L79 Flashcards
Define dyspepsia
Stomach pain
Might also be described as indegestion
“Non-ulcer dyspepsia” = dyspepsia w/o identifiable cause after eval
If you feel an abdominal mass on exam, what are you thinking?
CANCER
Food in the stomach would present as distension
What is peptic erosin vs ulcer?
@ stomach
Due to pepsin + acid secretion
Erosion = mucosal break
Ulcer = break + DEPTH
What is gastritis
Inflammation of stomach
Causes of acute gastritis
- NSAIDS
- Alcohol
- Chemo // radiation
- Portal HTN
- Curling or Cushing ulcer
What is Curling ulcer? Cushing ulcer?
Curling - ulcers that occur in BURN pts
Cushing - ulcers that occur in pts w/ severe intracranial pathology
5 main causes of chronic gastritis
- H.pylori
- AI: pernicious anemia
- Other GI diseases: Crohn’s
- Systemic disease: GVHD, sarcoid, chronic granulomatous
- Menetrier’s disease
3 things gastric ulcers do
Bleed
Perforation -> penetrate adj structures
Obstruct
H. pylori
Transmission
What layer of stomach
Cause
Fecal-oral Mucous layer **Chronic gastritis --> 1. Ulcers 2. Increased risk MALToma 3. Less gastric acid -> other gastric cancers
4 ways to dx H.pylori
- Ab in serum
- Antigen in stool
- Urea breath test (b/c bacteria makes urease)
- Biopsy w/ UEndoscopy
Treat H pylori infection
2 Ab + PPI
How are NSAIDs linked to ulcers?
Non-selective COX 1 & 2 inhibitor
No PGs = lose GI protection
Describe an NSAID ulcer
Ulcer w/o inflammation
How distinguish from gastritis
@ antrum
If you add what drug to NSAID - this will increase risk of NSAID complications (ulcer)
Corticosteroids
What can you give with NSAIDs to minimize ulcer risk
Misoprostol = PGE1 analog
What is Zollinger Ellison syndrome?
Ectopic pancreatic tissue
Gastrinomas
= Tumors that secrete gastrin
More acid from parietal cells
Some ZE pts don’t just have ZE alone - they have multiple endocrine neoplasia type 1. What is MEN1?
Adenomas in the:
- Parathyroid -> hyperCa
- Pancreatic islet cells -> ZE
- Pituitary gland
2 values to dx ZE
Acidic stomach
+
High gatrin in blood when fasting
Test to dx ZE
Secretin provocation
+ Secretin
See jump in serum GASTRIN
What are 3 reasons you’d have high serum gastrin w/o ZE?
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)
Describe how B12 gets absorbed in the diet
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
What type of anemia will you have if B12 def?
Megaloblastic
What are 5 causes of B12 def?
Pernicious anemia Gastric surgery Pancreatic dysfxn Ileal resection (Crohn's) Bacterial overgrowth
What is pernicious anemia? Why does it result in pernicious anemia?
Abs vs IF + parietal cells
Lose both
