Stomach and Duodenum Dz

Question 1

Gastritis

Answer 1

inflammatory changes of the gastric mucosa.

Question 2

Erosive and hemorrhagic gastritis.

Answer 2

Caused by stress, NSAIDS, alcoholic gastritis.

Question 3

Nonerosive gastritis

Answer 3

H. pylori, pernicious anemia, eosinophilic

Question 4

Erosive and hemorrhagic gastritis S/S

Answer 4

Anorexia
Epigastric pain
N/V
Upper GI bleed
Coffee ground emesis

Question 5

Stress gastritis

Answer 5

In critically ill patients occuring within 72 hours of admission.
At highest risk of bleeding
Mech. vent

Question 6

Stress gastritis prevention

Answer 6

IV PPI’s in all critically ill patients.

Question 7

NSAID gastritis

Answer 7

20-50% of chronic NSAID users develop gastritis.

10-20% have ulcers

Question 8

Which NSAIDS have a lower incidence of gastritis?

Answer 8

COX-2 inhibitors

celebrex

Question 9

Gastritis tx

Answer 9

PPi for 2-4 wks

D/C NSAIDS

Question 10

Portal HTN gastropathy

Answer 10

Portal HTN leads to congestion of gastric vessles

Tx with propranolol or nadolol

Question 11

Peptic ulcer dz (PUD)

Answer 11

Break in gastric or duodenal mucosa.
Caused by too much acid/pepsin.
More common in duodenum

Question 12

PUD epidmiology

Answer 12

Duodenal ulcers: 30-55
Gastric ulcers: 55-70 yrs
Most common in smokers and NSAID users

Question 13

PUD S/S

Answer 13

Dyspepsia
Epigastric pain (dull)
Pain relieved w/ food, comes back hours later
Nausea, anorexia

Question 14

Tx for PUD

Answer 14

PPI (heal 90% in 4 wks)

H2 blockers

Question 15

H. Pylori Tx

Answer 15

2-3 abx and PPI
50% strains resistant to flagyl
Quad therapy is 93% effective

Question 16

Zollinger-Ellison Syndrome

Answer 16

Gastrinoma
Gastrin secreting gut neuroendocrine tumor
Increased acid secretion

Question 17

Gastrinoma locations

Answer 17

45% duodenal wall
25% pancreas
5-15% lymph nodes

Question 18

Which syndrome is gastrinoma linked to?

Answer 18

MEN-1

Question 19

Gastrinoma S/S

Answer 19

Dyspepsia
Peptic ulcers (duodenal most common)
No isolates gastric ulcers
Diarrhea, steatorrhea if pancreas involved.

Question 20

Gastrinoma W/U

Answer 20

Fasting gastrin level
CT, MRI (hepatic mets)
SPECT
SRS

Question 21

Gastroparesis

Answer 21

Delayed gastric emptying in the absence of a mechanical obstruction.
Secondary to surgery, diabetes
Usually idiopathic

Question 22

Diabetic gastroparesis

Answer 22

Type I > Type II

11 - 18% of diabetics

Question 23

Viral gastroparesis

Answer 23

Sudden onset post viral infxn

Symptoms usually resolve within a year.

Question 24

Gastroparesis S/S

Answer 24

N/V
Early satiety
Bloating
Upper abd pain

Question 25

Which abx work as prokinetics?

Answer 25

Macrolide (erythromycin)

Question 26

Gastroparesis Tx

Answer 26

Hydration
Frequent small meals (low fat)
Prokinetics
Optimize glycemic control