Stomach Flashcards
Gastroparesis
info/cause
VAGAL NERVE dysfxn secondary to DIABETES
Also: post-surg, endocrine & musc disorders, drugs, meds, post-viral
Gastroparesis
pres
Early satiety, epigastric fullness
Pain, bloating, nausea/vomiting
Gastroparesis
Diagnx/Treat
Rule out outlet obstruction (upper endoscopy w/contrast) Radionuclide scan (GPar = >70% after 2 hrs, 10% after 4 hrs remaining) Treat: underlying cause, give prokinetics (ADR: tardive dysk)
Gastritis (infectious)
info/cause
H. pylori (GNR)
VacA endotoxin –> robust infl response
Virulence factors: flagella, adhesins, toxins, UREASE (urea–>NH4=higher pH)
[also syphilis, TB, fungal, CMV etc.)
H. pylori assoc with …
gastritis, PUD, gastric adenocarcinoma, MALT lymphoma
Gastritis (infectious)
pres
Abd pain, nausea/vomiting
1-10% will get peptic ulcer dx
Gastritis (infectious)
diagnx
Standard: Endoscopy (mucosal biopsy)
Rapid urease test
Noninvasive (blood Ab test, stool antigen, urea breath tests)
Gastritis (infectious)
THREE PHENOTYPIC FORMS
Mild, diffuse Antral predominant (high acid secretion, poss duod ulcer) Multifocal atrophic (low acid secretion, inc cancer risk)
Gastritis (infectious)
treatment
Triple tx: PPI + Clarithro and amox 10-14d)
Quadruple tx: PPI + metro + tetracyc + bismuth)
WHEN? If PUD, gastric lymphoma, FMH of gastric carcinoma
Gastritis (non infx causes)
Reactive: NSAIDs, cigs, bile reflux Lymphocytic: unknown (rule out H. pyl) Eosinophilic: exclude parasitic infx Systemic: Crohn's sarcoidosis Autoimmune: atrophic gastritic (autoAb to parietal cells, 10% of gastritis)
Gastritis (non infx)
pres/diagnx/treat
abd pain, nausea and vomiting (+ blood if active ulcer)
Diagnx: endoscopy & biopsy
Treat underlying cause
Pyloric Stenosis
info/cause
mostly PEDIATRIC
hyperplasia of pyloric muscularis propra –> obstructs gastic outflow
M:F, 4:1
consequence of ulcers near pylorus or antral gastritis
Pyloric Stenosis
pres
2-3rd week of life: regurg and projectile nonbilius vomiting
RARE in adults
Pyloric Stenosis
diagnx/treat
Endoscopy Surgery (myotomy)
HYPERTROPHIC FOLD SYNDROMES
Menetrier Dx
rare, hypertrophic rugal fold
Abd pain, weight loss, bleeding
Massive foveolar hyperplasia with cyctic dilation
Poss hypoalbuminemia
HYPERTROPHIC FOLD SYNDROMES
H. Pylori
Large gastric folds and protein-losing gatropathy
Abd pain, nausea/vomiting (+ blood if active ulcer)
Foveolar hyperplasia and chronic active gastritis
Give h .pylori triple tx
HYPERTROPHIC FOLD SYNDROMES
Zollinger-Ellison Syndrome
Large parietal cell mass, and/or high levels of gastin –> acid hyper-secretion
Abd pain, nausea/vomiting
NSAID-induced Gastropathy
Ulceration >5mm that breaches muscularis mucosa form decreased PG (so decreased mucous)
Abd pain, nausea/vomiting
NO INFLAMMATIOn (unlike gastritis)
Ulcer= when erosion reaches submucosa
TREAT WITH PPIs (and can continue NSAIDs), H2 better for duodenal ulcers
Ethanol-induced Gastropathy
Lesions similar to NSAIDs
Abd pain, nausea/vomiting
SUBEPITHELIAL HEMORRHAGE
Stress-induced Gastropathy
Impaired mucosa production or increased acid
CNS injury (Cushing’s), Burns (Curling’s), Hiatal hernia (Cameron’s)
Prolonged ventilation, coagulopathy
pain/nausea/vomiting
Give PPis/H2 blockers
PUD (peptic ulcer disease)
info/causes
5-10% lifetime prevalence
Due to failed mucosal integrity NOT acid hypersecretion
NSAIDs and H. pylori are MAJOR CAUSES
Increased in COPD, cirrhosis, renal failure, post-transplant
Gastric ulcers common in M&F, duodenal more common in M
PUD (peptic ulcer disease)
pres
burning epigastric pain
Complications: bleeding, perforation, outlet obstruction
PUD (peptic ulcer disease)
diagnx
ulceration = >5 mm that breaches muscularis muscosa due to decreased PG, thus decreased mucous
Subeptihelial hemorrhage
PUD (peptic ulcer disease)
treat
PPIs/H2 blockers
Treat H. pylori (if present)
Bleeding high mortality - treat with IV fluids, PPI, endoscopy, angiography (coils), then surgery
Gastric Polyps
Hyperplastic
75% of polyps
Assoc with chronic gastritis, high gastrin, exaggerated mucosal response to injury/infl
Common in autoimmune body gastritis
Pres: proliferation of foveolar epithelium & lamina propria
Gastric Polyps
Adenoma
Assoc with chronic gastritis
Metaplasia (squamous –> columnar)
High risk of malignancy (30%)
Pres: 80% solitary in antrum, well circumscribed and large (1cm), dysplasia of lining epithelium
Gastric Polyps
Fundic gland
Assoc with PPI use and FAP
Pres: Cystic dilation of fundic glands
Gastric Adenocarcinoma
Info/causes
Assoc with H Pylori, chronic gastritis
1) intestinal: age, male, tobacco, diet, smoked and salted, inherited cancer (FAP, LF, HNPCC)
2) Diffuse: younger, hereditary (CDH1) WORSE PROGN
RARE UNDER 30 y/o
Gastric Adenocarcinoma
pres
weight loss, abdominal fullness, altered bowel habits, anemia
Gastric Adenocarcinoma
diagnx/treat
Intestinal: gland forming, assoc atrophic gastritis
Diffuse: “signet ring” - linitis plastica (stomach won;t expand with air on endo)
TREAT: early - surgery, late (beyond submuscosa) = chemo & radiation
GIST
info/cause
benign tumors arising from stroma, origin in Cajal cells (pacemakers)
10-30% malignant, mean age 60
Increased incidence in Neurofibromatosis 1
GIST
pres/diagn/treat
weight loss, anemia, dyspepsia (pain bleeding if large)
Diagnx: Submucosal (no normal mucosa), c-kit (CD117)
Treat: GLEEVAC/imatinib, plus resection
Carcinoid/Neuroendocrine Tumor
Rare in stomach, mostly SI, mean age 55
Prognosis worse further down GI tract
Gastrinoma = hi gastrin, insulinoma = high insulin, VIPoma = high VIP
Diagnx: proliferation of endochromaffin cells of SI
Treat with resection
MALT Lymphoma
info/cause/pres
B-cell lymphoma from H PYLORI, median age 60, NF-kB translocation
Risks: celiac, IBD, immunodefic
H pylori infx –> B-cell prolif (MALToma)–>high grade lymphoma
MALT Lymphoma
diagnx/treat
CT/EUS staging so don’t miss high grade lymphoma
Treat: MALToma with ABX to eradicate H pylori, once lymphoma needs surgery/radiation/chemo
Benign & Metastases
Benign: Leimyomas, Schwannomas
Metastases (NOT benign): from any ther cacner (usually breast, melanoma)
