Stomach and Duodenum Flashcards by Meg Dolohanty

do all people with hiatal hernia have reflex

no, but there is a high association

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innervation of stomach

parasympathic- vagus

sympathetic- spinal segments T5-T10

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where are the oxynitic glands

fundus and body

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where are the antral glands

mucosa of distal stomach and pyloric channel

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what tell your parietal cells to produce acid?

gastrin
histamine
Ach

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what do antral glands contain

produce gastrin

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what does gastrin do?

Stimulates acid secretion from gastric parietal cells of the oxyntic glands
Controls GI mucosal growth

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what is the most important stimulant of gastrin

a meal- protein

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is regulation of acid and gastrin release – inhibitory

stomatostatin

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2 big causes of gastric ulcers

H. Pylori

NSAIDs

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gastric ulcers can harbor what

underlying malignancy

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what type gastric ulcer is a hypersecreter of accid in teh gastric body and duondeal.

type II

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what type of gastric ulcer is in the body and has normal or low acid secretion

type I

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what type gastric ulcer is a hypersecreter of acid, prepyloric, perforation/hemorrhage frequent

type III

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type of gastric ulcer that is high on lesser curvater, low acid serction

type IV

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what type gastric ulcer is NSAID-induced

type V

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most common symptom of gastric ulcers

epigastric pain
gnawing or burning sensation, occurs after meals
may radiate to the back

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associated symptoms w/ gastric ulcers

anorexia, weight loss, N/V, melena, hematochezia, hematemesis

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what may a PE look like with uncomplicated PUD

Epigastric tenderness
Guaiac-positive stools
Anemia

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diagnostics for gastric ulcers

CBC < LFTs, amylase, lipas, US

upper endoscopy- BIOPSY (can be malignant)

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tx for gastric ulcer

avoid NSAIDs, ASA, tobacco, steroids, EtOH

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ways to eradicate H. Pylori

PPI + abxs for 10-14 days then acid suppression for 6-8 weeks long

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when do you treat sx for PUD

only for complications

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symptoms w/ duodenal ulcers

2 – 3 hours after meals
Worsened by fasting – food can relieve – weight gain
Wakens from sleep
Relief with anti-acids

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complications of PUD

hemorrhage perforation obstruction intractability

do you have to biopsy duodenal ulcers?

no (don't harbor malignancy)

leading cause of death associated w/ PUD

hemorrhage

first tx for vomiting blody

endoscopy

surgery for duodenal hemorrhage

Duodenotomy with direct ligation of the bleeding vessel within the base of the ulcer (gastroduodenal artery) +/- procedure for acid production

surgery fo gastric ulcer

Excision or oversewing of bleeding ulcer +/- procedure for acid production Biopsy Biopsy Biopsy

tx for perf of duodenal ucler

omental patch- Graham patch | +/- procedure for acid

tx for gastric ulcer perf

Ulcer excision with omentoplasty +/- procedure for acid production Always Always Always biopsy GUs

if you see free air on an x-ray what do you do

go to the OR immediately

what can occur acutely or chronically in patients w/ DU dz caused by inflammation and edma

gastric outlet obstruction (GOO)

tx fo acute GOO

Treated with NPO, NGT, rehydration and IV antisecretoty drugs

what causes chronic gastric outlet obstruction

repeated episodes of ulceration and healing which can lead to pyloric scarring

tx for chronic GOO

upper endo to exclude cancer and balloon dilation | sx to tx underlying dz

mucosal healing refractory to medical treatment Initial healing is delayed, so that ulceration persists at 3 months despite active drug therapy ulcers recur w/i 1 year of therapy cycles of prolonged activity w/ remission

intractability

operative procedure for PUD (decrease gastric acid)

Truncal vagotomy and drainage (pyloroplasty) (tx acid by stopping Ach) Truncal vagotomy and antrectomy (take out gastric cells) Proximal vagotomy

what is postgastrectomy syndromes

dumping, early filling, cramping | improves w/ dietary changes

after truncal vagotomy and pyloroplasty or antrectomy Clinical triad of postprandial epigastric pain often associated with nausea and vomiting, evidence of reflux into the stomach and histologic evidence of gastritis

alkaline reflux gastritis

tx for alkaline reflux gastritis

is conversion to Roux-en-Y gastrojejunostomy with an intestinal limb of 50 – 60 cm

will have abdominal pain, diarreah with PUD or diarrhea alone. Can have esophageal symptoms.

Zollinger-Ellison Syndrome

what is MEN1 (Werner's)

Parathyroid tumor Pancreatic islet call tumors Pituitary tumors

What is MEN2a (sipple)

Medullary thyroid cancer Pheochromocytoma Parathyroid hyperplasia

What is MEN2b?

Medullary thyroid cancer Pheochromocytoma Mucosal neuromas

diagnosis of Zollinger-Ellison syndrome?

gastrin levels >200 if >1000 virtually diagnostic | check w/o antisecretory meds

tx of zollinger-ellison

long term acid suppression w/ high dose PPI resection (first line- take out gastrinoma) chemo/ octreotide

where is bleed with hematemesis usually?

Proximal to the LOT (usually the stomach or esophagus) | Denotes a more rapidly bleeding lesion

Blood has been in stomach long enough for gastric acid to convert hgb to methemoglobin Non-active bleeding

Coffee-ground emesis

bleeding Usually UGI source but can be LGI | black or tarry stools

melena

Bright-red blood per rectum Usually LGI source Can be UGI source if brisk bleed

hematochezia

risk factors for carcinoma of the stomach

``` high salt, cured and smoked foods Smoking Infection with H. Pylori Previous gastric surgery Gastric ulcers Family history Pernicious anemia, atrophic gastritis, gastric polyps Radiation exposure Obesity ```

protective for carcinoma of the stomach

diet that includes fruits and vegetables rich in vitamin C may have a protective effect

symptoms of carcinoma of the stomach

Indigestion, nausea or vomiting, dysphagia, postprandial fullness, loss of appetite, melena, hematemesis, and weight loss

late complications of carcinoma of the stomach

pathologic peritoneal and pleural effusions, GOO, obstruction of the GE junction; bleeding in the stomach from esophageal varices

where is an Irish node found?

anterior axillary

ovarian metastasis (from gastric cancer) palpated on pelvic exam

Krukenberg’s tumor

if someone comes in with abdominal pain and has a positive stool guiac what should be done next?

gastro-enterologist doctor should see them, probably need a endoscopy

labs to get for carcinoma of stomach

CEA, CA19-9 CBC for anemia, malnutition, LFTs upper endoscopy establishes the diagnosis CXR for mets

tx for carcinoma of the stomach

surgical resection | palliation- surgical/ chemo

what type gastric polyps have increased risk of adenocarcinoma w/ increased size

adenomatous polyps

Arises within 2 cm of the distal end of the CBD, where it passes through the wall of the duodenum and ampullary papilla Obstruct early on and present early w/ jaundice and can have GI bleeding Courvoisier sign

Cancer of the ampulla Vater

tx for cancer of the amuppla of Vater

Whipple if large | if small- endoscopy