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clin med III, exam 1 > PUD and gastric cancer > Flashcards

PUD and gastric cancer Flashcards

1
Q

two main causes of peptic ulcer disease

A
  • H. pylori infection
  • NSAID use
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2
Q

How does Helicobacter pylori cause peptic ulcer disease

A
  • disrupts protective properties by decreasing gastric mucus and mucosal bicarbonate secretion
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3
Q

H. pylori primarily affects what age group?

A
  • children
    • becomes chronic unless tx with abx
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4
Q

peptic ulcers extend into what layer of GI

A

muscularis mucosa

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5
Q

clinical presentation

  • burning/gnawing pain relieved by meals
  • symptoms 2-5 hrs after eating
  • symptoms occur without food as buffer (11pm-2am)
A

duodenal ulcers

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6
Q

clinical presentation

  • asymptomatic
  • epigastric pain
  • nausea
  • belching
  • epigastric fullness
  • bloating
  • anorexia
A

peptic ulcer disease

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7
Q

clinical presentation

  • burning/gnawing pain aggravated by meals
  • symptoms shortly after a meal/within 30 minutes
A
  • gastric ulcers
    • food causes G cells to secrete gastrin in stomach -> HCl
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8
Q

what are alarm symptoms when evaluating for PUD and need gastroenterology referral

A
  • bleeding/anemia
  • early satiety
  • unexplained weight loss
  • progressive dysphagia
  • recurrent vomiting
  • fhx GI cancer
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9
Q

What is the most common complication of peptic ulcer disease

A
  • hemorrhage (5-20%)
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10
Q

how is peptic ulcer disease with hemorrhage treated

A
  1. stabilization: IV fluids, PRBC
  2. PPI (IV)
  3. EGD: upper endoscopy
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11
Q

patient has a h/o peptic ulcer disease and presents with sudden, severe diffuse or epigastric abdominal pain, what is your primary concern? What modalities could you use to diagnose

A
  • acute perforation (2-10%)
    • seen most commonly in elderly + chronic NSAID use
    • tx: urgent surgical therapy
  • X-ray, CT scan, UGI with gastrografin
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12
Q

In peptic ulcer disease, a complication is an ulcer erodes through walls into adjacent organs. what is the most often site of perforation

A
  • pancreas
    • acute onset of pancreatitis, cholangitis, or diarrhea (undigested food)
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13
Q

If a patient with peptic ulcer disease presents with early satiety, bloating, N/V, epigastric discomfort, and weight loss, what is your primary concern?

A
  • gastric outlet obstruction (5%)
    • caused by scarring or inflammation in pyloric channel
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14
Q

What is a succussion splash? What conditions can cause this?

A
  • sloshing sound heard through the stethoscope/naked air when patient’s abd is shaken by holding each side of the pelvis
  • reflects presence of gas and fluid in an obstructed organ
    • gastric outlet obstruction
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15
Q

If you diagnose a patient who has no alarm symptoms with peptic ulcer disease, what is the managment

A
  • test and treat for H. pylori
    • if patient is under 55 yo
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16
Q

What are the three ways to diagnose H. Pylori? which is the gold standard

A
  • urea breath test
  • fecal antigen test
  • biopsy via endoscopy: gold standard
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17
Q

How does the urea breath testing work

A
  • pt drinks a solution with radioactively labeled urea
  • urease produced by H. pylori splits urea into CO2 and NH3
  • measure labeled CO2 in breath
18
Q

biopsy of stomach to test for H. pylori is taken via what mechanism

A
  • endoscopy
  • +/- rapid urease testing
    • fyi: biopsy of mucosa is placed into a medium containing urea and an indicator such as phenol red. The urease produced by H. pylori hydrolyzes urea to ammonia, which raises the pH of the medium, and changes the color of the specimen from yellow (NEGATIVE) to red (POSITIVE)
19
Q

Patient is under 55 yo is diagnosed with PUD. No alarm symptoms are present. What tests will you order

A
  • fecal antigen test OR
  • urea breath test
20
Q

Patient who is over 55 yo is diagnosed with PUD. +/- alarm symptoms are present. What tests will you order

A
  • endoscopy-> biopsy -> rapid urease test
    • test of choice for H.pylori
      • visualization, hemostasis, and biopsy
    • pt must be off abx and PPIs
21
Q

Managment of patients who are diagnosed with PUD but who take NSAIDs

A
  • discontinue NSAID use
  • treat with PPI x 8-12 weeks
  • patients that need to continue with NSAIDs or ASA
    • consider maintence therapy with a PPI + NSAID/ASA
22
Q

How is an uncomplicated duodenal ulcer tx

A
  1. treat H. pylori infection in found
  2. ensure eradication (UCT/fecal antigen test or biopsy)
23
Q

treatment of complicated duodenal ulcer

A
  1. if bleeding ulcer: address bleeding and endoscope for theraputic intervention
  2. PPI x 4-8 weeks
  3. treat H. pylori infection if found
  4. ensure eradication (UCT/fecal antigen test or biopsy)
24
Q

treatment of gastric ulcer

A
  • PPI x 8-12 weeks
  • repeat EGD to confirm healing
25
Q

treatment for a duodenal idiopathic ulcer and gastric idiopathic ulcer.

idiopathic: not caused by H. Pylori or NSAID

A
  • duodenal ulcer: PPI x 4-8 weeks
  • gastric ulcer: PPI x 8-12 weeks
26
Q

treatment of H. pylori consists of what 3 things

A
  1. proton pump inhibitor
  2. two different abx x 10-14 days
    • _​​_amoxicillin + clarithromycin
  3. +/- bismuth containing agent
    • PCN allergy or have failed one course of H. pylori tx
27
Q

it is recommended to confirm H. pylori eradication in the following settings

A
  1. H. pylori associated ulcer
  2. persistent dyspeptic symptoms despite treatment
28
Q

clinical presentation: what do you suspect

  • upper abd pain, chronic diarrhea (steatorrhea), heartburn/severe reflux esophagitis
  • patient with multiple peptic ulcers
  • ulcers that occur distal to duodenal bulb
  • FHx PUD
  • No hx of NSAID use or H Pylori infection
A
  • zollinger ellison syndrome
29
Q

What is the classic triad of zollinger ellison syndrome

A
  1. peptic ulcer in an unusual location (jejunum, distal duodenum)
  2. massive gastric acid hypersecretion
  3. gastrin producing non-beta islet cell tumor
30
Q

zollinger ellison syndrome is characterized by gastrinomas which are

A
  • neuroendocrine tumors that cuase gastric acid secretion -> peptic ulcer disease
    • majority located in duodenum and pancreas
31
Q

what diagnostic testing options are available for zollinger ellison syndrome

A
  1. fastin serum gastrin cocentration
  2. secretin stimulation test (if serum gastrin high but not diagnostic)
  3. imaging to stage/localize gastrinoma: CT or MRI
32
Q

zollinger ellison syndrome can occur sporadically or, in 10% of cases, is associated with what condition

A
  • MEN1
33
Q

What is the strongest risk factor for gastric cancer

A
  • Helicobacter pylori infection
34
Q

clinical presentation

  • persistent abd pain
  • weight loss
  • N/V
  • early satiety
  • dysphagia
  • postprandial fullness
  • loss of appetite
  • melena
  • anemia
  • hematemesis
A

gastric cancer

35
Q

What is Virchow’s node and what condition is it associated with

A
  • left supraclavicular lymph node
  • metastatic gastric cancer
36
Q

What is sister mary josephs node/nodule and what condition is it associated with

A
  • periumbilical nodule
  • metastatic stomach cancer
37
Q

what are paraneoplatic syndromes

A
  • rare disorders that are triggered by an altered immune system response to a neoplasm.
  • may be the first or most prominent manifestation of a cancer.
38
Q

What are paraneoplastic syndromes associated with gastric cancer

A
  • dermatomyositis
  • acanthosis nigricans
39
Q

what is the gold standard for diagnosis of gastric cancer

A
  • EGD
    • allows for biopsy
40
Q

what is the most common type of gastric cancers

A

adenocarcinomas

clin med III, exam 1 (5 decks)

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