Lecture 1 Flashcards
what is occult GI bleeding?
positive fecal blood test or iron deficient anemia w/o physical signs of blood
what is overt GI bleeding?
visible presence of blood in the feces
what is dyspepsia?
acid peptic disease symptoms w/o endoscopic evidence
what is gastritis/duodenitis?
evidence of mucosal inflammation
what is hematemesis?
vomiting blood or “coffee grounds”
what is melena?
black/tarry stool
what is hematochezia?
passage of bright red, bloody stools
what does hematochezia suggest?
brisk and major bleeding
what is a peptic ulcer
> 0.5cm mucosal defect that penetrates the musclularis mucosa
what mucosal layer do peptic ulcers penetrate?
muscularis mucosa
what area of the GI tract can acid peptic disease affect?
esophagus
stomach
duodenum
GI ulcers are more common in what patients?
smokers
what microbe can cause peptic ulcer disease?
h. hylori
what drugs/toxins can cause peptic ulcer disease?
NSAIDs ASA bisphosphonates corticosteroids cocaine alcohol
what are bisphosphonates used to treat?
osteoporosis
by what mechanism can mesentaric vascular occlusion or P. Vera cause a peptic ulcer?
ischemia
how can Zollinger-Ellison syndrome cause a peptic ulcer?
secretion of gastrin –> lowers pH
how does Crohn’s disease cause peptic ulcers?
systemic inflammation
what patients can develop stress ulcers?
crical pts
burn pts
how does h. pylori swim through mucosa?
flagella
how does h. pylori neutralize stomach acid?
urease
what is the purpose of h. pylori urease production?
neutralized stomach acid
what is the #1 cause of gastric ulcers?
h. pylori
what factors increase the risk of an h. pylori infection?
immune response
smoking
stress
what types of gastritis can develop from a chronic h. pylori infection?
antral predominant gastritis
nonatrophic pangastritis
corpus predominant atrophic gastritis
what can develop from antral-predominant gastritis?
duodenal ulcer
asymptomatic h. pylori infection
what can develop from nonatrophic pangastritis?
MALT lymphoma
asymptomatic h. pylori infection
what can develop from corpus predominant atrophic gastritis?
asymptomatic h. pylori infection
gastric ulcer
intestinal metaplasia leading to gastric cancer
how can you test for h. pylori?
histologic exam of gastic mucosa
stool antigen test
carbon-13 urea breath test
serum antibodies
what is the treatment for active h. pylori associted ulcers?
bismuth quadruple therapy: PPI, bismuth subsalicylate, tetracycline, metronidazole
nonbismuth quadruple therapy: PPI, amoxicillin, metronidazole, clarithromycin
how are prostaglandins protective against gastric ulcers?
increase blood flow to mucosa
how to NSAIDS increase risk of PUD?
inhibit prostaglandins
inhibit platelet function
what type of NSAID are least likely to cause gastritis?
COX-2 inhibitors
how does acid aid in UGI bledding?
decreases platelet aggregation
activated pepsin–> enhances clot lysis
increases fibrinolytic activity
where is the tumor typically located in Zollinger-Ellison Syndrome?
pancreas
proximal small bowel
what other disease is Zollinger Ellison syndrome associated w/?
multiple endocrine neoplasias (MEN1)
what patients are most at risk for mesenteric vascular occlusion?
elderly w/ ASVD
what initiates symptoms w/ mesenteric vascular occlusion?
food
physical activity
where are stress ulcers most often located?
fundus
how soon after the initial stress do stress ulcers present?
48-72hrs
what are stress ulcers due to a head injury called?
Cushing’s ulcer
what are stress ulcers due to severe burns called?
Curling’s ulcer
what is the treatment for stress ulcers?
maximal hemodynamical support
IV PPI
what are the symptoms of an uncomplicated ulcer?
often no symptoms radiating epigastric pain pain relieved by food N/V heartburn
what are symptoms of a complicated ulcer?
severe abdominal pain shock guarding free intraperitoneal air hemorrhage syptomatic anemia gastric outlet obstruction weight loss
how does complicated PUD cause air under the diaphragm?
perforation
what drugs can you use to treat PUD?
antacids
H2 blockers
PPIs
mucosal protective agents (sulcrafate, misoprostol, bismuth subsalicylate)
what are antacids used for?
occasional dyspepsia
what are H2 blockers used for?
chronic dyspepsia
what is the suffix of H2 blockers?
-tidine
what is the suffix for PPIs?
-prazole
what is the MOA of sulcrafate?
coats ulcers
what is the MOA of misoprostol?
prostaglandin analog
when is misoprostol contraindicated?
pregnancy
when should you use bismuth subsalicylate?
h. pylori
what are red flags with abdominal pain?
weight loss recurrent vomiting dsphagia GI bleeding anemia family hx of GI cancer abdominal mass
when is surgery indicated w/ PUD?
intractable
bleeding
perforation
obstruction
