Stomach 1 Flashcards
Resolution rate of post viral Gastroparesis?
80% after one year
Medications that induce gastroparesis?
GAsTrOParesis
GLP1 agonists
Pramlintide (amylin agonists)
Opioids, Anticholinergic’s, TCAs
Medical conditions associated with gastroparesis?
Hypothyroid, hyperparathyroid
Addison’s
Scleroderma
Parkinson’s
Gastroparesis levels based on emptying study?
Mild 11-20%
Moderate 21-35
Severe 36-50%
Very severe >50%
Gastroparesis drug that should generally be continued only for two weeks? Why?
Erythromycin; tachyphylaxis
Role of TCAs in gastroparesis?
Not effective
Role of intra-pyloric injection of Botox in gastroparesis?
Generally not recommended
ROME IV diagnostic criteria for cyclic vomiting syndrome?
- Stereotypical episodes (acute onset, duration less than one week)
- 3+ episodes in the prior year
- absence of vomiting between episodes
Supportive criteria for cyclic vomiting syndrome?
Personal or family history of migraines
Prophylactic therapy for cyclic vomiting syndrome?
Propranolol
Amitriptyline
Keppra
Zonisamide
Rumination syndrome?
Supportive criteria?
Persistent regurgitation of undigested food (a few minutes after eating) without retching
No nausea; non-acidic regurgitation
Treatment of rumination syndrome?
Behavioral therapy (optimizing postprandial diaphragmatic breathing)
Baclofen TID
Medication induced causes of dyspepsia?
NSAIDs/colchicine, iron, narcotics, acarbose
Rome criteria for functional dyspepsia?
- 1+ of :bothersome postprandial fullness, early satiety, epigastric pain, epigastric burning
- no evidence of structural disease
Subtypes of functional dyspepsia?
Post prandial distress syndrome (postprandial fullness and early satiety)
Epigastric pain syndrome (not relieved by defecation, Meal unrelated)
Herbal medications for functional dyspepsia?
Iberogast
Artichoke leaf extract
Peppermint oil
Carraway oil
Acotiamide - Mechanism of action?
Gastroprokinetic agent; acetylcholinesterase inhibitor
Classes of treatments for functional dyspepsia? (7)
Herbal medications
SSRIs (not better than placebo)
TCAs
Acotiamide (works in Japan)
GABA agents
Buspirone
Mirtazapine
Mechanism of the breath test for H pylori?
How long must a patient be off PPI?
- Baseline breath sample
- Drink solution with carbon labeled urea
- If h pylori present, urea converted into CO2, absorbed into the blood, and excreted in the lungs
2 weeks
H. pylori biopsy and stool antigen – sensitivity decreased if?(3)
Effect of G.I. bleeding on breath test and stool antigen tests?
PPI, antibiotics, bismuth
Reduces sensitivity of breath test; causes false positives on stool antigen
Difference between C13 and C14 urea breath test?
Do not give latter to?
C 13 non-reactive
C 14 low radiation
Pregnant patients
In order to use clarithromycin for H pylori, must ensure?
- No patient history of prior macrolide exposure
- Clarithromycin resistance under 15%
Disease characterized by hypertrophic gastric folds? Symptoms? Difference in adults and children?
Ménétrier’s disease
Abdominal pain, anemia, peripheral edema
Adults - insidious onset and progressive
Children – sudden onset, resolves spontaneously
Ménétrier’s disease - Molecular pathogenesis?
Endoscopically, usually has sparing of? In order to diagnose, need?
Enhanced RTK-EGFR signaling
Antrum; deep biopsies or snare resections
Ménétrier’s disease - histology (4)?
-foveolar Hyperplasia
-tortuosity and dilation of the glands
– smooth muscle hyperplasia
– decreased parietal cells
Elevated gastrin -differential if appropriate secretion?
Appropriate - —acid suppressive medications —atrophic gastritis (autoimmune, pernicious anemia, H pylori) — chronic renal failure — vegotomy without antrectomy
Elevated gastrin -differential if inappropriate secretion?
Inappropriate —Zollinger Ellison —Retained antrum syndrome — antral predominant H pylori infection —GOO —Small bowel resection
Retained antrum syndrome?
Small segment of the antrum is retained after Billroth 2;
Exposure to alkaline pancreatic secretions increases acid secretion
Gastrin levels over thousand are mostly associated with?
ZES and chronic atrophic gastritis
Diagnosis of the ZES if gastrin is NOT above 10xULN?
Gastrin increases over 120 pg/ml after secretin test
