stomach disorders Flashcards
PUD, tumor, gastritis, diverticulitis, pyloric stenosis
what causes type A gastritis
involves what part of stomach
autoimmune disorders(pernicious anemia) and other non infectious factors
involves the body of the stomach
H pylori present in what ulcers
70% duodenal
up to 90% of peptic ulcers
relief with food, recurring in 2-4 hrs
PUD
epigastric pain turning to a radiating and constant pain
think perf or penetration from a PUD
meds for good mucosal defense
misoprotol, sulcralfate
H pylori eradication
combo therapy for 2-3 weeks:
1) PPI with [clarithomycin and amoxicillin] or [clarithomycin and addition of metronidazole] or
2) bismuth subsalicylate plus tetracycline, metronidazole, and PPI
prophylactic tx with misoprostol or a PPI: hx of ulcer who require a daily NSAID, hx of bleed, need for chr steroids or anticoagulants, signficant co morbidities
h pylori shape
implicated in what cases
gram neg, spiral shaped bacillus
almost all non NSAID induced GI mucosal inflammation
h pylori causes what
type B gastritis; involves the antrum and body of stomach
h pylori associated with what 3 diseases
why is in the stomach
it tolerates the acidity of the stomach;
peptic ulcer, gastric adenocarcinoma, and gastric lymphoma
NSAIDs and the stomach lining
it can cause gastric injury by diminishing local prostaglandin production in the stomach and duodenum.
.other causes of gastritis
alcohol, stress from CNS, burns, sepsis
.common indicators of gastritis
dyspepsia and abdominal pain n/v
dx tests for h pylori
2 for sure tests
2 maybe tests
initial: endoscopy with bx
urea breath test;
fecal antigen testing or serology is also helpful
nausea and feeling of excessive fullness after meals
delayed gastric emptying
tx: prokinetic meds
prokinetic meds
cisapride, metoclopramide
NSAID induced GI mucosal inflammation implicates what usually
h pylori
H pylori involves what part of the stomach
antrum and body which is type B gastritis
.gastric vs duodenal ulcers assoc with malignancy?
gastric
.gnawing or burning abdominal pain that often radiates to the back
PUD
also think ZES
.difference with pain between a duodenal ulcer and a gastric ulcer
duodenal pain improves with food. gastric worsens with food
.what is the most common cause of non hemorrhagic GI bleeds
PUD
.best test for PUD and why
upper endoscopy b/c its more sensitive and definitive
differeniates gastritis from ulcer disease;
all gastric ulcers need repeat endoscopy to document healing
.tx for PUD (h pylori +)
pepto with tetracycline, metronidazole, and PPI x 14 days
.PUD related to ZES?
1%
.what is PUD
any ulcer of the upper digestive system
h pylori found in what percentage of cancer pts
gender?
80%
male 3:1
.common cause of PUD
whats good about this
H pylori
the disease can be erradicated with treatment
.gastric ulcers and h pylori: association with gastric malignancy
although most patients with h pylori or a gastric ulcer will not get gastric cancer, almost all pts with gastric cancer have had h pylori or a gastric ulcer
.common cause of non hemorrhagic GI bleeds
PUD
.melena
PUD
dyspepsia symptoms
belching
bloating
distention
heartburn
think PUD, may have nausea and bleeding
.disadvantage of PUD tests:
barium radiography,
serum antibody test
stoot antigen testing,
urea breath test
barium radiography: cheap but less sensitive, 30% false neg rate
serum antibody test: highly sensitive but cannot be used to confirm cure
stoot antigen testing and urea breath test: s and s but not accurate for 4 weeks after completion of treatment
how much of gastrinomas are part of multiple endocrine neoplasia(autosomal dominant condition)
one third
what fasting gastrin level indicates hypergastrinemia
> 150
.what test diagnoses ZES
what tests to localize the tumor
secretin: givin 2 units, gastrin levels will increase by more than 200
endoscopy, CT, MRI
.tx of ZES
PPI or sx
.what gender is gastrin adenocarcinoma twice as common in
age
incidence
males
usually over 40 y/o
common cancer worldwide but less common in US
.gastrin adenocarcinoma strongly associated with what
what decreases risk
h pylori
asa, nsaids, wine, lots of fruits/veg
progressive dysphagia vs postprandial vomiting in terms on gastrin adenocarcinoma
progressive means the neoplasm is impinging on esophagus and postprandial means its near the pylorus
metastatic spread of gastrin adenocarcinoma
left supraclavicular lymphnode(virchows node) and umbiliical node(sister mary joseph node)
common finding in gastrin adenocarcinoma
other tests
iron def anemia
liver enzymes may be elevated with hepatic metastases
endoscopy with cytology should be done a pt with 40 years of age with dyspepsia who is unresponsive to therapy
do CT after to determine the extent of the disease
what is the common extra-nodal site for non hodgekins lymphoma
stomach
what is the risk of gastric lymphoma if H pylori is present
6 fold!
.what is ZES
results in what
% of cases of PUD from this
gastrin secreting tumor resulting in excessive acid production; causes hypergastrinemia
results in refractory PUD
1% of cases of PUD are caused by ZES
most gastrinomas found where
in pancreas and duodenum;
but may be found anywhere or may metastasize
.presentation of ZES
similar to PUD and maybe…
abdominal pain may have secretory diarrhea that improves with H2 blockers or PPI
occult or frank bleeding, causing anemia
presentation of gastric adenocarcinoma
dyspepsia and weight loss associated with anemia and occult GI bleeding
progressive dysphagia may be caused by a neoplasm impinging on the esophagus
postprandial vomiting may be caused by a neoplasm near the pylorus
advantage of early diagnosis of gastric adenocarcinoma
80% cure rate;
if the muscularis propria is involved, the cure rate is 50%
but is there is lymphatic spread, the cure rate is 10%
progressive dysphagia or postprandial vomiting
think gastric adenocarcinoma
dyspepsia and weight loss associated with anemia and occult GI bleeding
progressive dysphagia may be caused by a neoplasm impinging on the esophagus
postprandial vomiting may be caused by a neoplasm near the pylorus
tx of gastric adenocarcinoma
curative or palliative resection of tumor
chemo or radiation may provide some palliative benefit
.carcinoid tumors in stomach location
55% occur in GI tract, 30% in lungs
rarely occur in response to hypergastrinemia and are generally benign and self limited
gastric lymphomas incidence
risk
sx
dx
tx
less than 2% of gastric malignancies
risk is greater by 6 fold if h pylori present
sx same as gastric adenocarcinoma
dx: findings differ than adenocarcinoma only in the pathology of the lesion
tx: resection with or w/out radiation or chemo
stomach the most common extranodal site for what
non hodgkin’s lymphoma
discuss type A and type B in chronic gastritis
type A(10%) occurs in fundus and d/t autoantibodies to parietal cells. causes pernicious anemia and assoc with other autoimmune disorders and increased risk of gastric adenocarcinoma and carcinoid tumors
type b(90%) occurs in antrum and may be caused by NSAIDs or h pylori infection. often asymptomatic, but assoc with increased risk of PUD and gastric cancer.
why is type A gastritis assoc with pernicious anemia
due to lack of intrinsic factor necessary for the absorption of vitamin B12
stress ulcers and burn injuries
curling ulcers;
associated with traumatic brain injury
h pylori antibodies after an infection
they stay positive even when cleared;
use the urea breath test or a repeat stool antigen as a test of cure
.risk factors for gastric cancer (3)
diet high in nitrates and salt; low in fresh vegetables
h pylori colonization (90%)
chronic gastritis
.what to do if you suspect a perforation with PUD
get a KUB upright to evaluate diaphram and CT abdomen
.how to remember ulcer pain after a meal
after a meal, pain from a GASTRIC ulcer is GREATER
whereas DUODENAL pain DECREASES
misoprostol
can help pts with PUD who require NSAID therapy
1) hypercalcemia (MEN type 1)
2) epigastric pain(peptic ulcer)
3) diarrhea (due to mucosal damage and pancreatic enzyme inactivation leading to malabsorption)
3 key things about ZES
.constipation definition
under 2 BM a week
.MOA of bulk forming laxatives
psyllium
absorbs water and increases fecal mass
.MOA Of stimulant laxatives
bisacodyl, senna
increases acetycholine-regulated GI motility and alters electrolyte transport in the mucosa
.what is hirschsprung’s ds
outlet delay
.most common cause of acute lower GI bleeding(painless hematochezia)
diverticulosis
.diverticulosis most common location
left colon usually in incidence.
right colon most common location for bleeding.
.diverticulosis test if colonoscopy does not visualize bleeding
radionuclide imaging followed up by a arteriography
.diverticulosis tx
most cases stop spontaneously;
resuscitation with fluids
.diverticulosis s/s
usually asymptomatic; lower GI bleeding, hematochezia, painless
.diverticulitis most common area
age
sigmoid due to high intraluminal pressure.
> 40
.diverticulitis s/s
LLQ pain, N/V, low fever. poss tender mass
.diverticulitis tx
uncomplicated: antibx(flagly + either cipro or levoquin) 7-10 days. clear liquid diet.
alternative: bactrim plus flagyl
.diverticulitis dx
CT initial imaging. labs: leukocytosis
.which pud ulcer is more common
duodenal
.hallmark of PUD
dyspepsia(burning, gnawing, epigastric pain)
.increase damaging factors in ___ ulcers
duodenal
.decreased protective mechanisms with ___ ulcers
gastric
.most common in the antrum of the stomach
gastric
.ages of pts with duodenal and gastric ulcers
duodenal younger (30-55)
gastric older (55-70)
.upper endoscopy shows thick, edematous erosions <0.5
gastritis
.location of autoimmune metaplastic atrophic gastritis
gastric fundus and body
.severe recurrent multiple or refractory ulcers + diarrhea
suspect ZES
.carcinoid syndrome
periodic diarrhea, flushing, tachycardia, bronchoconstriction, and hemodynamic instability
.pyloric stenosis common at what age
what med is a r/f
first 3-12 weeks of life
emycin within the 1st 2 weeks of life
.pyloric stenosis located where
sx?
right of epigastrium
nonbilious projectile vomiting hallmark
.pyloric stenosis dx
abd u/s initial test of choice
upper GI series shows string sign or railroad sign
.labs from vomiting
hypokalemia and hypochloremic metabolic alkalosis
.upper GI series shows string sign or railroad sign
pyloric stenosis
