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stomach disorders Flashcards

PUD, tumor, gastritis, diverticulitis, pyloric stenosis

1
Q

what causes type A gastritis

involves what part of stomach

A

autoimmune disorders(pernicious anemia) and other non infectious factors

involves the body of the stomach

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2
Q

H pylori present in what ulcers

A

70% duodenal

up to 90% of peptic ulcers

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3
Q

relief with food, recurring in 2-4 hrs

A

PUD

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4
Q

epigastric pain turning to a radiating and constant pain

A

think perf or penetration from a PUD

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5
Q

meds for good mucosal defense

A

misoprotol, sulcralfate

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6
Q

H pylori eradication

A

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

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7
Q

h pylori shape

implicated in what cases

A

gram neg, spiral shaped bacillus

almost all non NSAID induced GI mucosal inflammation

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8
Q

h pylori causes what

A

type B gastritis; involves the antrum and body of stomach

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9
Q

h pylori associated with what 3 diseases

why is in the stomach

A

it tolerates the acidity of the stomach;

peptic ulcer, gastric adenocarcinoma, and gastric lymphoma

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10
Q

NSAIDs and the stomach lining

A

it can cause gastric injury by diminishing local prostaglandin production in the stomach and duodenum.

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11
Q

.other causes of gastritis

A

alcohol, stress from CNS, burns, sepsis

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12
Q

.common indicators of gastritis

A

dyspepsia and abdominal pain n/v

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13
Q

dx tests for h pylori

2 for sure tests

2 maybe tests

A

initial: endoscopy with bx

urea breath test;

fecal antigen testing or serology is also helpful

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14
Q

nausea and feeling of excessive fullness after meals

A

delayed gastric emptying

tx: prokinetic meds

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15
Q

prokinetic meds

A

cisapride, metoclopramide

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16
Q

NSAID induced GI mucosal inflammation implicates what usually

A

h pylori

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17
Q

H pylori involves what part of the stomach

A

antrum and body which is type B gastritis

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18
Q

.gastric vs duodenal ulcers assoc with malignancy?

A

gastric

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19
Q

.gnawing or burning abdominal pain that often radiates to the back

A

PUD

also think ZES

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20
Q

.difference with pain between a duodenal ulcer and a gastric ulcer

A

duodenal pain improves with food. gastric worsens with food

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21
Q

.what is the most common cause of non hemorrhagic GI bleeds

A

PUD

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22
Q

.best test for PUD and why

A

upper endoscopy b/c its more sensitive and definitive

differeniates gastritis from ulcer disease;

all gastric ulcers need repeat endoscopy to document healing

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23
Q

.tx for PUD (h pylori +)

A

pepto with tetracycline, metronidazole, and PPI x 14 days

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24
Q

.PUD related to ZES?

A

1%

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25
.what is PUD
any ulcer of the upper digestive system
26
h pylori found in what percentage of cancer pts gender?
80% male 3:1
27
.common cause of PUD whats good about this
H pylori the disease can be erradicated with treatment
28
.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
29
.common cause of non hemorrhagic GI bleeds
PUD
30
.melena
PUD
31
dyspepsia symptoms
belching bloating distention heartburn think PUD, may have nausea and bleeding
32
.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
33
how much of gastrinomas are part of multiple endocrine neoplasia(autosomal dominant condition)
one third
34
what fasting gastrin level indicates hypergastrinemia
>150
35
.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
36
.tx of ZES
PPI or sx
37
.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
38
.gastrin adenocarcinoma strongly associated with what what decreases risk
h pylori asa, nsaids, wine, lots of fruits/veg
39
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
40
metastatic spread of gastrin adenocarcinoma
left supraclavicular lymphnode(virchows node) and umbiliical node(sister mary joseph node)
41
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
42
what is the common extra-nodal site for non hodgekins lymphoma
stomach
43
what is the risk of gastric lymphoma if H pylori is present
6 fold!
44
.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
45
most gastrinomas found where
in pancreas and duodenum; but may be found anywhere or may metastasize
46
.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
47
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
48
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%
49
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
50
tx of gastric adenocarcinoma
curative or palliative resection of tumor chemo or radiation may provide some palliative benefit
51
.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
52
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
53
stomach the most common extranodal site for what
non hodgkin's lymphoma
54
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.
55
why is type A gastritis assoc with pernicious anemia
due to lack of intrinsic factor necessary for the absorption of vitamin B12
56
stress ulcers and burn injuries
curling ulcers; associated with traumatic brain injury
57
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
58
.risk factors for gastric cancer (3)
diet high in nitrates and salt; low in fresh vegetables h pylori colonization (90%) chronic gastritis
59
.what to do if you suspect a perforation with PUD
get a KUB upright to evaluate diaphram and CT abdomen
60
.how to remember ulcer pain after a meal
after a meal, pain from a GASTRIC ulcer is GREATER whereas DUODENAL pain DECREASES
61
misoprostol
can help pts with PUD who require NSAID therapy
62
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
63
.constipation definition
under 2 BM a week
64
.MOA of bulk forming laxatives
psyllium absorbs water and increases fecal mass
65
.MOA Of stimulant laxatives
bisacodyl, senna increases acetycholine-regulated GI motility and alters electrolyte transport in the mucosa
66
.what is hirschsprung's ds
outlet delay
67
.most common cause of acute lower GI bleeding(painless hematochezia)
diverticulosis
68
.diverticulosis most common location
left colon usually in incidence. right colon most common location for bleeding.
69
.diverticulosis test if colonoscopy does not visualize bleeding
radionuclide imaging followed up by a arteriography
70
.diverticulosis tx
most cases stop spontaneously; resuscitation with fluids
71
.diverticulosis s/s
usually asymptomatic; lower GI bleeding, hematochezia, painless
72
.diverticulitis most common area age
sigmoid due to high intraluminal pressure. >40
73
.diverticulitis s/s
LLQ pain, N/V, low fever. poss tender mass
74
.diverticulitis tx
uncomplicated: antibx(flagly + either cipro or levoquin) 7-10 days. clear liquid diet. alternative: bactrim plus flagyl
75
.diverticulitis dx
CT initial imaging. labs: leukocytosis
76
.which pud ulcer is more common
duodenal
77
.hallmark of PUD
dyspepsia(burning, gnawing, epigastric pain)
78
.increase damaging factors in ___ ulcers
duodenal
79
.decreased protective mechanisms with ___ ulcers
gastric
80
.most common in the antrum of the stomach
gastric
81
.ages of pts with duodenal and gastric ulcers
duodenal younger (30-55) gastric older (55-70)
82
.upper endoscopy shows thick, edematous erosions <0.5
gastritis
83
.location of autoimmune metaplastic atrophic gastritis
gastric fundus and body
84
.severe recurrent multiple or refractory ulcers + diarrhea
suspect ZES
85
.carcinoid syndrome
periodic diarrhea, flushing, tachycardia, bronchoconstriction, and hemodynamic instability
86
.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
87
.pyloric stenosis located where sx?
right of epigastrium nonbilious projectile vomiting hallmark
88
.pyloric stenosis dx
abd u/s initial test of choice upper GI series shows string sign or railroad sign
89
.labs from vomiting
hypokalemia and hypochloremic metabolic alkalosis
90
.upper GI series shows string sign or railroad sign
pyloric stenosis

GI (14 decks)

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