Lecture 1 Flashcards by Hannah Simpson

what is occult GI bleeding?

positive fecal blood test or iron deficient anemia w/o physical signs of blood

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what is overt GI bleeding?

visible presence of blood in the feces

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what is dyspepsia?

acid peptic disease symptoms w/o endoscopic evidence

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what is gastritis/duodenitis?

evidence of mucosal inflammation

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what is hematemesis?

vomiting blood or “coffee grounds”

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what is melena?

black/tarry stool

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what is hematochezia?

passage of bright red, bloody stools

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what does hematochezia suggest?

brisk and major bleeding

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what is a peptic ulcer

> 0.5cm mucosal defect that penetrates the musclularis mucosa

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what mucosal layer do peptic ulcers penetrate?

muscularis mucosa

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what area of the GI tract can acid peptic disease affect?

esophagus
stomach
duodenum

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GI ulcers are more common in what patients?

smokers

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what microbe can cause peptic ulcer disease?

h. hylori

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what drugs/toxins can cause peptic ulcer disease?

NSAIDs
ASA
bisphosphonates
corticosteroids
cocaine
alcohol

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what are bisphosphonates used to treat?

osteoporosis

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by what mechanism can mesentaric vascular occlusion or P. Vera cause a peptic ulcer?

ischemia

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how can Zollinger-Ellison syndrome cause a peptic ulcer?

secretion of gastrin –> lowers pH

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how does Crohn’s disease cause peptic ulcers?

systemic inflammation

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what patients can develop stress ulcers?

crical pts

burn pts

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how does h. pylori swim through mucosa?

flagella

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how does h. pylori neutralize stomach acid?

urease

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what is the purpose of h. pylori urease production?

neutralized stomach acid

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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