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GI II Exam 1. > 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 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
Strains of *H. pylori*positive for which virulence factor significantly increase the risk for an ulcer?
Cag-A positive
26
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?
- Urea breath test - Fecal antigen test - Endoscopy w/ biopsy - At least **4 weeks** after completing Ab tx and **1-2 weeks** after PPI's
27
What are the major cause of ulcers (those not due to *H. pylori)?*
NSAIDs
28
The risk of NSAID complications associated with ulcers is greater within how long of starting treatment? Which 3 patients factors increase risk?
- Within first 3 months of therapy - Pts **\>60 yo** - Prior Hx of ulcer disease - Taking NSAIDs + aspirin, **corticosteroids**, or anticoagulants
29
What are some other risk factors/associations for PUD?
- Smoking - Hypercalcemia - Blood group O - Corticosteroids - Alcohol
30
Which test for *H. pylori* eradication is sensitive, specific, and inexpensive?
Fecal antigen test
31
How many days before fecal and breath tests for *H. pylori* should PPIs be stopped as to avoid a false negative test?
14 days
32
Leukocytosis as a lab findings suggests what about an ulcer?
Ulcer **penetration** or **perforation**
33
Increased serum amylase as a lab findings + severe epigastric pain suggests what about an ulcer?
**Penetration** into the **pancreas**
34
With PUD what may been seen with hematocrit and BUN levels?
- **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
An active GI bleed associated with perforation of a peptic ulcer should be treated how?
- Continous infusion of a **IV PPI**; starting with **bolus** - Once stable needs **EGD**
36
What are some of the complications associated with gastric surgery for PUD?
- Obstruction - Bile reflux gastritis - **Bezoar** - Dumping syndrome - Anemia - Malabsorption - Osteomalacia
37
What are 5 differential diagnosis considerations for patients with Upper GI Bleeds (UGIB)?
- PUD - Erosive gastritis - AV malformations/angioectasias - Mallory-Weiss tear - Esophageal varices
38
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?
Aspirin
39
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?
COX-2 inhibitors (Coxibs)
40
Which type of ulcer is often **nocturnal** and **relieved by food?**
Duodenal ulcer
41
Gastric ulcers typically have (increased/decreased/normal) rates of gastric acid? Duodenal ulcers have what level of gastric acid?
- **Gastric ulcers** usually have **normal gastric acid** **- Duodenal ulcer** have **hypersecretion** of **gastric acid**
42
What is the standard of treatment for acid suppression when managing a gastric or duodenal ulcer? Timeline?
PPIs for 6-8 weeks
43
Which 2 factors when combined are associated with an increased risk of Gastric Ulcers?
*H. pylori **+*** smoking
44
Ulcers where indicate the need for exclusion of malignancy as a treatment objective?
Gastric Ulcers
45
Which histological findings are associated with Gastric Adenocarcinoma?
- Signet-ring cells - Linitis plastica
46
On PE which LN's may be associated with Gastric Adenocarcinoma?
- Virchow sentinel node - Krukenberg tumor
47
Smoked fish and meats, pickled vegetables, nitrosamines, benzypyrene and reduced intakes of fruits and vegetables are associated with what type of cancer?
Gastric adenocarcinoma
48
When ulcer disease is severe, not responding to treatment, associated with steatorrhea/weight loss, what should be considered?
Zollinger-Ellison syndrome
49
What seen on endoscopy or upper GI radiograph is **suggestive** of ZE syndrome?
Large mucosal folds
50
When checking serum gastrin for diagnosis of ZE syndrome, what level should be seen? Levels are drawn under what conditions?
- \>1000 ng/L - Drawn while **fasting** and on **no acid suppression meds**
51
Which diagnostic method has emerged as the most sensitive test for detecting primary tumors and metastases?
Radiolabeled octreotide scanning
52
In all patients with ZE syndrome which 4 levels should be drawn to exclude MEN-1?
- Serum PTH - iPTH (intact PTH) - Prolactin - LH-FSH - GH
53
What is the treatment of choice during evaluation of ZE syndrome and in patients who are not surgical candidates?
PPI (i.e., omeprazole or lansoprazole)
54
Other than PPI's what other treatment options exist for ZE syndrome?
- **Exploratory laparotomy** w/ resection of 1° tumor and metastases - **Chemotherapy**
55
In patients with ZE syndrome and MEN-1, the tumors are often multifocal and unresectable. What is the standard of treatment in these cases?
- Treat **hyperparathyroidism FIRST** (hypergastrinemia may improve) - Unresectable tumors may benefit from parietal cell vagotomy
56
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?
Gastroparesis
57
Gastroparesis is associated with what underlying endocrine condition?
Diabetes
58
Gastroparesis is sometimes seen as a post-surgical complication with what 5 procedures?
- Vagotomy - Parietal gastric resection - Fundoplication - Gastric bypass - Whipple procedure
59
What are some of the common presenting signs and symptoms of someone with Gastroparesis?
- Intermittent of chronic sx's of postprandial fullness (early satiety) - N/V espeically 1-3 hours after meals
60
What is the diagnostic study of choice for Gastroparesis and the optimal conditions for this study?
- **Gastric scintigraphy** --\> assesses gastric emptying - With a **low-fat solid meal**
61
Although there is no specific treatment for Gastroparesis which 2 drugs may be of benefit?
- Erythromycin - Metoclopramide
62
The use of Metoclopramide for \>3 months for gastroparesis is associated with a small risk of developing what complication?
Tardive dyskinesia
63
What are 6 conditions that may be risk factors for Food (foreign object) Impaction aka Food Bolus impaction?
- Schatzki ring - Peptic stricture - Esophageal Webs - Eosinophilic Esophagitis - Achalasia - Cancer
64
Inability to swallow liquids including their own saliva is a symptom associated with what condition?
Food bolus impaction
65
Dumping syndrome is commonly seen after what procedure? Common signs/symptoms?
- Post-vagotomy - Nausea, diarrhea, palpitations, sweating, lightheadedness, and reactive hypoglycemia

GI II Exam 1. (25 decks)

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