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GI II Exam 2 EH > Lecture 2 - Stomach Disorders > Flashcards

Lecture 2 - Stomach Disorders Flashcards

1
Q

What are 3 vestibular disorders which may be causes of nausea or vomiting?

A
  1. Labyrinthitis
  2. Meniere syndrome
  3. Motion sickness
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2
Q

What are 3 causes of Gastroparesis that may be associated with N/V?

A
  1. Diabetes
  2. Postviral
  3. Postvagotomy
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3
Q

The use of what reduces the risk of stress-related gastric bleeding?

What reduces the incidence?

A
  • Use of enteral nutrition reduces risk of stress-related bleeding
  • Use of H2 blocker or PPI reduce incidence
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4
Q

Which meds are indicated as causes of Hemorrhagic Gastritis?

A

Aspirin and other NSAIDs

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5
Q

Alcohol is a risk factor for what type of Gastropathy?

A

Portal HTN gastropathy

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6
Q

Portal HTN gastropathy is correlated with the severity of what?

A

Severity of portal HTN and underlying liver disease

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7
Q

Treatment of portal HTN gastropathy with what pharmacological agents reduces the incidence of recurrent acute bleeding?

A

Propranolol or Nadolol

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8
Q

Pts with portal HTN gastropathy who fail propranolol therapy may be successfully treated with what?

A

Portal decompression

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9
Q

What is the most common clinical manifestation of erosive gastritis?

How about in a patient receiving nasogastric suction?

A
  • Upper GI bleed which presents as hematemesis, “coffee ground” emesis
  • Bloody aspirate in pt receiving nasogastric suction
  • Melena
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10
Q

How is the diagnosis of erosive gastritis made?

What is usually seen?

Inflammation?

A
  • Upper endoscopy
  • Superficial lesions, varying in size and #, which may be focal or diffuse
  • There is usually NO significant inflammation on histo exam
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11
Q

What is the recommended treatment for erosive gastritis?

A

Removal of offending agent and maintenance of O2 and blood volume as required

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12
Q

Hourly oral administration of what drugs can be used for prevention of stress ulcers in critically ill patients?

A

Liquid antacids, sucralfate, or IV PPI

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13
Q

Type A gastritis is the type found where in the stomach?

A

Fundic type (predominantly the body)

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14
Q

Type A gastritis is caused by?

A

Autoimmune mechanism

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15
Q

What are some of the common findings with Type A gastrities (i.e., gastrin and H+ levels)?

A
  • Achlorhydria –> pronounced hypergastrinemia –> hyperplasia of gastric ECL cells
  • May lead to the development of carcinoid tumors
  • Decreased IF –> Pernicious Anemia
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16
Q

Type A gastritis (autoimmune type) is associated with what types of cancer?

A
  • Gastric Adenocarcinoma
  • Carcinoid tumors
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17
Q

Type B Gastritis is also know as what type?

Predominantly affects which part of th stomach?

A
  • H. pylori gastritis
  • Antral predominant disease
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18
Q

The eradication of H. pylroi for chronic gastritis is recommended in what 2 instances?

A
  • MALT lymphoma
  • PUD
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19
Q

A small # of patients with Menetrier Disease have shown dramatic improvement after the administration of which drug?

A

Cetuximab, an Ab that binds EGFR

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20
Q

By definition, ulcers extend through the ___________ (layer) and are usually over _____mm in diameter

A

By definition, ulcers extend through the muscularis mucosae and are usually over 5 mm in diameter

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21
Q

PUD results when which factors overwhelm “defensive” factors involved in mucosal resistance?

A

Gastric acid or pepsin

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22
Q

What is the typical patient description of the epigastric pain associated with PUD?

A

Gnawing, dull, aching, or “hunger-like”

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23
Q

Most patients with PUD have symptomatic periods lasting up to several weeks with intervals of months to years in which they are pain free, a concept known as?

A

Periodicity

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24
Q

Does recovered nasogastric lavage fluid that is negative for blood exclude active bleeding from a duodenal ulcer?

A

NO

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25
Q

Strains of H. pyloripositive for which virulence factor significantly increase the risk for an ulcer?

A

Cag-A positive

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26
Q

Successful eradication of H. pylori can be confirmed with what tests?

How long after antibiotic therapy and PPI treatment should you wait to run these tests?

A
  • Urea breath test
  • Fecal antigen test
  • Endoscopy w/ biopsy
  • At least 4 weeks after completing Ab tx and 1-2 weeks after PPI’s
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27
Q

What are the major cause of ulcers (those not due to H. pylori)?

A

NSAIDs

28
Q

The risk of NSAID complications associated with ulcers is greater within how long of starting treatment?

Which 3 patients factors increase risk?

A
  • Within first 3 months of therapy
  • Pts >60 yo
  • Prior Hx of ulcer disease
  • Taking NSAIDs + aspirin, corticosteroids, or anticoagulants
29
Q

What are some other risk factors/associations for PUD?

A
  • Smoking
  • Hypercalcemia
  • Blood group O
  • Corticosteroids
  • Alcohol
30
Q

Which test for H. pylori eradication is sensitive, specific, and inexpensive?

A

Fecal antigen test

31
Q

How many days before fecal and breath tests for H. pylori should PPIs be stopped as to avoid a false negative test?

A

14 days

32
Q

Leukocytosis as a lab findings suggests what about an ulcer?

A

Ulcer penetration or perforation

33
Q

Increased serum amylase as a lab findings + severe epigastric pain suggests what about an ulcer?

A

Penetration into the pancreas

34
Q

With PUD what may been seen with hematocrit and BUN levels?

A
  • Hematocrit may fall due to: bleeding or expansion of the intravascular volume w/ IV fluids
  • BUN may rise due to: absorption of blood nitrogen from the SI and prerenal azotemia
35
Q

An active GI bleed associated with perforation of a peptic ulcer should be treated how?

A
  • Continous infusion of a IV PPI; starting with bolus
  • Once stable needs EGD
36
Q

What are some of the complications associated with gastric surgery for PUD?

A
  • Obstruction
  • Bile reflux gastritis
  • Bezoar
  • Dumping syndrome
  • Anemia
  • Malabsorption
  • Osteomalacia
37
Q

What are 5 differential diagnosis considerations for patients with Upper GI Bleeds (UGIB)?

A
  • PUD
  • Erosive gastritis
  • AV malformations/angioectasias
  • Mallory-Weiss tear
  • Esophageal varices
38
Q

Patients with a prior history of peptic ulcers of GI bleeds have a maredly increased risk of complications on low-doses of which OTC drug?

A

Aspirin

39
Q

In regards to COX-2 inhibitors, aspirin, and NSAIDs which is associated with less risk of ulcers and significant clinical events of an ulcer including obstruction, perforation, and bleeding?

A

COX-2 inhibitors (Coxibs)

40
Q

Which type of ulcer is often nocturnal and relieved by food?

A

Duodenal ulcer

41
Q

Gastric ulcers typically have (increased/decreased/normal) rates of gastric acid?

Duodenal ulcers have what level of gastric acid?

A
  • Gastric ulcers usually have normal gastric acid

- Duodenal ulcer have hypersecretion of gastric acid

42
Q

What is the standard of treatment for acid suppression when managing a gastric or duodenal ulcer?

Timeline?

A

PPIs for 6-8 weeks

43
Q

Which 2 factors when combined are associated with an increased risk of Gastric Ulcers?

A

H. pylori + smoking

44
Q

Ulcers where indicate the need for exclusion of malignancy as a treatment objective?

A

Gastric Ulcers

45
Q

Which histological findings are associated with Gastric Adenocarcinoma?

A
  • Signet-ring cells
  • Linitis plastica
46
Q

On PE which LN’s may be associated with Gastric Adenocarcinoma?

A
  • Virchow sentinel node
  • Krukenberg tumor
47
Q

Smoked fish and meats, pickled vegetables, nitrosamines, benzypyrene and reduced intakes of fruits and vegetables are associated with what type of cancer?

A

Gastric adenocarcinoma

48
Q

When ulcer disease is severe, not responding to treatment, associated with steatorrhea/weight loss, what should be considered?

A

Zollinger-Ellison syndrome

49
Q

What seen on endoscopy or upper GI radiograph is suggestive of ZE syndrome?

A

Large mucosal folds

50
Q

When checking serum gastrin for diagnosis of ZE syndrome, what level should be seen?

Levels are drawn under what conditions?

A
  • >1000 ng/L
  • Drawn while fasting and on no acid suppression meds
51
Q

Which diagnostic method has emerged as the most sensitive test for detecting primary tumors and metastases?

A

Radiolabeled octreotide scanning

52
Q

In all patients with ZE syndrome which 4 levels should be drawn to exclude MEN-1?

A
  • Serum PTH - iPTH (intact PTH)
  • Prolactin
  • LH-FSH
  • GH
53
Q

What is the treatment of choice during evaluation of ZE syndrome and in patients who are not surgical candidates?

A

PPI (i.e., omeprazole or lansoprazole)

54
Q

Other than PPI’s what other treatment options exist for ZE syndrome?

A
  • Exploratory laparotomy w/ resection of 1° tumor and metastases
  • Chemotherapy
55
Q

In patients with ZE syndrome and MEN-1, the tumors are often multifocal and unresectable.

What is the standard of treatment in these cases?

A
  • Treat hyperparathyroidism FIRST (hypergastrinemia may improve)
  • Unresectable tumors may benefit from parietal cell vagotomy
56
Q

What is a chronic condition characterized by intermittent, waxing and waning symptoms and signs of gastric obstruction in the absence of any mechanical lesions to account for the findings?

A

Gastroparesis

57
Q

Gastroparesis is associated with what underlying endocrine condition?

A

Diabetes

58
Q

Gastroparesis is sometimes seen as a post-surgical complication with what 5 procedures?

A
  • Vagotomy
  • Parietal gastric resection
  • Fundoplication
  • Gastric bypass
  • Whipple procedure
59
Q

What are some of the common presenting signs and symptoms of someone with Gastroparesis?

A
  • Intermittent of chronic sx’s of postprandial fullness (early satiety)
  • N/V espeically 1-3 hours after meals
60
Q

What is the diagnostic study of choice for Gastroparesis and the optimal conditions for this study?

A
  • Gastric scintigraphy –> assesses gastric emptying
  • With a low-fat solid meal
61
Q

Although there is no specific treatment for Gastroparesis which 2 drugs may be of benefit?

A
  • Erythromycin
  • Metoclopramide
62
Q

The use of Metoclopramide for >3 months for gastroparesis is associated with a small risk of developing what complication?

A

Tardive dyskinesia

63
Q

What are 6 conditions that may be risk factors for Food (foreign object) Impaction aka Food Bolus impaction?

A
  • Schatzki ring
  • Peptic stricture
  • Esophageal Webs
  • Eosinophilic Esophagitis
  • Achalasia
  • Cancer
64
Q

Inability to swallow liquids including their own saliva is a symptom associated with what condition?

A

Food bolus impaction

65
Q

Dumping syndrome is commonly seen after what procedure?

Common signs/symptoms?

A
  • Post-vagotomy
  • Nausea, diarrhea, palpitations, sweating, lightheadedness, and reactive hypoglycemia

GI II Exam 2 EH (15 decks)

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