Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

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

A
  • GERD: Heartburn
  • Stomach Disorder: Dyspepsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define gastropathy.

A

A condition with epithelial or endothelial damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define gastritis.

A

Condition with histological inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the two categories of gastritis?

A
  • Erosive/hemorrhagic (acute)
  • Non-erosive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What medication most commonly causes erosive gastritis?

A

NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the common etiologies of erosive gastritis?

A
  • Medications (NSAIDs esp)
  • Alcohol
  • Stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why do NSAIDs cause gastritis?

A

Inhibition of COX-1 prevents mucus production.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the pathophysiology behind stress-related gastritis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the most common clinical manifestation of erosive gastritis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do we diagnose erosive gastritis?

A

EGD within 24 hours of admission.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

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

A

Sucralfate suspension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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

A

Pantoprazole IV 80mg bolus + 8mg/hr infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the best way to prevent and heal gastritis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

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

A

Prophylactic PPIs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the common etiologies for NON-erosive gastritis?

A
  • H. pylori
  • NSAIDs
  • Autoimmune gastritis
  • Can be acute or chronic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does H. pylori look like?

A

Spiral, G- bacteria.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Who does H. pylori infection occur in most commonly?

A

Children in crowded areas with poor sanitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

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

A

Gastric cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do you diagnose nonerosive gastritis?

A

Histological biopsy of goblet cells/Paneth cells via EGD.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What ethnicities are most susceptible to gastric metaplasia?

A
  • Hispanics
  • African Americans
  • Native Americans

All the non-north americans simplified

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What tests are used to help establish the etiology of nonerosive gastritis?
* Urea breath test * Blood test * Stool test (Fecal antigen)
26
What is the work-up protocol for a patient < 60 with uncomplicated gastritis?
* Non-invasive tests like urea breath and fecal antigen * Empiric abx tx + PPIs
27
When is EGD indicated for nonerosive gastritis workup?
1. Older than 60 2. Alarm symptoms (wt loss, severe dysphagia, severe vomiting) 3. Failure of initial therapy 4. FMHx of gastric cancer
28
What is a positive urea breath test?
Expiring CO2 tagged with urea isotope.
29
Prior to doing a fecal antigen test or urea breath test, what must a patient stop prior?
No PPIs or ABX 2 week prior.
30
What is the typical antibody seen in a H. pylori infection?
IgG
31
What is 1st line therapy for H. pylori eradication?
Triple therapy of 10-14 days of 1. Omeprazole/PPI 20mg BID 2. Amoxicillin 1g BID 3. Clarithomycin 500mg BID | Please Cure Abdomen
32
What is quadruple therapy for H. pylori eradication? | Please Make Tummy Better
1. PPI 2. Bismuth 3. Tetracycline 4. Metronidazole | 10-14 day ## Footnote For allergy to amoxicillin, resistance to clarithomycin, or failure Please Make Tummy Better
33
What is peptic ulcer disease?
Break in gastric or duodenal mucosa that extends through the **muscularis mucosa** into deeper layers
34
When do duodenal ulcers typically occur?
30-55 yrs
35
When do stomach ulcers typically occur?
55-70 | D before S
36
What is the MCC of duodenal ulcers? Stomach ulcers?
* Duodenum: H. pylori * Stomach: NSAIDs
37
What is zollinger-ellison syndrome and what does it predispose you to?
Increased gastric acid, which predisposes you to ulcers
38
What are the risk factors for PUD?
* NSAID use * Age > 60 * Prior h/o of PUD or H. pylori infection * Smoking
39
What are the hallmark signs of PUD?
* **Epigastric, dull, gnawing pain that resolves after eating.** * **Nocturnal pain wakes the patient** * Nausea * Anorexia * Epigastric tenderness
40
How do we diagnose PUD?
* **EGD with gastric mucosal biopsy** * For low-risk: non-invasive H. pylori testing
41
How do we treat PUD due to H. pylori?
H. pylori eradication treatment.
42
How do we confirm H. pylori eradication?
Urea breath test or EGD 4 weeks after therapy
43
When is it indicated to continue medications for PUD?
1. Pt has a giant ulcer > 2cm 2. Couldn't eradicate H. pylori 3. Recurrent ulcers 4. Continued NSAID use
44
If PUD needs additional med treatment after H. pylori eradication, what should we give?
PPIs for 4-6 weeks after ABX.
45
If a patient has NSAID PUD but needs the NSAIDs, what must they take?
PPIs as long as they are taking the NSAID.
46
What is the main complication with PUD?
Upper GI bleed
47
How do we manage a UGI bleed due to PUD?
1. Hospitalize, fluids 2. Check hemodynamic status 3. IV PPI 4. Emergent EGD within 24 hours
48
How does stomach/duodenal perforation present?
* **Sudden, severe abdominal pain** * Ill-appearance * Rigid, guarding, rebound tenderness
49
How do we workup a perforation?
* Abd CT to confirm * CBC with leukocytosis * Surgery to close
50
What CT findings suggest abd perforation?
Free air in anterior peritoneal space
51
How does PUD with penetration typically present and what structures are most commonly affected?
* Pancreas and liver * Gradual, increasing pain radiating to the back * Severe and constant pain * Unresponsive to antacids/foods
52
How do we diagnose and manage PUD penetration?
* Diagnosis: EGD for ulcers and then a CT to confirm penetration. * Management: IV PPIs or surgery
53
How does gastric outlet obstruction due to PUD occur?
Edema or cicatricial narrowing or pylorus or duodenal bulb.
54
How does gastric outlet obstruction present?
* Early satiety, vomiting, wt loss, epigastric fullness * Dehydration
55
How do we treat gastric outlet obstruction?
* IV PPI * EGD * Dilation of obstruction via hydrostatic balloons
56
What is misoprostol's indication?
NSAID gastritis/ulcer prevention
57
What does misoprostol do?
Replacement of prostaglandins
58
What is the BBW of misoprostol?
PREGNANCY or women trying to become pregnant | It is used to terminate pregnancies by inducing labor
59
What is the MC SE of misoprostol?
Diarrhea
60
What should we order prior to giving a patient misoprostol?
Pregnancy test 2 weeks prior
61
What is sucralfate used for?
* NSAID induced gastritis/prophylaxis * Stress gastritis/prophylaxis * PUD
62
What does sucralfate do?
Stimulates prostanglandin synthesis to form a mucoprotective layer to help healing.
63
What are the main concerns with sucralfate?
* Constipation * Alters absorption of drugs
64
What causes gastric outlet obstruction in babies?
Post-natal muscular hypertrophy of pylorus
65
How does gastric outlet obstruction present in adults?
* **Postprandial N/V** * Epigastric pain * Early satiety * Abdominal distension * Wt loss * Lyte abnormalities
66
How does gastric outlet obstruction present in babies?
* Postprandial vomiting * **Projectile vomiting** * Wt loss * Lyte abnormalities
67
How does an adult physical present for gastric outlet obstruction?
* Abd distension * Epigastric tenderness * Succussion splash | Like the more severe version of gastroparesis
68
How does a baby physical present for gastric outlet obstruction?
* Upper abdomen with peristaltic waves * Olive shaped mass in right upper abdomen post vomiting * Dehydration
69
How do we workup gastric outlet obstruction for adults and babies?
* Adults: EGD (diagnosis) and CT (obstruction) * Children: Abd US
70
How do we manage GOO for adults?
* NPO * IV fluids * NG tube * IV PPI * Treatment of PUD or mass
71
What surgery can we do for GOO management?
Pyloromyotomy
72
What is gastroparesis?
Delayed gastric emptying
73
Who is gastroparesis MC in?
* Women * DM
74
What are the common etiologies for gastroparesis?
* Idiopathic * DM, hypothryoidism * Scleroderma * Post-viral * Meds * Surgery/nerve injury
75
How does gastroparesis typically present?
* N/V * Abd/epigastric pain * Early satiety * Bloating * GERD
76
How does gastroparesis present on PE?
* Potential epigastric distension or tenderness * **No guarding or rigidity** * +/- succussion splash
77
How do we confirm a diagnosis of gastroparesis?
* Gastric emptying test **(only confirms presence)** * Blood tests for underlying cause!!!
78
How do we treat gastroparesis?
* Treat underlying cause * Low fat diet * Metoclopramide * Erythromycin | Meto makes u move ## Footnote Erythroymicin SE is increased gastric motility
79
What is considered a positive gastric emptying test?
Gastric retention > 10% after 4 hours
80
What is zollinger-ellison syndrome?
A rare endocrine disorder with 3 interrelated pathologies.
81
What is the triad of zollinger-ellison syndrome?
1. Gastrinoma (pancreas or duodenal) 2. Increased gastric acid secretion 3. Peptic ulcers
82
What % of masses in zollinger-ellison syndrome are malignant?
* 2/3 malignant * 1/3 solitary
83
How does zollinger-ellison typically present?
* PUD * Heartburn * Wt loss * Diarrhea
84
How do we diagnose zollinger-ellison syndrome?
* Serum fasting gastrin level (stop PPIs 6 days prior) * Diagnostic: **10x ULN with a gastric pH below 2.**
85
What is a secretin stimulation test mainly used to check for?
Gastrinoma
86
What imaging test helps identify gastrinomas?
Somatostatin receptor scintigraphy
87
How do we manage localized zollinger-ellison syndrome?
* PPIs * Surgical resection
88
What are the two primary metastatic sites for Zollinger-ellison?
1. Liver 2. Bones | You can resect liver mets to help prognosis
89
What are the benign gastric tumors?
* Inflammatory epithelial polyps * Adenomatous polyps
90
What are the malignant gastric tumors?
* Gastric adenocarcinoma * Gastric lymphoma * Gastric carcinoid tumors (From zollinger-ellison)
91
What is the MC cancer of the stomach?
Gastric adenocarcinoma | Intestinal type specifically
92
What are the risk factors for intestinal type gastric adenocarcinomas?
* Chronic H. pylori infection * Smoking * High nitrate/salt diet * Advanced age
93
What are the risk factors for diffuse-type gastric adenocarcinomas?
Genetic mutations/hereditary | Spreads faster
94
What are the stages of stomach cancer? (Image)
95
How do gastric adenocarcinomas typically present?
* Dyspepsia * Vague epigastric pain * Anorexia * Wt loss * Early satiety * Hematemesis * Postprandial vomiting if obstructed
96
What 3 locations suggest metastasis of a gastric adenocarcinoma upon palpation?
* Left supraclavicular lymph node (Virchow's node) * Umbilical nodule (Sister Mary Joseph nodule) * Rigid rectal shelf (Blumer shelf)
97
What is the primary procedure of choice for working up gastric adenocarcinomas?
EGD
98
What is the #1 risk factor for gastric lymphoma?
Chronic H. pylori infection
99
How do you diagnose and treat gastric lymphoma?
* Diagnosis: EGD with biopsy * Tx: Radiation and/or chemo

GI (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions