Stomach Disorders Flashcards
Stomach Disorders
Gastritits
Peptic Ulcer Disease
Gastric Resection
Gastric Malignancy
Functional Dyspepsia
Gastroparesis
Gastritis
Histological finding of injury and inflammation
Diagnosed by “Fab Five:” 5 biopsies from 5 different parts of stomach
Acute Gastritis
- Development of hemorrhagic or erosive lesions soon after exposure of gastric mucosa to toxic substances or reduced blood flow; compromised mucosal lining then allows for further damage
- MC causes NSAIDs, EtOH, bile acids
- MC scenarios: trauma, burns, hypothermia, sepsis
- Tx: treat underlying injury/remove offending agent; aggressive acid suppression to limit mucosal injury
Chronic Gastritis
Many types:
-
Atrophic: associated with loss of glands, mucosal thinning, and metaplastic changes. Two types:
- Autoimmune Atrophic Gastritis: immune response against parietal cells and intrinsic factor leading to severe atrophy, inflammation and metaplasia
- Multifocal Atrophic Gastritis: Directly due to H. pylori
- Chronic reactive
- Infectious
- Lymphocytic/Eosinophilic
- Granulomatous
PUD Disease Definitions
Ulcer: a break in mucosal lining with appreciable depth on endoscopy; involvement of submucosa
Erosion: break in surface epithelium without depth
PUD: erosions and ulcers in stomach and duodenum
PUD
**Pathophysiology: **
- Imbalance between mucosal insults and mucosal defense mechanisms
- “Stress” ulcers= disease states like shock, CV, liver, and renal disease
MC cause: H. pylori and NSAIDs
Other causes: EtOH, illicit drugs, chemo/radiation, Crohn’s, sarcoidosis
Smoking= RF b/c decreases blood flow
H. pylori PUD
Helicobacter pylori
- Gram Negative, produce urease, generates ammonia which neutralizes acid
- Produces protease that allows to break mucous layer
Most commonly progresses to chronic gastritis which is asymptomatic. Leads to atrophic gastritis–>more likely to develop gastric cancer
Dx: Urease Breath Testing (inexpensive and accurate), “Fab Five” bxs
Tx: Antibiotics with PPI
PUD
(Clinical features, dx, complications, tx)
**Clinical features: **
- Gnawing, burning, aching pain which may be accompanied by nausea, vomiting, hematemesis, or melena
- Gastric ulcer: pain is worse with eating
- Duodenal ulcer: pain initially improves with eating, then painful 2-4hrs after meal
Dx: Endoscopy most sensitive test and can control bleeding if present
Complications:
- GI bleeding (coffee ground hematemesis/melena)
- penetration (pain more severe, longer duration)
- perforation (sudden, severe abdominal pain
- Gastric outlet obstruction
Tx: Avoid ulcer causing medications, use PPI’s, tx H. pylori if present
High Risk Ulcers that Require F/U
- Endemic groups–Asians or Latinos
- FHx of gastric CA
- No recent Hx of NSAID use
- H. pylori
- Over 50y.o.
- Size greater than 2 cm
Non-healing ulcer causes
Ongoing NSAID use
Smoking
Refractory H. pylori
Zollinger-Ellison Syndrome (neoplasm causes gastric acid hypersecretion)
Crohn’s
Malignancy
Stress ulcers/gastritis
Risk factors: critically ill patients
- mechanical ventilation
- coagulopathy
- trauma
- burns
- shock
- liver/kidney failure
- major surgery
Most common presentation is GI bleeding
Treatment:
- IV PPI therapy
- Endoscopy with epi injection or clipping if indicated
Most common type of gastric CA
Gastric Adenocarcinoma
Gastric Adenocarcinoma
Pathogenesis: Chronic gastritis–>intestinal metaplasia–>dysplasia–>adenocarcinoma (similar to Barrett’s)
**Risk factors: **
- Diet: ingestion of nitrates and high salt diets (less common in US b/c refridgerators so less cured meats)
- Smoking
- Gastric Disorders or Surgery
- Infection: H. pylori and EBV
- Genetics
Clinical features: usually vague
- epigastric pain
- early satiety
- meal induced dyspepsia
- weight loss, nausea, anorexia when advanced
B/c sxs are vague until advanced disease, poor prognosis. Will invade adjacent structures including pancreas, colon, spleen, kidney and liver.
Tx: surgery–Roux-en-y bypass MC (chemo/rad relatively ineffective)
Functional Dyspepsia
MC cause of chronic dyspepsia
Sxs may arise from visceral hypersensitivity, impaired accomodation (doesn’t stretch to accomodate food), psychosocial stress
R/O other conditions. If have alarm symptoms (weight loss, GIB, dysphagia, vomiting, anemia, abnormal imaging) get endoscopy
Tx: Food diary may indicate triggers. Acupuncture, cognitive behavioral therapy, or hypnosis work well. Reassurance.
Gastroparesis
Delayed gastric emptying in the absence of mechanical obstruction b/c dysfunction in nervous system coordination
Not very common. MC causes–idiopathic, DM
Sx: early satiety, N/V, epigastric pain, bloating and fullness
Dx: Gastric emptying scintigraphy
Tx:
- dietary mod: small frequent meals that are easy to digest
- medications: promotility agents, anti-emetics, acupuncture, hypnosis, cognitive behavioral therapy
- devices/procedures: venting G tube, J tube
Complications: bacterial overgrowth, constipation, reflux
