Stomach. Dyspepsia/zolinger/gastroparesis/autoimune Flashcards
Dyspepsia. table. Presentation? 2
Chronic, intermittent epigastric pain, ,,burning”;
+/- nausea, vomiting, epigastric fullness, discomfort, heartburn.
Dyspepsia. Etiologies?
75 proc. functional
Malignancy (gastro, eso)
PUD, NSAIDS, GERD
H-pylori
Infection - patients from low income countries are at significant risk
Dyspepsia. workup. >=60 yo?
Upper endoscopy
Dyspepsia. workup. <60 yo?
Testing and treatment of H pylori
Upper endoscopy in high-risk patients (overt GI bleeding, significant wieght loss, >1 alarm symptom)
Dyspepsia. what alarm symptoms?
progressive dysphagia
iron deficiency anemia
odynophagia
palpable mass or lymphadenopathy
Persistent vomiting
Family history of GI malignancy
Erosive gastropathy. definition?
severe hemorrhagic lesions after the exposure of gastric mucosa to various injurious agents or after substantial reduction in blood flow
Erosive gastropathy. etiology?
● Aspirin –> decreases prostaglandin production.
● Cocaine –> vasoconstriction.
● Aspirin and alcohol –> decrease protective barriers.
Erosive gastropathy. presentation?
Hematemesis, abdominal pain
zollinger (gastrinoma) epidemiology?
Age 20-80
80proc sporadic
20 proc MEN 1
zollinger (gastrinoma). part of MEN1, what to check?
PTH, ionized calcium, prolactin
zollinger (gastrinoma). CP?
multiple big and refractory peptic ulcers
Ulcers distal to duodenum
Chronic diarrhea - due to pancreatic enzyme deactivation
zollinger (gastrinoma) diagnosis?
Increased GASTRIN levels (> 1000) in the presence of norml gastric acid (pH <4)
zollinger (gastrinoma). what nomal gastrin?
<110
zollinger (gastrinoma) what is gastrin levels 110-1000?
do secretin test. If negative and high suspicion –> do calcium infusion study
zollinger (gastrinoma) diagnosis. what intrumental?2
Endoscopy
Somatostatin receptor scintigraphy. (pick this one)
CT/MRI scan.
zollinger (gastrinoma) treatment?
resection
can induce gastric malignancy
zollinger (gastrinoma). buvo dar schema, atspausdinta
.
diabetic gastroparesis. patho? 3
autonomic neuropathy
destruction of enteric neurons
failure of relaxation in fundus and uncoordinated peristalsis
diabetic gastroparesis. risk factors? 3
long standing DM (esp. type 1)
chronic poor control
labile blood glucose
diabetic gastroparesis. cp?
postprandial bloating and vomiting
early satiety
impaired nutrition and weight loss
diabetic gastroparesis. diagnosis?
nuclear gastric emptying study: delayed transit into duodenum
diabetic gastroparesis.treatment?
promotility drugs: metoclopramide, erythromycin
gastroparesis. definition?
Gastric paralysis. Failure of stomach to empty.
gastroparesis. why in DM?
peripheral neuropathy of the Vagus nerve
gastroparesis. what also look for in DM?
associated diabetic foot disease.
gastroparesis. diagnosis? 2
EGD: rule out other causes.
Emptying study to diagnose.
gastroparesis. Emptying study to diagnose? percent
▪ Off opiates, off anticholinergics, good blood glucose control.
▪ More than 60% in 2 hours.
▪ More than 10% in 4 hours.
gastroparesis. treatment. avoid what?
Avoid opiates. Avoid anticholinergics. Maintain BG control.
gastroparesis. metoclopramide in what cases?
Metoclopramide (PO) - used for stable disease
gastroparesis. erythomycin in what cases?
Erythromycin (IV) – Used for flare ups. Used for short periods (<4 weeks). Tachyphylaxis.
gastroparesis. Domperidone - no longer used
.
gastroparesis. behavioral?
Low-fiber small-volume diets.
autoimmune gastritis. epidemiology?
a. More common in women
b. More common in patients with other autoimmune conditions - eg DM1 and autoimmune thyroid disease.
autoimmune gastritis. pathophysiology?
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
autoimmune gastritis. CP?
Macrocytic anemia
Dyspepsia with postprandial abdominal pain
Bloating
Nausea
Heartburn
Regurgitation
autoimmune gastritis. Should be suspected in patients with macrocytic anemia.
.
autoimmune gastritis. diagnosis.labs? 2
Elevated gastrin levels.
Iron deficiency anemia – hypochlorhydria leads to decr. iron bioavailability
autoimmune gastritis. incr risk of what? what need to do?
Since atrophic gastritis is associated with an increased risk of adenocarcinoma and neuroendocrine tumor, routine surveillance endoscopy is indicated
