pylori, try antibiotics first

29
Q

Symptoms of gastric cancer

A

ASYMPTOMATIC

Why they have such bad prognosis

30
Q

What is angiodysplasia?

A

= cause of occult GI bleeds

31
Q

What causes watermelon stomach?

A

Dilated venules @ antrum

32
Q

What is gatroparesis? Causes

A

Delayed stomach emptying

  1. Peristalsis wrong
  2. Diabetes
33
Q

Dx + treat gastroparesis

A

Dx = gastric emptying test

Treatment not great

34
Q

What are the 2 types of bezoar you can get?

A

Bezoar is stuff stuck in the stomach
Phyto = veggie
Tricho = hair

35
Q

What are the 2 colors hematemesis can be?

A

Red = acute bleed

Coffee grounds = past bleed since acid has broken down the bleed

36
Q

What are the 3 colors stool can be if it has blood in it?

A

Brown = occult
Black with red hue + smells BAD = melena
Red = hematochezia
Stool blood can def be from upper GI!!!

37
Q

Why does it make sense that normally high serum gastrin should present with high stomach pH (basic)?

A

B/c gastrin is secreted from G cells when the pH in stomach isn’t acid enough
Circulating to reach parietal cells to secrete acid to lower the pH

P&T Block 3 Pulm & GI (31 decks)

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