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Clin Med GI > Stomach Disorders > Flashcards

Stomach Disorders Flashcards

1
Q

etiology of gastritis

A
  1. erosive

2. non erosive

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2
Q

what are causes of erosive gastritis

A

NSAIDS (MC)
ETOH
mental or physical stressors (trauma, post-op)

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3
Q

what are causes of non erosive gastritis

A

H pylori (MC)
pernicious anemia
CMV (AIDS)
Candida (DM)

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4
Q

what is H pylori

A
  • gram neg rod transmitted person to person, infects sub mucosal gastric layer
  • can survive in acidic environments thur high urease activity that converts urea into alkaline ammonia and carbon dioxide
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5
Q

what is pernicious anemia

A

autoimmune disorder of fundic glands, B12 absorption deficiency

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6
Q

PE findings in erosive gastritis

A

complaints include anorexia, pain, N/V, hematemesis (coffee ground or bright red), exam may reveal epigastric tenderness

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7
Q

PE findings in non-erosive gastritis

A

nonspecific hx

pt may have nausea and pain for short period then be asymptomatic until ulcer or CA formation

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8
Q

DDx of gastritis

A
  • ulcer (w/ or w/o perforation)
  • reflux
  • CA
  • viral GE
  • TAA/AAA
  • biliary/pancreatic dz
  • esophageal rupture
  • gastric volvulus or gastroparesis
  • MI/angina
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9
Q

tx of gastritis

A

specific to causative etiology

  1. stress: prophylaxis or tx with H2 blocker or PPI
  2. NSAID: discontinue, PPI’s more effective than H2’s 2-4wks
  3. Alcoholic: discontinue ETOH, H2, PPI or sucralfate x 2-4wk
  4. H pylori: re test 4 wks after completion of 1 of following
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10
Q

triple therapy for gastritis

A

PPI, clarithromycin 500mg, amox or metronidazole 500mg, all BID x 10-14days

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11
Q

quadruple therapy for gastritis

A

PPI or H2 BID, bismuth QID, metronidazole 250mg QID & tetracycline 500mg QID x 10-14 days

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12
Q

examples of H2s

A

cimetdine, famotidine, nizatidine, ranitidine

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13
Q

examples of PPIs

A

pantoprazole, esomeprazole, omeprazole, lansoprazole

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14
Q

definition of peptic ulcer dz

A

erosion in gastric or duodenal mucosa >5mm through msucularis

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15
Q

epidemiology of peptic ulcer dz

A

10% lifetime prevalence in adult population
male slightly greater than female
duodenal (30-5yo) 5:1 vs gastric (55-70yo)

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16
Q

etiology of PUD

A

NSAID use, H pylori, smoking - increases acid decresaes bicarb = greatest risk factors

ETOH diet and stress = not causative

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17
Q

hx for PUD

A

epigastric pain abrupt or gradual more common at night
nausea and anorexia
pain may increase with eating
duodenal ulcer pain subsides with eating = returns 2-4hrs postprandial

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18
Q

w/u of PUD

A

same as gastritis

endoscopy most useful

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19
Q

% of population infected with H pylori

A

30-40%

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20
Q

H pylori is transmitted via

A

oral-oral, fecal -oral, gastric-oral

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21
Q

stool quality with H pylori

A

may be loose

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22
Q

what makes eradication of H pylori difficult?

A

smoking

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23
Q

w/u for H pylori infection in PUD

A

urea breath test, serum antibody, stool antigen, direct culture

24
Q

what patients would you test for H pylori in PUD

A

active PUD
hx PUD not prev treated
gastric CA
dyspepsia in high prevalence area

25
tx for PUD - PPIs
1. PPI - preferred to H2, gastric ulcers treat 8wks, duodenal x 4wks
26
tx for PUD - H2's
QD at bedtime x 6-8wks
27
tx for PUD - H pylori
14d combo therapy (continue PPI or H2 up to 6 wks for ulcer >1cm)
28
adjuncts to tx for PUD
bismuth, misoprostol, sucralfate
29
hemostasis tx for PUD
endoscopic cautery or surgical clips. IR arterial emoblization
30
complications of PUD
1. perforation: sudden, severe pain with peritonitis, free air on urpight xray or CT 2. gastric outlet obstruction: edema at pylorus or duodenal bulb (PUD vs CA) 3. gastric carcinoma: chronic gastritis can lead to CA
31
s/s of gastric outlet obstruction
early satiety | vomiting partially digested food, weight loss
32
dx/rx of gastric outlet obstruction
NGT to decompress and presence of foul smelling fluid is diagnostic PPI, electrolyte correction and 24-72 hr endoscopy
33
definition of GERD
displacement of acidic stomach contents into the esophagus
34
etiologies of GERD
1. relaxation of esophageal sphincter 2. hiatal hernias 3. obesity 4. diminished esophageal peristalsis 5. delayed gastric emptying
35
relaxation of LES in GERD
via normal vagovagal reflex in response to gastric distention or hypotensive sphincter (idiopathic vs smoking) permits reflux during bearing down or supine position postprandial acid secretions can form an acid pocket on top of meal contents
36
hiatal hernias & GERD
LES is displaced above the diaphragm resulting in LES dysfunction and delayed gastric emptying
37
obesity and GERD
external forces increase in the intra abdominal pressure
38
diminsied esophageal peristalsis & GERD
slowed clearance distally secondary to underlying pathology | -scleroderma, Sjorgren's, anticholinergics, radiation
39
delayed gastric emptying & GERD
gastroparesis or gastric outlet obstruction
40
hx/pe for GERD
``` heartburn sensation 30-60min postprandial or when supine relieved with antacieds sour/bitter regurg episodes dysphagia cough laryngitis sore throat posterior dental caries ```
41
ddx of GERD
``` angina/MI costochondritis TAA pneumomediastinum PE ```
42
w/u of GERD
most can be diagnosed via H&P and DDX exclusion | endoscopy is usually definitive and can r/o other pathology
43
rx for GERD
1. lifestyle modifications - avoid acidic foods, smoking, ETOH, weight loss, avoid postprandial lying supine x 3hrs, elevate head of bed 2. H2 blockers for mild or PPI for mod-severe symptoms x 8-12 wks 3. surgical fundoplication if uncontrolled 4. recurrence somewhat common with meds or surgery
44
complications of GERD
Barrett's esophagus | strictures
45
definition of Barrett's esophagus
normal esophageal epithelium replaced with columnar
46
etiology of barrett esophagus
occurs in up to 10% of pts with chronic GERD
47
complications of barrett's esophagus
up to 0.33%/yr increase in adenocarcinoma formation
48
s/s of Barrett's esophagus
same as GERD
49
endoscopic visualization and biopsy
repeat q3-5 yrs
50
rx for Barrett's esophagus
long term GERD control with PPI | aggressive lifestyle modifications
51
definition of gastroparesis
decreased or absent gastric motility in the absence of any mechanical lesion
52
etiology of gastroparesis
``` DM hypothyroid post surgical parkinson's MD/MS idiopathic ```
53
s/s of gastroparesis
intermittent post prandial fullness, nausea, vomiting, pain
54
ddx of gastroparesis
SBO, gastric outlet obstruction, gastritis, GERD
55
w/u of gastroparesis
upright abd xray may reveal dilated stomch and A/F level | gastric emptying study (nuclear) is definitive, retention of >60% of contents at 2hrs or >10% at 4 hrs
56
rx of gastroparesis
- eat smaller meals low in fiber, milk, and gas forming foods - acute exacerbation may require NGT and TPN - metoclopramide for acute event or erythromycin for prophylaxis - gastric electrical stimulator
57
definition of gastritis
irritation of the stomach lining

Clin Med GI (3 decks)

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