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GI > Stomach > Flashcards

Stomach Flashcards

1
Q

Protective fx for gastritis/duodenitis (7)

A

mucus, bicarb, mucosal blood flow, prostaglandins, alkaline state, hydrophobic layer, epithelial renewal

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2
Q

Gastritis/duodenitis causes

A
  1. Autoimmune (pernicious anemia) or noninfectious –> type A gastritis – body of stomach
  2. HPylori: g-, spiral shaped bacillus – almost all non-NSAID induced GI mucosal inflamm
  3. NSAIDs – dec prostaglandin production in stomach/duodenum
  4. Stress from CNS inj/burns/sepsis/surg –> erosion
  5. OH use
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3
Q

ASA and PUD MOA

A

ASA blocks prostaglandins –>PUD (NOT d/t local irritation)

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4
Q

PUD gen/causes

A

Any ulcer of upper GI system
Cause: any discreet break in mucosa caused by inj, NSAIDs, stress, OH, irritants (MCC: HP)
Lifetime risk: 5-10%
Men = Women
PUD and HP are highly assoc w/ gastric malignancy

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5
Q

PUD clinical

A

Abd pain/discomfort (burning/gnawing) – radiates to back/R shoulder
Pain improves w/ food in DUODENAL, worsens w/ food in GASTRIC –> anorexia/wt loss
Dyspepsia (belch, bloat, distend, heartburn)

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6
Q

PUD complications

A

bleeding (melena), perforation, penetration

PUD MCC of nonhemorrhagic GI bleeds

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7
Q

PUD labs

A

Endoscopy: best for detecting small/healing ulcers
Ba readiography: cheaper/less sensitive, 30% false neg. rate
Urea breath: for HP

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8
Q

PUD tx

A

avoid smoke, NSAIDs, OH
HP regimen:
–PPI w/ clarithromycin and amox (+/- metro)
–Bismuth subsalicylate + tetracycline, metro, and PPI
Prophylaxis: misoprostol or PPI in pt w/ h/o PUD who require daily NSAID use, h/o complications (bleed), chronic steroids or anticoag, significant other comorbidities

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9
Q

Zollinger Ellison Syndrome general

A

60% males (MC in relatively young males)
–onset 20-50y
2/3 of tumor are malignant
gastrin-secreting tumor (gastrinoma) –> hypergastrinemia –> refractory PUD
1% of PUDs caused by ZES
Most gastrinomas in pancreas or duodenum
1/3 of gastrinoma are part of mult endocrine neoplasia, type I (MEN1), autosomal dominant condition

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10
Q

ZES clinical

A

PUD that is more adv. or refractory to tx
–perforation, penetration/bleeding, obstruction
Pain +/- secretory diarrhea that improves w/ H2 blockers or PPI
Occult or frank bleeding –> anemia

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11
Q

ZES lab findings

A 
Mult ulcers in 2nd, 3rd, 4th portion of duodenum/jejunum (NOT 1ST PART)
Fasting gastrin > 150pg/mL
--PPIs on reg basis can elev gastrin lvl
Gastrin>300 per Medina's lec
Secretin test REQ to find ZES
--pts given 2U/kg IV, then if +ZES, gastrin inc by >200pg/mL
Endoscopy, CT, or MRI can localize tumor
HyperCa w/ MEN-1
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12
Q

ZES tx

A

use PPI to ctrl gastrin secretion

Surgical resection of gastrinoma

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13
Q

Gastric adenocarcinoma

A

Gastric AC, MC type of CA worldwide, not as much so in US
2x more CMN in men than women
Almost NEVER in pt <40y/o
Early dx, 80% cure rate
Involvement of muscularis propria, 50% cure rate
Lymphatic spread, 10% cure rate
STRONG assoc w/ HP

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14
Q

Gastric AC clinical

A

CMN: dyspepsia, wt loss, anemia, occult GI bleed
Progressive dysphagia – neoplasm impinging of esophagus
Postprandial vomiting– neoplasm near pylorus
Metastatic spread: L supraclav LAD (Virchow’s node), umbilical nodule (Sister Mary Joseph nodule)

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15
Q

Gastric AC labs

A

MC finding: IDA
Liver enz elev w/ hepatic metastases
Endoscopy w/ cytology: on any pt>40+ w/ dyspepsia who is unresponsive to therapy
After dx, abd CT to determine extent

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16
Q

Gastric AC tx

A

tx: curative or palliative resection of tumor

Chem or radiation can be palliative

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17
Q

Carcinoid tumors of stomach

A

rarely occur in response to hypergastrinemia

USU benign and self-limited

18
Q

Gastric lymphoma

A

< 2% of gastric malignancies
Stomach is MC extranodal site for non-hodgkin’s
Risk is greater 6x if HP infxn present
SIMILAR TO Gastric AC – only different by pathology
Tx: resect w/ or w/o radiation/chemo

19
Q

Role of gastrin and pepsin

A

Gastrin– produced in stomach –> blood to stimulate acid production in stomach
Pepsin– helps protein digestion, an aggressive factor that can lead to ulceration

20
Q

Acethycholine’s role in PUD

A

Cephalic phase of digestion: brain stimulates INC ACh –> stimulates parietal cells –>INC in acid production (also stim. prod of proton pump K+, H+, ATPase)

21
Q

Billroth surgery

A

Cut out portion of stomach that has parietal cells that produce HCl acid – old way to tx PUD

22
Q

NSAIDs role in PUD

A

Prostaglandin blocker in inflammation injury and stomach – bad.
Celecoxib/celebrex block prostaglandins NOT in stomach
Endogenous prostaglandins produce MUCUS and BICARB

23
Q

Prostaglandin mechanism

A

membrane phospholipids –>prostaglandins–> araciodonic acid –> COX1 and 2
COX1: GOOD. protects stomach lining (COX non-selective inhibitors –> bleeding risk)
COX2: inflammation

NSAID use –> Renal, GI, platelet issue

24
Q

H Pylori MOA

A

INC HCl acid secretion
Causes INC in WBC, all chemical mediators/body’s defenses cause the ulcer
Protects itself from acid by producing ammonium ions which accept the H+ –> neutralizing environment around it w/ enzyme, urase
INC pepsin production

25
Q

Highest prevalence of HP

A

10% in Caucasians < 30
Recent immigrants to US
Individuals w/ low socioecon. status – MOST POTENT FX
Pt>60y/o, 50%+

Majority of infxns acquired as kid

26
Q

Stomach cell locations

A

Esophageal entrance of stomach: Mucus secreting cells
Body of Stomach: Parietal cells and chief cells –> pepsinogen –>pepsin
End of stomach: G cells –> gastrin, stimulates proton pumps to prod HCl

27
Q

Histamine and acid production

A

Histamane stim. acid production in parietal cell

– H2 blockers –> less acid production

28
Q

PPI

A

NOT dose dependent, take 30min to work

29
Q

HP labs

A

Serum IgG Ab detectable by ELISA
–IgM NOT reliable
–better for pts who have NOT been tx for HP before
C-14 and C-13 urea breath tests
–HP contain a lot of urease which breaks down into CO2 and ammonia
–Drink urea, wait 0.5h, if you have HP, breaks down the urea
Stool and urine Ag test verify eradication
DO STOOL/BREATH 4 wks after complete tx of ABX and PPIs

30
Q

Duodenal ulcer

A

Men>women
2-3x more CMN than gastric ulcers
95% occur in duodenal bulb
Mult in different parts of duodenum? –> GASTRINOMA! or due to HP
20-25% have minor obstruction, esp from scarring

31
Q

PUD timing

A

45-60min after meal; worse b/w midnight and 2AM
-Wake up w/ pain
Relief by food, milk, alkali, vomiting w/in 5-30min
–MILK has protein which can be acid stimulator

32
Q

PUD red flags

A

SEND TO GASTRO AND SCOPE:
early satiety, anorexia, older than 45y/o, rectal bleeding or melena, wt loss>10% of wt, anemia, dysphagia, abd mass, jaundice, FHx of gastric CA, PMH of peptic ulcer

33
Q

PUD Labs

A 
Hypochromic Anemia if bleeding
--adult w/ Fe deficiency anemia: maj source: GI
--females could be menstrual
Occult blood
Amylase in ulcer penetration to pancreas
X-ray single contrast upper GI, +50-80%, Double contrast is 90% accurate
--not really done, except in dysphagia
--endoscopy way better
34
Q

X-ray findings suggestive of ulceration

A
  • rritability of bulb, difficulty retaining barium
  • pylorospasm
  • gastric hyperperistalsis
  • hypersecretion
35
Q

Cholelithiasis populations

A

Native Americans, Latinos

36
Q

Gastric ulcer gen

A

HP assoc less in gastric than duodenal ulcer
More CMN in 55-70y/o
DEC tissue resistance more imp than hypersecretion
60% of ulcers occur 6cm from pylorus
if see ulcers in upper GI, MUST bx ulcers to r/o gastric carcinoma

37
Q

Peritonitis, complication of PUD

A

Acute epigastric pain, radiate to shoulder
N/V
Rigid abd, fever, absent B/S
XR: free air under diaphragm

38
Q

MC organs penetrated from PUD

A

pancreas, liver – elev serum amylase or ALT/AST

pain radiates to back – does NOT improve w/ food

39
Q

Obstruction, complication of PUD

A

20-25% of duodenal ulcers
S/sx: epigastric fullness, heaviness, vomit after meals w/ partially digested food
Dx by endoscopy
tx: PPI

40
Q

PUD Diets

A

Diet has no therapeutic value – no bland diets
Acid stim w/ both decaf/reg coffee
Restrict coffee, tea, cola, OH
CEASE SMOKING – most imp.

41
Q

Gastric ulcer s/sx differ from duodenal

A

Gasric: referred to L subcostal
Duodenal: referred to back/R shoulder

GI (5 decks)

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