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GI > Lecture 4: Disorders of the Stomach > Flashcards

Lecture 4: Disorders of the Stomach Flashcards

1
Q

Define dyspepsia.

A

Epigastric fullness or burning, early satiety, nausea, postprandial fullness.

Hallmark sign of a stomach disorder.

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2
Q

What is the hallmark sign of GERD and a stomach disorder?

A
  • GERD: Heartburn
  • Stomach Disorder: Dyspepsia
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3
Q

Define gastropathy.

A

A condition with epithelial or endothelial damage.

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4
Q

Define gastritis.

A

Condition with histological inflammation

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5
Q

What are the two categories of gastritis?

A
  • Erosive/hemorrhagic (acute)
  • Non-erosive
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6
Q

What medication most commonly causes erosive gastritis?

A

NSAIDs

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7
Q

What are the common etiologies of erosive gastritis?

A
  • Medications (NSAIDs esp)
  • Alcohol
  • Stress
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8
Q

Why do NSAIDs cause gastritis?

A

Inhibition of COX-1 prevents mucus production.

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9
Q

What is the pathophysiology behind stress-related gastritis?

A

Inadequate gastric mucosal blood flow during periods of intense physiologic stress.

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10
Q

What is the most common clinical manifestation of erosive gastritis?

A

Upper GI bleeding, aka hematemesis or melena or coffee ground emesis.

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11
Q

How do we diagnose erosive gastritis?

A

EGD within 24 hours of admission.

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12
Q

What medication added to a PPI can assist with treating erosive gastritis?

A

Sucralfate suspension

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13
Q

What is used to suppress acid secretion to help with erosive gastritis?

A

Pantoprazole IV 80mg bolus + 8mg/hr infusion

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14
Q

If a patient with NSAID gastritis still needs a NSAID, what might be a good alternative?

A

Celebrex, which is a COX-2 inhibitor.

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15
Q

What is the best way to prevent and heal gastritis?

A

PPIs (Omeprazole 20-40mg PO daily for 2-4 weeks)

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16
Q

For critically ill patients, what should we do if they have risk factors for GI bleeding?

A

Prophylactic PPIs.

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17
Q

What are the common etiologies for NON-erosive gastritis?

A
  • H. pylori
  • NSAIDs
  • Autoimmune gastritis
  • Can be acute or chronic
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18
Q

What does H. pylori look like?

A

Spiral, G- bacteria.

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19
Q

Who does H. pylori infection occur in most commonly?

A

Children in crowded areas with poor sanitation

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20
Q

What does a H. pylori infection do?

A
  • Inflammatory response
  • Release of PMNs and lymphocytes
  • Gastric mucosal inflammation, making it more susceptible to damage.
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21
Q

What does a history of H. pylori infection increase the risk of?

A

Gastric cancer

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22
Q

How does nonerosive gastritis typically present?

A
  • Dyspepsia/epigastric discomfort
  • N/V
  • Anorexia

Often, it is clinically SILENT.

No bleeding like in erosive

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23
Q

How do you diagnose nonerosive gastritis?

A

Histological biopsy of goblet cells/Paneth cells via EGD.

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24
Q

What ethnicities are most susceptible to gastric metaplasia?

A
  • Hispanics
  • African Americans
  • Native Americans

All the non-north americans simplified

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25
Q

What tests are used to help establish the etiology of nonerosive gastritis?

A
  • Urea breath test
  • Blood test
  • Stool test (Fecal antigen)
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26
Q

What is the work-up protocol for a patient < 60 with uncomplicated gastritis?

A
  • Non-invasive tests like urea breath and fecal antigen
  • Empiric abx tx + PPIs
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27
Q

When is EGD indicated for nonerosive gastritis workup?

A
  1. Older than 60
  2. Alarm symptoms (wt loss, severe dysphagia, severe vomiting)
  3. Failure of initial therapy
  4. FMHx of gastric cancer
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28
Q

What is a positive urea breath test?

A

Expiring CO2 tagged with urea isotope.

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29
Q

Prior to doing a fecal antigen test or urea breath test, what must a patient stop prior?

A

No PPIs or ABX 2 week prior.

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30
Q

What is the typical antibody seen in a H. pylori infection?

A

IgG

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31
Q

What is 1st line therapy for H. pylori eradication?

A

Triple therapy of 10-14 days of

  1. Omeprazole/PPI 20mg BID
  2. Amoxicillin 1g BID
  3. Clarithomycin 500mg BID

Please Cure Abdomen

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32
Q

What is quadruple therapy for H. pylori eradication?

Please Make Tummy Better

A
  1. PPI
  2. Bismuth
  3. Tetracycline
  4. Metronidazole

10-14 day

For allergy to amoxicillin, resistance to clarithomycin, or failure
Please
Make
Tummy
Better

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33
Q

What is peptic ulcer disease?

A

Break in gastric or duodenal mucosa that extends through the muscularis mucosa into deeper layers

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34
Q

When do duodenal ulcers typically occur?

A

30-55 yrs

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35
Q

When do stomach ulcers typically occur?

A

55-70

D before S

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36
Q

What is the MCC of duodenal ulcers? Stomach ulcers?

A
  • Duodenum: H. pylori
  • Stomach: NSAIDs
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37
Q

What is zollinger-ellison syndrome and what does it predispose you to?

A

Increased gastric acid, which predisposes you to ulcers

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38
Q

What are the risk factors for PUD?

A
  • NSAID use
  • Age > 60
  • Prior h/o of PUD or H. pylori infection
  • Smoking
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39
Q

What are the hallmark signs of PUD?

A
  • Epigastric, dull, gnawing pain that resolves after eating.
  • Nocturnal pain wakes the patient
  • Nausea
  • Anorexia
  • Epigastric tenderness
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40
Q

How do we diagnose PUD?

A
  • EGD with gastric mucosal biopsy
  • For low-risk: non-invasive H. pylori testing
41
Q

How do we treat PUD due to H. pylori?

A

H. pylori eradication treatment.

42
Q

How do we confirm H. pylori eradication?

A

Urea breath test or EGD 4 weeks after therapy

43
Q

When is it indicated to continue medications for PUD?

A
  1. Pt has a giant ulcer > 2cm
  2. Couldn’t eradicate H. pylori
  3. Recurrent ulcers
  4. Continued NSAID use
44
Q

If PUD needs additional med treatment after H. pylori eradication, what should we give?

A

PPIs for 4-6 weeks after ABX.

45
Q

If a patient has NSAID PUD but needs the NSAIDs, what must they take?

A

PPIs as long as they are taking the NSAID.

46
Q

What is the main complication with PUD?

A

Upper GI bleed

47
Q

How do we manage a UGI bleed due to PUD?

A
  1. Hospitalize, fluids
  2. Check hemodynamic status
  3. IV PPI
  4. Emergent EGD within 24 hours
48
Q

How does stomach/duodenal perforation present?

A
  • Sudden, severe abdominal pain
  • Ill-appearance
  • Rigid, guarding, rebound tenderness
49
Q

How do we workup a perforation?

A
  • Abd CT to confirm
  • CBC with leukocytosis
  • Surgery to close
50
Q

What CT findings suggest abd perforation?

A

Free air in anterior peritoneal space

51
Q

How does PUD with penetration typically present and what structures are most commonly affected?

A
  • Pancreas and liver
  • Gradual, increasing pain radiating to the back
  • Severe and constant pain
  • Unresponsive to antacids/foods
52
Q

How do we diagnose and manage PUD penetration?

A
  • Diagnosis: EGD for ulcers and then a CT to confirm penetration.
  • Management: IV PPIs or surgery
53
Q

How does gastric outlet obstruction due to PUD occur?

A

Edema or cicatricial narrowing or pylorus or duodenal bulb.

54
Q

How does gastric outlet obstruction present?

A
  • Early satiety, vomiting, wt loss, epigastric fullness
  • Dehydration
55
Q

How do we treat gastric outlet obstruction?

A
  • IV PPI
  • EGD
  • Dilation of obstruction via hydrostatic balloons
56
Q

What is misoprostol’s indication?

A

NSAID gastritis/ulcer prevention

57
Q

What does misoprostol do?

A

Replacement of prostaglandins

58
Q

What is the BBW of misoprostol?

A

PREGNANCY or women trying to become pregnant

It is used to terminate pregnancies by inducing labor

59
Q

What is the MC SE of misoprostol?

A

Diarrhea

60
Q

What should we order prior to giving a patient misoprostol?

A

Pregnancy test 2 weeks prior

61
Q

What is sucralfate used for?

A
  • NSAID induced gastritis/prophylaxis
  • Stress gastritis/prophylaxis
  • PUD
62
Q

What does sucralfate do?

A

Stimulates prostanglandin synthesis to form a mucoprotective layer to help healing.

63
Q

What are the main concerns with sucralfate?

A
  • Constipation
  • Alters absorption of drugs
64
Q

What causes gastric outlet obstruction in babies?

A

Post-natal muscular hypertrophy of pylorus

65
Q

How does gastric outlet obstruction present in adults?

A
  • Postprandial N/V
  • Epigastric pain
  • Early satiety
  • Abdominal distension
  • Wt loss
  • Lyte abnormalities
66
Q

How does gastric outlet obstruction present in babies?

A
  • Postprandial vomiting
  • Projectile vomiting
  • Wt loss
  • Lyte abnormalities
67
Q

How does an adult physical present for gastric outlet obstruction?

A
  • Abd distension
  • Epigastric tenderness
  • Succussion splash

Like the more severe version of gastroparesis

68
Q

How does a baby physical present for gastric outlet obstruction?

A
  • Upper abdomen with peristaltic waves
  • Olive shaped mass in right upper abdomen post vomiting
  • Dehydration
69
Q

How do we workup gastric outlet obstruction for adults and babies?

A
  • Adults: EGD (diagnosis) and CT (obstruction)
  • Children: Abd US
70
Q

How do we manage GOO for adults?

A
  • NPO
  • IV fluids
  • NG tube
  • IV PPI
  • Treatment of PUD or mass
71
Q

What surgery can we do for GOO management?

A

Pyloromyotomy

72
Q

What is gastroparesis?

A

Delayed gastric emptying

73
Q

Who is gastroparesis MC in?

A
  • Women
  • DM
74
Q

What are the common etiologies for gastroparesis?

A
  • Idiopathic
  • DM, hypothryoidism
  • Scleroderma
  • Post-viral
  • Meds
  • Surgery/nerve injury
75
Q

How does gastroparesis typically present?

A
  • N/V
  • Abd/epigastric pain
  • Early satiety
  • Bloating
  • GERD
76
Q

How does gastroparesis present on PE?

A
  • Potential epigastric distension or tenderness
  • No guarding or rigidity
  • +/- succussion splash
77
Q

How do we confirm a diagnosis of gastroparesis?

A
  • Gastric emptying test (only confirms presence)
  • Blood tests for underlying cause!!!
78
Q

How do we treat gastroparesis?

A
  • Treat underlying cause
  • Low fat diet
  • Metoclopramide
  • Erythromycin

Meto makes u move

Erythroymicin SE is increased gastric motility

79
Q

What is considered a positive gastric emptying test?

A

Gastric retention > 10% after 4 hours

80
Q

What is zollinger-ellison syndrome?

A

A rare endocrine disorder with 3 interrelated pathologies.

81
Q

What is the triad of zollinger-ellison syndrome?

A
  1. Gastrinoma (pancreas or duodenal)
  2. Increased gastric acid secretion
  3. Peptic ulcers
82
Q

What % of masses in zollinger-ellison syndrome are malignant?

A
  • 2/3 malignant
  • 1/3 solitary
83
Q

How does zollinger-ellison typically present?

A
  • PUD
  • Heartburn
  • Wt loss
  • Diarrhea
84
Q

How do we diagnose zollinger-ellison syndrome?

A
  • Serum fasting gastrin level (stop PPIs 6 days prior)
  • Diagnostic: 10x ULN with a gastric pH below 2.
85
Q

What is a secretin stimulation test mainly used to check for?

A

Gastrinoma

86
Q

What imaging test helps identify gastrinomas?

A

Somatostatin receptor scintigraphy

87
Q

How do we manage localized zollinger-ellison syndrome?

A
  • PPIs
  • Surgical resection
88
Q

What are the two primary metastatic sites for Zollinger-ellison?

A
  1. Liver
  2. Bones

You can resect liver mets to help prognosis

89
Q

What are the benign gastric tumors?

A
  • Inflammatory epithelial polyps
  • Adenomatous polyps
90
Q

What are the malignant gastric tumors?

A
  • Gastric adenocarcinoma
  • Gastric lymphoma
  • Gastric carcinoid tumors (From zollinger-ellison)
91
Q

What is the MC cancer of the stomach?

A

Gastric adenocarcinoma

Intestinal type specifically

92
Q

What are the risk factors for intestinal type gastric adenocarcinomas?

A
  • Chronic H. pylori infection
  • Smoking
  • High nitrate/salt diet
  • Advanced age
93
Q

What are the risk factors for diffuse-type gastric adenocarcinomas?

A

Genetic mutations/hereditary

Spreads faster

94
Q

What are the stages of stomach cancer? (Image)

A
95
Q

How do gastric adenocarcinomas typically present?

A
  • Dyspepsia
  • Vague epigastric pain
  • Anorexia
  • Wt loss
  • Early satiety
  • Hematemesis
  • Postprandial vomiting if obstructed
96
Q

What 3 locations suggest metastasis of a gastric adenocarcinoma upon palpation?

A
  • Left supraclavicular lymph node (Virchow’s node)
  • Umbilical nodule (Sister Mary Joseph nodule)
  • Rigid rectal shelf (Blumer shelf)
97
Q

What is the primary procedure of choice for working up gastric adenocarcinomas?

A

EGD

98
Q

What is the #1 risk factor for gastric lymphoma?

A

Chronic H. pylori infection

99
Q

How do you diagnose and treat gastric lymphoma?

A
  • Diagnosis: EGD with biopsy
  • Tx: Radiation and/or chemo

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