Stomach Disorders Flashcards
What is gastritis?
superficial inflammation/irritation of the stomach with mucosal injury
What is gastropathy?
Mucosal injury without evidence of inflammation
What is the pathologic causes of gastritis?
imbalance between aggressive (increased) and protective (decreased) mechanisms of gastric mucosa.
What are the most common causes of gastritis?
- H. pylori (most common!)
- NSAIDs/ASA (2nd most common)
- Acute stress (ICU pts)
What are the clinical manifestations of gastritis?
Patients are most commonly asymptomatic
If symptomatic —-> upper GI bleed (hematemesis, melena)
Epigastric pain, N/V
What is the diagnostic test of choice for gastritis?
Endoscopy and H.pylori testing
What is the management for H.pylori + gastritis or PUD?
CAP —> clarithromycin, amoxicillin, and a PPI
metronidazole if allergic to PCN
_____ ulcers are 4x more common than ______ ulcers.
Duodenal ulcers
Gastric ulcers
Gastric ulcers are more common in the ______.
elderly
What are the most common causes of peptic ulcers?
- H. pylori
- NSAIDs
- Zollinger Ellision syndrome
- ETOH
- smoking
- stress
Why do NSAIDs cause peptic ulcers?
because they inhibit prostaglandins, which are mucosal protective factors
How does a duodenal ulcer typically present?
Dyspepsia that is worse 2-5 hours AFTER meals and is better with meals and/or antacids
How does a gastric ulcer typically present?
Dyspepsia that is WORSE with meals (especially 1-2 hours after meals). Patients typically have weight loss b/c don’t want to eat.
What is the MOST common cause of an upper GI bleed?
Peptic ulcer disease!!!!
What is the gold standard diagnostic test for diagnosing PUD?
Endoscopy with biopsy (r/o malignancy especially with GU)
What are considered the “alarming” symptoms of PUD to suggest cancer?
- > 50 years
- dyspepsia
- hx of GU
- anorexia/weight loss
- anemia
- dysphagia
What is the gold standard diagnostic test for diagnosing H. pylori?
Endoscopy with biopsy and rapid urease test
When if the urea breath test utilized?
Testing for H. pylori if endoscopy can’t be done
Also used to confirm eradication after therapy**
H. pylori converts urea to _____.
carbon dioxide
Which test can be utilized to confirm eradication of H. pylori after therapy?
- Urea breath test
2. H. pylori stool antigen (HpSA)**
What is Zollinger-Ellison syndrome?
A gastrinoma (gastrin secreting tumor resulting in gastric acid hyper secretion leading to PUD)
What are the clinical manifestations of Zollinger-Ellison syndrome?
- multiple peptic ulcers that are refractory to tx
2. diarrhea
What are the best screening tests for Zollinger-Ellison syndrome?
- Fasting gastrin level —-> will be elevated
2. Secretin test —-> increase gastrin release (gastrin normally inhibited by secretin)
What is the management of Zollinger-Ellision syndrome?
Local —> surgical resection
Metastatic —> PPIs, surgical resection if involves liver
What is pyloric stenosis?
hypertrophy and hyperplasia of the muscular layers of the pylorus causing a functional outlet obstruction
Pyloric stenosis most commonly presents when in life?
95% present in 1st 3-12 weeks of life (rare after 3 months)
What are the clinical manifestations of pyloric stenosis?
- NONbilious vomiting/regurgitation that is projectile after feeding**
- signs of dehydration and malnutrition
- may have jaundice and metabolic alkalosis
An infant with pyloric stenosis will most likely have what on physical exam?
“olive-shaped” nontender mobile hard pylorus** (palpated especially after infant has vomited)
What diagnostics are ordered for pyloric stenosis?
- Ultrasound*** —> elongation/thickening of pylorus
2. Upper GI contrast study (not done 1st to prevent radiation) —> string sign
What is the management of pyloric stenosis?
pyloromyotomy and rehydration
What is the most common gastric carcinoma?
Adenocarcinoma (90% worldwide)
What is the most important risk factor of gastric carcinoma?
H. pylori!!!
Gastric carcinoma is most commonly occurs in ____.
males > 40 years
What are the clinical manifestation of gastric carcinoma?
- indigestion
- weight loss
- early satiety
- abdominal pain/fullness
- often have iron deficiency anemia
What are 3 signs of metastasis of gastric carcinoma?
- Virchow’s node —> supraclavicular lymph node
- Sister Mary Joseph’s node —> umbilical lymph node
- Irish sign —> left axillary lymph node
What is linitis plastica?
diffuse thickening of stomach wall due to cancer (worse type of gastric cancer)
What is the management of gastric carcinoma?
gastrectomy, radiation, and chemotherapy
poor prognosis
What is pyloric stenosis?
hypertrophy and hyperplasia of the muscular layers of the pylorus causing functional outlet obstruction
What is the most common epidemiology of pyloric stenosis?
1st 3-12 weeks of life (rare after 3 months)
What are the clinical manifestations of pyloric stenosis?
NONbilious vomiting/regurgitation projectile
emesis after eating
signs of dehydration and malnutrition
metabolic alkalosis
What will be seen of physical exam with an infant with pyloric stenosis?
“olive-shaped” nontender mobile mas 1-2 cm in diameter
Felt especially AFTER infant has vomited
What are the most common diagnostic studies performed for pyloric stenosis and what will they show?
Ultrasound**– elongation/thickening of the pylorus
Upper GI contrast study– string sign (delayed gastric emptying)
Upper GI not done first to prevent radiation
What is the management of pyloric stenosis?
Pyloromyotomy and rehydration
Is incision through the tense muscle so it can loosen so the food in the stomach can move into the small intestine
