Stomach & Duodenal Diseases Flashcards
Diseases of the Stomach & Duodenum
Gastritis PUD Gastric & duodenal ulcers H. pylori Zollinger-Ellison syndrome Gastroparesis
Features of Dyspepsia
Indigestion Chronic/recurrent pain in upper abdomen Upper abdominal fullness Early satiety Bloating Belching Nausea Heartburn
Types of Gastritis
Erosive & hemorrhagic gastritis
Nonerosive, nonspecific gastritis
Types of Erosive & Hemorrhagic Gastritis
Stress (medical or surgical illness)
NSAID
Alcoholic
Portal hypertension
Types of Nonerosive & Nonspecific Gastritis
H. pylori
Pernicious anemia
Eosinophilic
Asymptomatic Gastritis May Have
Anorexia Epigastric pain Nausea Vomiting Upper GI bleed
Upper GI Bleeding from Erosive Gastritis
Melena (dark, sticky feces)
Coffee ground emesis
Blood in NG tube
Work up of Erosive Gastritis
CBC
Serum iron
Upper endoscopy
Highest Risk for Bleeding in Stress Gastritis
Coagulopathy Need for mechanical ventilation Trauma, burns, shock Sepsis, liver failure, kidney disease Multi-organ failure CNS injury
Prophylaxis of Stress Gastritis
PPIs are best
H2 Blockers
Treatment for GI Bleeding due to Stress Induced Gastritis
PPI bolus followed by continuous infusion
Sucralfate suspension
Endoscopy
Red Flags for Gastritis
Severe pain Weight loss Vomiting GI bleeding Anemia Refer for Upper Endoscopy
Treatment of Gastritis
Trial of PPI for 2-4 weeks
H2 blockers
Refer for endoscopy
Pathophysiology of ETOH Gastritis
Alcohol disrupts mucosal barrier
Alcohol & aspirin increase the permeability of gastric mucosal barrier
Symptoms of Alcoholic Gastritis
Dyspepsia
Nausea
Emesis
Minor hematemesis
Treatment for Alcoholic Gastritis
H2 blockers or PPI
+ sucralfate 2-4 weeks
Decrease ETOH consumption
Portal Hypertensive Gastropathy
Congestion of gastric vessels
Chronic GI bleeding
Treatment of Portal Hypertensive Gastropathy
Porpranolol or nadolol
Nonerosive, nonspecific gastritis
H. pylori
Pernicious anemia
Eosinophilic gastritis
H. pylori
Lives beneath gastric mucous layer Secrete urease & produce ammonia Causes gastric mucosal inflammation Increases risk of gastric CA Fecal-oral spread
Risk Factors for H. Pylori
Correlates inversely with SES
Contaminated water supply
What can H. pylori lead to over time?
Cellular changes
Duodenal/gastric ulcers
Gastric CA
Low grade B cell gastric lymphoma
Testing for H. pylori
Serology
Urea breath test
Stool antigen test
Endoscopy biopsy
Treatment for H. pylori
Eradication therapy
2-3 antibiotics + PPI or bismuth
Pernicious Anemia Gastritis
Autoantibodies to gastric gland parietal cells and intrinsic factor
What causes loss of acid production in pernicious anemia gastritis?
Gastric gland atrophy
Mucosal atrophy
What can pernicious anemia gastritis be associated with?
Hashimoto thyroiditis
Addison disease
Graves disease
Define Eosinophilic Gastritis
Infiltration of eosinophils into GI tissue
Symptoms of Eosinophilic Gastritis
Abdominal pain
N/V
Early satiety
Diarrhea
Eosinophilic Gastritis is Associated with
Hx of allergies
Hx or asthma
Hx of atrophy
Diagnosis of Eosinophilic Gastritis
Biopsy
Treatment of Eosinophilic Gastritis
Elimination diet
Steroids
Define PUD
Break in gastric or duodenal mucosa which can be caused by too much acid or pepsin
>5 mm & extend through muscular mucosae