STOMACH Flashcards
The LARGEST artery of the stomach
Left Gastric Artery - from CELIAC trunk
The most potent STIMULANTS of gastrin release
Peptides and Amino Acids
The most potent INHIBITOR of gastrin release
acid
Helicobacter pylori infection primarily mediates duodenal ulcer pathogenesis via
Antral alkalinization leading to inhibition of somatostatin release
Alarm symptoms that indicate the need for upper endoscopy
age >55 w/ new onset dyspepsia unintentional weight loss persistent or recurrent vomiting progressive dysphagia recent onset odynophagia unexplained IDA or GI bleeding palpable abdominal mass or lymphadenopathy family history of family GI cancer
Drugs that accelerate gastric emptying
Dopamine antagonist - Metoclopramide, Domperidone
Motilin - agonistErythromycin
The most accurate diagnostic test or Zollinger-Ellison syndrome (ZES) is
Secretin stimulation test
The MC complication of PUD
BLEEDING - melena, hematemesis, syncope
Other complications of PUD
PERFORATION - sudden severe abdominal pain, tenderness
OBSTRUCTION - early satiety, anorexia, abdominal pain, distention and vomiting
Tends to penetrate posteriorly into the PANCREAS leading to pancreatitis
Duodenal Ulcer
Tends to penetrate into the LEFT HEPATIC LOBE
Gastric Ulcer
DDx of Intractability or Nonhealing PUD
cancer persistent H.pylori infection noncompliant patient motility disorder Zollinger-Ellison Syndrome
PPI Triple Therapy
PPI bid
Amoxicillin 1 g bid
Clarithromycin 500 mg bid
Quadruple Therapy - Gold standard for treatment of PUD
PPI bid
Bismuth, 2 tablets QID
Metronidazole, 250 mg tid
Tetracycline, 500 mg qid
Bismuth triple therapy
Bismuth, 2 tablets qid
Metronidazole, 250 mg tid
Tetracycline, 500 mg qid
MC symptoms of ZES
epigastric pain
GERD
diarrhea
Uncontrolled secretion of gastrin by pancreatic or duodenal neuroendocrine tumor
Zollinger-Ellison Syndrome
The preoperative imaging study of choice for gastrinoma
Somatostatin receptor scintigraphy (Octreotide scan)
The overall risk of significant serious adverse gastrointestinal (GI) events in patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) increases to 5 times in:
patient age >60 prior GI event high NSAID dose concurrent steroid intake concurrent anticoagulant intake
Indications for surgery in PUD
bleeding
perforation
obstruction
intractability or nohnhealing
Risk factors for gastric cancer
family history diet rich in nitrates (preserved, smoked and cured foods) and salt diet low in vitamins A and C type A blood familial polyposis and adenoma HNPCC H.pylori infection previous gastric surgery atrophic gastritis cigarette smoking adenomatous gastric polyps Menetrier disease pernicious anemia
MC mesenchymal tumor of GIT
Gastrointestinal Stromal Tumor (GIST)
from interstitial cells of Cajal c-KIT (CD 117) and CD 34 - tumor markers
The standard treatment for an isolated 3 cm gastrointestinal stromal tumor (GIST) in the body of the stomach
wedge resection
Management for LOW grade gastric lymphoma
H. pylori eradication
persistent localized lesion: 2nd course of H.pylori eradication + low doses of external beam radiation (EBRT)
advanced lesion: initial H. pylori eradication + EBRT w/ chemotherapy then endoscopic surveillance
Management for HIGH grade gastric lymphoma
chemoradiation
surgery - reserved for urgent situations or tumor complications like acute hemorrhage, obstruction not relieved by steroids or failure of response to chemoradiation
Arise from ENTEROCHROMAFFIN CELLS and are characterize by the ability to secrete biologically active substances
Gastric Carcinoids
Subtypes of Gastric Carcinoids
TYPE I associated w/ type A chronic atrophic gastritis, w/ or w/o pernicious anemia MC variant occurs in px w/ hypergastrinemia women benign
TYPE II
carcinoid associated w/ ZES
MEN I
TYPE III sporadic form or neuroendocrine carcinoma NOT associated w/ hypergastrinemia MEN SOLITARY WORSE prognosis large tumors and more advances stage
Carcinoid syndrome consists of
secretory diarrhea flushing telangiectasia valvular heart disease pellagra cramping edema bronchial constriction
debulking surgery + Octreotide (somatostatin analogue)
Management of Carcinoid Tumors
TYPE I
endoscopic polypectomy
antrectomy for recurrence
TYPE II
treatment of gastrinoma
somatostatin analogue
possible local excision or antrectomy
TYPE III
en bloc resection w/ regional lymph nodes
possible chemotherapy or radiation
Middle aged men with epigastric pain, weight loss, diarrhea and hypoproteinemia
Hypertrophic gastropathy (Menetrier disease)
associated w/ protein losing enteropathy and hypochloryhydria large rugal folds spare the antrum increased risk of cancer
Elderly women w/ chronic GI blood loss, associated autoimmune CT disorder and chronic liver disease
Watermelon Stomach (Gastric Antral Vascular Ectasia)
dilated mucosal blood vessels in the stomach resembles portal gastropathy (proximal stomach) endoscopic therapy antrectomy
Men w/ UGIB which is usually intermittent
Dieulafoy lesion
congenital malformation unusually large tortuous submucosal artery endoscopic hemostasis, angiographic embolization oversew or resection
Treatment for severe early dumping after gastrectomy that is persistent despite an antidumping diet and fiber
Octreotide
MC complicating symptom post vagotomy
diarrhea
