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DEMS 1 > Stomach > Flashcards

Stomach Flashcards

1
Q

Gastroparesis

info/cause

A

VAGAL NERVE dysfxn secondary to DIABETES

Also: post-surg, endocrine & musc disorders, drugs, meds, post-viral

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2
Q

Gastroparesis

pres

A

Early satiety, epigastric fullness

Pain, bloating, nausea/vomiting

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3
Q

Gastroparesis

Diagnx/Treat

A 
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)
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4
Q

Gastritis (infectious)

info/cause

A

H. pylori (GNR)
VacA endotoxin –> robust infl response
Virulence factors: flagella, adhesins, toxins, UREASE (urea–>NH4=higher pH)
[also syphilis, TB, fungal, CMV etc.)

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5
Q

H. pylori assoc with …

A

gastritis, PUD, gastric adenocarcinoma, MALT lymphoma

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6
Q

Gastritis (infectious)

pres

A

Abd pain, nausea/vomiting

1-10% will get peptic ulcer dx

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7
Q

Gastritis (infectious)

diagnx

A

Standard: Endoscopy (mucosal biopsy)
Rapid urease test
Noninvasive (blood Ab test, stool antigen, urea breath tests)

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8
Q

Gastritis (infectious)

THREE PHENOTYPIC FORMS

A 
Mild, diffuse
Antral predominant (high acid secretion, poss duod ulcer)
Multifocal atrophic (low acid secretion, inc cancer risk)
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9
Q

Gastritis (infectious)

treatment

A

Triple tx: PPI + Clarithro and amox 10-14d)
Quadruple tx: PPI + metro + tetracyc + bismuth)
WHEN? If PUD, gastric lymphoma, FMH of gastric carcinoma

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10
Q

Gastritis (non infx causes)

A 
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)
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11
Q

Gastritis (non infx)

pres/diagnx/treat

A

abd pain, nausea and vomiting (+ blood if active ulcer)
Diagnx: endoscopy & biopsy
Treat underlying cause

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12
Q

Pyloric Stenosis

info/cause

A

mostly PEDIATRIC
hyperplasia of pyloric muscularis propra –> obstructs gastic outflow
M:F, 4:1
consequence of ulcers near pylorus or antral gastritis

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13
Q

Pyloric Stenosis

pres

A

2-3rd week of life: regurg and projectile nonbilius vomiting

RARE in adults

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14
Q

Pyloric Stenosis

diagnx/treat

A 
Endoscopy
Surgery (myotomy)
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15
Q

HYPERTROPHIC FOLD SYNDROMES

Menetrier Dx

A

rare, hypertrophic rugal fold
Abd pain, weight loss, bleeding
Massive foveolar hyperplasia with cyctic dilation
Poss hypoalbuminemia

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16
Q

HYPERTROPHIC FOLD SYNDROMES

H. Pylori

A

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

17
Q

HYPERTROPHIC FOLD SYNDROMES

Zollinger-Ellison Syndrome

A

Large parietal cell mass, and/or high levels of gastin –> acid hyper-secretion
Abd pain, nausea/vomiting

18
Q

NSAID-induced Gastropathy

A

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

19
Q

Ethanol-induced Gastropathy

A

Lesions similar to NSAIDs
Abd pain, nausea/vomiting
SUBEPITHELIAL HEMORRHAGE

20
Q

Stress-induced Gastropathy

A

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

21
Q

PUD (peptic ulcer disease)

info/causes

A

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

22
Q

PUD (peptic ulcer disease)

pres

A

burning epigastric pain

Complications: bleeding, perforation, outlet obstruction

23
Q

PUD (peptic ulcer disease)

diagnx

A

ulceration = >5 mm that breaches muscularis muscosa due to decreased PG, thus decreased mucous
Subeptihelial hemorrhage

24
Q

PUD (peptic ulcer disease)

treat

A

PPIs/H2 blockers
Treat H. pylori (if present)
Bleeding high mortality - treat with IV fluids, PPI, endoscopy, angiography (coils), then surgery

25
Q

Gastric Polyps

Hyperplastic

A

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

26
Q

Gastric Polyps

Adenoma

A

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

27
Q

Gastric Polyps

Fundic gland

A

Assoc with PPI use and FAP

Pres: Cystic dilation of fundic glands

28
Q

Gastric Adenocarcinoma

Info/causes

A

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

29
Q

Gastric Adenocarcinoma

pres

A

weight loss, abdominal fullness, altered bowel habits, anemia

30
Q

Gastric Adenocarcinoma

diagnx/treat

A

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

31
Q

GIST

info/cause

A

benign tumors arising from stroma, origin in Cajal cells (pacemakers)
10-30% malignant, mean age 60
Increased incidence in Neurofibromatosis 1

32
Q

GIST

pres/diagn/treat

A

weight loss, anemia, dyspepsia (pain bleeding if large)
Diagnx: Submucosal (no normal mucosa), c-kit (CD117)
Treat: GLEEVAC/imatinib, plus resection

33
Q

Carcinoid/Neuroendocrine Tumor

A

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

34
Q

MALT Lymphoma

info/cause/pres

A

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

35
Q

MALT Lymphoma

diagnx/treat

A

CT/EUS staging so don’t miss high grade lymphoma

Treat: MALToma with ABX to eradicate H pylori, once lymphoma needs surgery/radiation/chemo

36
Q

Benign & Metastases

A

Benign: Leimyomas, Schwannomas

Metastases (NOT benign): from any ther cacner (usually breast, melanoma)

DEMS 1 (16 decks)

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