SG Stomach

Question 1

How does food change a gastric vs duodenal ulcer pain?

Answer 1

Duodenal gets better with food

Stomach gets worse

Question 2

2 color options for hematemasis

Answer 2

Red

Coffee grounds: not actively bleeding

Question 3

3 color options for stool if bleeding

Answer 3

Brown - occult
Black with red hue - melena
Red = hematochezia

Question 4

What might look like melena - other things that could be confused for melena?

Answer 4

Digestion of:

• Peptobismol
• Dark leafy greens
• Iron supplements

Question 5

Familial things that cause duodenal ulcers

Answer 5

H.pylori

Zollinger Ellison

Question 6

Why would a patient with GI ulcers have orthostatic HTN?

Answer 6

B/c bleeding - large volume losses

Question 7

What is Hct?

Answer 7

% of blood that is solid cells

Question 8

What happens is a pt you think is bleeding has normal Hct?

Answer 8

Pt is losing blood and volume at same rate
Aka both plasma and blood cells
= ACUTE bleed
Chronic bleed would show decreased Hct
Will only see the fall in Hct acutely after you resuscitate with fluids (increase volume w/ blood cells)

Question 9

Why are you worried if INR is high during a GU bleed?

Answer 9

B/c pt can’t stop their own bleed
Maybe:
- Used all clotting factors (more severe bleed, varice)
- Liver disease so not making the clotting factors

Question 10

How would epi help stop a bleed

Answer 10

Inject epinephrine - constrict surrounding vessels

Question 11

Why would a pt with ulcer have peritonits

Answer 11

Perforate through stomach
Contents leak into peritoneal cavity
Dx: pneumoperitonitis on XR

Question 12

Ulcers do 3 things:

Answer 12

Bleed
Perforate
Obstruct

Question 13

3 ways stomach handles acid

Answer 13

Mucin
Epithelial turnover
Thin layer protective bicarb over epithelium

Question 14

Do ZE pts get diarrhea?

Answer 14

Yes:

• Malabsoption
• Pouring acid from stomach out into SI so the SI isn’t as basic as it needs to be to activate pancreatic enzymes

Question 15

3 stimuli to parietal cells to increase acid secretion

Answer 15

Gastrin (G cells)
ACh (vagus)
Histamine (ECL cells)

Question 16

3 reasons you might have high gastrin for no reason

Answer 16

ZE
You’re on a PPI
Lost parietal cell fxn due to AI gastritis

Question 17

Secretin test - what is it testing for

Answer 17

ZE pts

Give sectrin - gastrin levels go up

Question 18

What is MEN 1

Answer 18

ZE combo cancer 
= Multiple endocrine neoplasia type 1 = adenoma in:
Pancreas - ZE 
Parathyroid - hyperCa
Pituitary

Question 19

Fe deficiency levels of:
Ferratin
Transferratin

Answer 19

Low ferratin

High trans = is the carrier, goes up because wants to grab anything it can

Question 20

Causes of elevated gastric pH

Answer 20

AI gastritis - Ab vs parietal cells

Antacids, PPI, H2 blockers

Question 21

3 reasons for B12 def

Answer 21

Pancreatic def
Crohn’s - lose terminal ilium
AI gastritis