Stomach_Stress_Gastritis

Question 1

Characterize the findings on endoscopy for acute stress gastritis.

Answer 1

Multiple superficial erosions that begin in the proximal region of the stomach and occasionally progress distally

Question 2

When does stress gastritis develop?

Answer 2

Within 2 days of a major traumatic event.

Question 3

Give risk factors for stress gastritis.

Answer 3

Multiple traumas (often w/ hypotension + massive transfusion), sepsis (often w/ ARDS or SIRS), MOF, burns, CNS and steroid use.

Question 4

Give the eponym for a gastric ulcer in burn patients

Answer 4

Curling’s ulcer (although on the internets it is more of a duodenal ulcer..)

Question 5

Give the eponym for a gastric ulcer in patients with a neuro injury.

Answer 5

Cushing’s ulcer.

Question 6

What is the best way to diagnose a stress ulcer?

Answer 6

Endoscopy

Question 7

What is the initial treatment for stress gastritis?

Answer 7

Correct coagulopathy, blood transfusion if needed, NGT for saline lavage and decompression, anti-acid secratory agents

Question 8

What is the first procedure intervention for bleeding stress gastritis?

Answer 8

Endoscopy for heater probe coagulation and injection of bleeding mucosa

Question 9

What is the next step if bleeding persists after endoscopy?

Answer 9

Angiographic embolization of the left gastric artery or infusion of vasopressin

Question 10

If bleeding persists after angiography, what is the next step.

Answer 10

Surgery.

Question 11

What is the surgical approach for bleeding stress gastritis?

Answer 11

Anterior gastrostomy, deep figure-eight sutures of bleeding segment/artery. Partial gastrotomy, near-total gastrectomy or devascularization of the stomach can be performed under dire conditions.