Stomach Flashcards
In H. pylori infection, what mutation is associated with increased risk of malignancy?
CagA
What are the first line treatment options for H. pylori infection?
- Bismuth quad therapy (PPI, bismuth, tetracycline, metronidazole)
- clarithromycin triple therapy (if known low resistence to claritho)- PPI, clarithro and either amox or metronidazole
- concomitant therapy with PPI, amoxicilin, metronidazole, clarithromycin
What are second line therapies for H. pylori infection?
- give bismuth quad therapy if not given initially
No PCN allergy
-PPI, amoxicilin, levaquin or rifabutin
PCN allergy
-PPI, bismuth, levaquin, tetracycline or metronidazole -PPI, bismuth, tetracycline, clarithromycin
When do you test for eradication of H. pylori?
4 weeks after treatment, 2 weeks off PPI
What are to two most common types of atrophic gastritis?
- H.pylori (antrum)
- autoimmune (body)
What are the features of autoimmune gastritis?
parietal cell ab
intrinsic factor ab
hypochloridia
hypergastrinemia
low acid secretion
b12 deficiency (pernicious anemia)
IDA
type 1 gastric NET
Someone is diagnosed with pernicious anemia- what should you do next?
EGD w/in 6 months, often precedes cancer
Who qualifies for surveillance for GIM (not associated with atrophic gastritis)?
- incomplete GIM (colon +small intestine type)
- extensive (body + antrum)
- FDR with gastric cancer
- immigrant from high risk area
- racial/ethnic minorities
If GIM is detected on rouine EGD, should short term repeat EGD be performed to complete staging?
No
Yes only if considered high risk - incomplete GIM, extensive, FDR with gastric cancer, immigrant
What is the differential for hypertrophic gastric folds?
-Menetrier’s disease- foveolar hyperplasia associated with bleeding, malnutrition and pain
- gastric lymphoma
- gastric adenoCa
-amyloidosis,
- zollinger-ellison
What is the best NSAID for high risk CV patients?
What is the best NSAID for patients w/ history of bleeding PUD?
high risk CV patients- naproxen
high risk PUD- use COX2 selective
What are the diagnostic and clinical features of Zollinger-Ellison Syndrome?
Diagnostic
-high gastrin
-high acid section
-Basal acid output >15
Clinical
- diarrhea, PUD, acid reflux
-assoc with MEN1 - pancreatic, pituitary, parathyroid
**surgery is only curative in non-MEN ZE.
Pathological and EUS features of GIST. How do you manage it?
+ cKIT
4th layer (dark)- muscularis propria
homogenous
well demarcated smooth borders
remove if >2cm
annual surveillance if <2cm
TKI if metastati
What are the 3 types of GI neuroendocrine tumors?
Type 1 - ECL cells
high gastrin, low acid secretion
associated with atrophic gastritis
Type 2- ECL cells
high gastrin, high acid secretion
associated with ZE
Type 3- Enterochromaffin cells
normal gastrin
normal acid secretion
sporadic
**highest risk of malignancy
How do you manage a new presentation of dyspepsia?
How do you diagnosis eosinophilic gastroenteritis?
-personal history of atopy
-gastrointestinal symptoms
- peripheral eosinophilia
-bowel all thickening on CT
-pathology with increased eos/hpf
AND
r/o other causes such as parasitic infection, inflammatory bowel disease, drugs, vaculitis, and malignancy (in particular, lymphoma, leukemia, and mastocytosis)
How do PPIs cause B12 deficiency?
acid suppression reduces the cleavage of cobalamin from dietary proteins (as pepsin is not as readily activated outside of an acidic milieu)
definition for Eosinophilic gastritis
Eosinophilic gastritis is present when at least 30 eosinophils/HPF are found in 5 HPFs.
p/w PUD resistent to ppi
hereditary diffuse gastric cancer (HDGC)- criteria, genes?
– Families with 2 or more cases of stomach cancer, with at least 1 being diffuse gastric cancer.
– CDH1 is the gene most common
– also CTNNA1
