Stomach. Dyspepsia/zolinger/gastroparesis/autoimune

Question 1

Dyspepsia. table. Presentation? 2

Answer 1

Chronic, intermittent epigastric pain, ,,burning”;

+/- nausea, vomiting, epigastric fullness, discomfort, heartburn.

Question 2

Dyspepsia. Etiologies?

Answer 2

75 proc. functional
Malignancy (gastro, eso)
PUD, NSAIDS, GERD
H-pylori
Infection - patients from low income countries are at significant risk

Question 3

Dyspepsia. workup. >=60 yo?

Answer 3

Upper endoscopy

Question 4

Dyspepsia. workup. <60 yo?

Answer 4

Testing and treatment of H pylori
Upper endoscopy in high-risk patients (overt GI bleeding, significant wieght loss, >1 alarm symptom)

Question 5

Dyspepsia. what alarm symptoms?

Answer 5

progressive dysphagia
iron deficiency anemia
odynophagia
palpable mass or lymphadenopathy
Persistent vomiting
Family history of GI malignancy

Question 6

Erosive gastropathy. definition?

Answer 6

severe hemorrhagic lesions after the exposure of gastric mucosa to various injurious agents or after substantial reduction in blood flow

Question 7

Erosive gastropathy. etiology?

Answer 7

● Aspirin –> decreases prostaglandin production.
● Cocaine –> vasoconstriction.
● Aspirin and alcohol –> decrease protective barriers.

Question 8

Erosive gastropathy. presentation?

Answer 8

Hematemesis, abdominal pain

Question 9

zollinger (gastrinoma) epidemiology?

Answer 9

Age 20-80
80proc sporadic
20 proc MEN 1

Question 10

zollinger (gastrinoma). part of MEN1, what to check?

Answer 10

PTH, ionized calcium, prolactin

Question 11

zollinger (gastrinoma). CP?

Answer 11

multiple big and refractory peptic ulcers
Ulcers distal to duodenum
Chronic diarrhea - due to pancreatic enzyme deactivation

Question 12

zollinger (gastrinoma) diagnosis?

Answer 12

Increased GASTRIN levels (> 1000) in the presence of norml gastric acid (pH <4)

Question 13

zollinger (gastrinoma). what nomal gastrin?

Answer 13

<110

Question 14

zollinger (gastrinoma) what is gastrin levels 110-1000?

Answer 14

do secretin test. If negative and high suspicion –> do calcium infusion study

Question 15

zollinger (gastrinoma) diagnosis. what intrumental?2

Answer 15

Endoscopy

Somatostatin receptor scintigraphy. (pick this one)

CT/MRI scan.

Question 16

zollinger (gastrinoma) treatment?

Answer 16

resection

can induce gastric malignancy

Question 17

zollinger (gastrinoma). buvo dar schema, atspausdinta

Answer 17

.

Question 18

diabetic gastroparesis. patho? 3

Answer 18

autonomic neuropathy
destruction of enteric neurons
failure of relaxation in fundus and uncoordinated peristalsis

Question 19

diabetic gastroparesis. risk factors? 3

Answer 19

long standing DM (esp. type 1)
chronic poor control
labile blood glucose

Question 20

diabetic gastroparesis. cp?

Answer 20

postprandial bloating and vomiting
early satiety
impaired nutrition and weight loss

Question 21

diabetic gastroparesis. diagnosis?

Answer 21

nuclear gastric emptying study: delayed transit into duodenum

Question 22

diabetic gastroparesis.treatment?

Answer 22

promotility drugs: metoclopramide, erythromycin

Question 23

gastroparesis. definition?

Answer 23

Gastric paralysis. Failure of stomach to empty.

Question 24

gastroparesis. why in DM?

Answer 24

peripheral neuropathy of the Vagus nerve

Question 25

gastroparesis. what also look for in DM?

Answer 25

associated diabetic foot disease.

Question 26

gastroparesis. diagnosis? 2

Answer 26

EGD: rule out other causes.
Emptying study to diagnose.

Question 27

gastroparesis. Emptying study to diagnose? percent

Answer 27

▪ Off opiates, off anticholinergics, good blood glucose control.
▪ More than 60% in 2 hours.
▪ More than 10% in 4 hours.

Question 28

gastroparesis. treatment. avoid what?

Answer 28

Avoid opiates. Avoid anticholinergics. Maintain BG control.

Question 29

gastroparesis. metoclopramide in what cases?

Answer 29

Metoclopramide (PO) - used for stable disease

Question 30

gastroparesis. erythomycin in what cases?

Answer 30

Erythromycin (IV) – Used for flare ups. Used for short periods (<4 weeks). Tachyphylaxis.

Question 31

gastroparesis. Domperidone - no longer used

Answer 31

.

Question 32

gastroparesis. behavioral?

Answer 32

Low-fiber small-volume diets.

Question 33

autoimmune gastritis. epidemiology?

Answer 33

a. More common in women
b. More common in patients with other autoimmune conditions - eg DM1 and autoimmune thyroid disease.

Question 34

autoimmune gastritis. pathophysiology?

Answer 34

a. Autoantibodies are produced against parietal cells, resulting in atrophy and metaplasia of gastric corpus, hypochlorhydria, and unchecked gastrin production
b. Autoantibodies are also produced against intrinsic factor, resulting in vitamin B12 deficiency

Question 35

autoimmune gastritis. CP?

Answer 35

Macrocytic anemia
Dyspepsia with postprandial abdominal pain
Bloating
Nausea
Heartburn
Regurgitation

Question 36

autoimmune gastritis. Should be suspected in patients with macrocytic anemia.

Answer 36

.

Question 37

autoimmune gastritis. diagnosis.labs? 2

Answer 37

Elevated gastrin levels.

Iron deficiency anemia – hypochlorhydria leads to decr. iron bioavailability

Question 38

autoimmune gastritis. incr risk of what? what need to do?

Answer 38

Since atrophic gastritis is associated with an increased risk of adenocarcinoma and neuroendocrine tumor, routine surveillance endoscopy is indicated