Stomach Disorders Flashcards
define gastritis
stomach lining irritation
gastritis etiology (2 types)
- erosive
- non-errosive
MC cause of erosive gastritis
- NSAIDs
- ETOH
- stress
MC cause of non-errosive gastritis
H. pylori
physical exam of erosive gastritis
- anorexia
- pain
- n/v
- hematemesis
- epigastric tenderness
physical exam of non-erosive gastritis
- asx until ulcer or CA then nausea, pain
gastritis workup
- CBC
- fecal antigen
- urea hydrogen test
- endoscopy w/ bx
When working up gastritis and H. pylori is suspected what must be avoided prior to testing and for how long?
PPI x 7-10d or abx x 28d
gastritis tx
- specific to cause
- stress = H2 or PPI
- NSAIDs = d/c NSAIDs (duhh), PPI
- ETOH = d/c ETOH (again, duh); H2, PPI, or sucralfate
- H. pylori = triple or quadruple abx
define pepticu ulcer disease (PUD)
erosion in gastric or duodenal mucosa over 5mm deep into muscularis
PUD epidemiology
- males more than females
- duodenal (35-55 y/o) 5:1 gastric (55-70 y/o)
PUD etiology
- NSAIDs
- H. pylori
- smoking
What are NOT PUD etiologies?
- ETOH
- diet
- stress
PUD physical exam
- epigastric pain, MC @ night (abrupt = perforation or irritation)
- nausea
- anorexia
- incr. pain w/ eating
ddx PUD with duodenal ulcer
duodenal = decr. pain w/ eating, incr. s/p eating x 2-4hr
PUD workup
- same as gastritis
- endoscopy
PUD tx
- PPI w/ probiotic
- H2
- bismuth, misoprostol, cautery/clips, IR arterial embolization
PUD complication
- perforation
- gastric outlet obstruction
- gastric carcinoma
describe the PUD complication of perforation
- sudden, severe pain w/ peritonitis
- free air on upright XR or CT
describe the PUD complication of gastric outlet obstruction
- edema at pylorus or duodenal bulb
- S+S: early saitiety, regurgitation, wt loss
- dx: NGT to decompress; will have a “foul smell”
- tx: PPI, electrolytes, endoscopy x 24-72hr
define GERD
displacement of acidic stomach contents into esophagus
GERD etiology
- relaxation of LES
- hiatal hernia
- obesity
- decr. esophageal peristalsis
- delayed gastric empty
Hx/PE GERD
- “heartburn” w/in 30-60mins of meal or when supine (relieved w/ antacids)
- sour/bitter taste w/regurgitation
- dysphagia, cough, sore throat, or laryngitis
- posterior dental carries
GERD workup
- endoscopy
GERD tx
- lifestyle modification
- H2 v. PPI
- surgical fundoplication
GERD complication
- Barrett esophagus
- strictures
define Barrett esophagus
replacement of normal esophageal epithelium w/ columnar cells
Barrett esophagus S+S
same as GERD
- “heartburn” w/in 30-60mins of meal or when supine (relieved w/ antacids)
- sour/bitter taste w/regurgitation
- dysphagia, cough, sore throat, or laryngitis
- posterior dental carries
Barrett esophagus complication
adinocarcinoma
Barrett esophagus treatment
- long term GERD control w/ PPI
- lifestyle modificaton
Barrett esophagus dx
endoscopic visualization w/ bx (repeat q3-5y)
define gastroparesis
decrease or no gastric motility w/o mechanical lesion
gastroparesis etiology
- MC = DM
- hypothyroid
- post-op
- Parkinson’s
- MD/MS
- idopathic
gastroparesis S+S
- intermittent postprandial fullness
- n/v
- pain
gastroparesis workup
- upright XR = mildly dilated stomach + air-fluid level
- gastric emptying study = over 60% retention @ 2hrs, 10% @ 4hrs
gastroparesis tx
- sm meals low in fiber, milk, and gas forming foods
- NGT + TPN
- metoclopramide = acute
- erythromycin = prophylaxis
- gastric electric stimulatior
