Stomach Flashcards
almost all no NSAID induced gi mucosal inflammation is cased by what?
Helicobacter pylori, a gram-negative bacillus
inflammation of the stomach is refer to as
gastritis
how does gastritis cause local injury and then gastritis
NSAIDs inhibit/ decrease prostaglandin production
common causes of gastritis
autoimmune disorders Helicobacter pylori NSAIDs Stress Alcohol
2 most common presentations of gastritis
dyspepsia and abdominal pain
what is the benefit of performing an endoscope with biopsy for suspected gastritis?
you can identify gastritis and confirm H. pylori through biopsy
a urea breath test, stool antigen test, and serology for H. pylori also can be used
if gastritis is NSAID induced what is used to treat?
a PPI
H. pylori treatment length
treat for 14 days, test for eradication post treatment
H. pylori treatment: concern for macrolide resistance
Bismuth, tetracyline, metronidazole, PPI
H. pylori treatment: no concern for macrolide resistance, no PCN allergy
clarithromycin, amoxicillin, PPI
H. pylori treatment: no concern for macrolide resistance, PCN allergy
clarithromycin, metronidazole, PPI
any ulcer if the upper GI system (gastric, duodenal) is referred to as
Peptic Ulcer Disease
Peptic Ulcer Disease is associated with
gastric cancer
most common cause of Peptic Ulcer Disease?
what are other causes?
H, pylori
other causes break in mucosa from injury, NSAIDs, stress, alcohol
a patient comes in with a pain she describes as burning or gnawing that radiates to the back, she notices it is much worse after she eats so she has stopped eating most meals of the day, what do you suspect she has?
a gastric ulcer
a patient comes in with a pain he describes as burning or gnawing that radiates to the back, he notices it is somewhat better after he eats so he keeps snacks on him at all times, what do you suspect he has?
a duodenal ulcer
Belching, bloating, distention, heartburn, regurgitation related to dyspepsia are common in what condition ?
Peptic Ulcer Disease
Indigestion, nausea, heartburn, upper abd fullness, early satiety, bloating, belching related to dyspepsia are common in what condition?
gastritis
H. pylori gastritis associated with what 3 conditions?
PUD, gastric adenocarcinoma, low-grade B cell gastric lymphoma
is a barium swallow used for PUD?
yes it is a diagnostic tool that may be used
what diagnostic tool allows you to differentiates gastritis from ulcer disease
endoscopy
PUD treatment
avoid triggers
H pylori. for 2-4 weeks
PPI
how long is PPI therapy used for gastric ulcers?
12 weeks
how long is PPI therapy used for duodenal ulcers?
4 to 8 weeks
3 Prophylactic treatment for patients with hx of peptic ulcers
Misoprostol (to prevent ulcers when using NSAIDs)
Sucralfate (take 1 hr before meals)
PPI
4 complications of PUD
obstruction, GI bleed, Ulcer perforation, Penetration/ fistulization
diabetes is associate with which condition related to the stomach?
gastroparesis
Delayed gastric emptying/altered motility associated with many diseases is referred to as what?
gastroparesis
what is the clinical presentation of Gastroparesis?
nausea, early satiety, bloating, weight loss, abdominal pain
Scintigraphic gastric emptying study is used for what?
Gastroparesis diagnosis
Gastroparesis diet modification
smaller meals, avoid carbonation
Gastroparesis medications
pro kinetic medication, cisapride and metoclopramide
incidence of Hiatal/Diaphragmatic Hernia increases with
age
Hiatal/Diaphragmatic Hernia clinical presentation
many asymptomatic, but may present with GERD or chest discomfort
Hiatal/Diaphragmatic Hernia is diagnosed how?
with a barium esophagogram and endoscopy
what are the treatment options for Hiatal/Diaphragmatic Hernia
acid reduction and surgical repair
a Hiatal/Diaphragmatic Hernia is a protrusion of what through the diagram via the esophageal hiatus?
the stomach
a Gastrinoma secretes what?
gastrin, this cause hypergastrinemia which causes PUD (1%)
most common location of a Gastrinoma?
the duodenum
Gastrinoma is also called
Zollinger-Ellison syndrome
1/3 of Gastrinomas are a part of what MEN I, what does this stand for?
multiple endocrine neoplasia I, therefore screen those positive for Gastrinomas for MEN1
clinical presentation of Gastrinomas
Abdominal pain, diarrhea, GI bleed
fasting serum gastrin level positive for gastrinomas will be above
150 pg/mL
during a secretin test used to confirm ZES gastrin levels will rise by
over 200
treatment options for Gastrinomas
PPI and surgery to remove tumor
Gastric adenocarcinoma
age population and risk factors
almost never occurs before 40
risk factors smoking, H pylori infection, genetic facotrs
Gastric adenocarcinoma clinical presentation
dyepsia, weight loss, anemia, GI bleeding
Abdominal mass
Signs of metastatic spread (vchhow node and sister Mary Joesph node)
a Sister Mary Joseph nodule is what?
an umbilical nodule, which is a sign of metazoic spread in gastric adenocarcinomas
a Virchow node is what?
a left supraclavicular lymphadenopathy, which is a sign of metazoic spread in gastric adenocarcinomas
when to do an endoscopy for possible gastric adenocarcinomas
any patient over 40 years old with dyspepsia who is unresponsive to therapy
most common lab finding on CBC for gastric adenocarcinomas
Iron deficiency anemia is most common lab finding
gastric adenocarcinomas treatment options
surgery +/- chemo and radiation
2 types of Gastric lymphoma
1) MALT mucosa associated lymphoid tissue
2) Diffuse large B cell lymphoma
what increases risk of gastric lymphoma
k is 6-fold higher if positive for H. pylori infection
