The Food Pouch-Ross

Question 1

What three regulatory systems stimulate the stomach’s production of acid?

Answer 1

1. Neurocrine
2. Paracrine
3. Endocrine

Question 2

What disease is this?

chronic or acute inflammation of gastric mucosa: multiple etiologies

Answer 2

gastritis

Question 3

This is a continuous or recurrent upper abdominal pain it’s a symptom not a pathophysiologic condition

Answer 3

dyspepsia

Question 4

Is gastritis erosive?

Answer 4

Non, non-erosive

Question 5

Endoscopy of what disease can cause subepithelial hemorrhages, petechiae and erosions

Answer 5

gastritis, specifically stress gastritis

Question 6

What disease is this?

Gastric and duodenal is a more chronic illness characterized by the formation of recurrent ulcers (>5mm in size) in the stomach an proximal duodenum

Answer 6

PUD

Question 7

Helix shaped curved gram neg rod with flagella that penetrate through mucosa of stomach to a less acidic environment. Also produces ammonia.

Answer 7

H. pylori

Question 8

How do we test for H. pylori?

Answer 8

Serum IgG antibody, urea breath test, *endoscopy

Question 9

What is the gold standard way to test for H.pylori?

Answer 9

endoscopy

Question 10

Do you get relief from eating with a duodoneal or gastric ulcer?

Answer 10

duodenal

Question 11

Gastric or duodenal ulcer?
• Burning pain 1-3 hours after meals, relieved by food
• Epigastric pain (vague discomfort, cramping, hunger pangs)
• Nocturnal pain with early morning awakening
• usually within 3cm of pylorus

Answer 11

duodenal

Question 12

Gastric or duodenal ulcer?
•Not common to see post- prandial epigastric pain
• Weight loss
• later in life peak 6th decade 
• associated with malignancy

Answer 12

gastric

Question 13

Treatment for peptic ulcer?

Answer 13

• Antacids
• H2 blockers
• PPIs

Question 14

Should you test everyone with H. pylori?

Answer 14

test only if you plan to treat

Question 15

What test has a good sensitivity and specificity for H. pylori?

Answer 15

Stool antigen

Question 16

A patient comes in with peptic ulcer disease or new-onset dyspepsia, what do you do next?

Answer 16

Test for H. pylori

Question 17

If a patient has a positive H. pylori test, what do you do next?

Answer 17

First line tx then wait 1 month after tx finishes to

Question 18

Bowel obstructions present with what type of pain?

Answer 18

diffuse colicky pain

Question 19

Mesenteric ischemia presents with what type of pain?

Answer 19

pain out of proportion to exam

Question 20

Pancreatitis presents with what type of pain?

Answer 20

epigastric pain radiating to back left shoulder blade

Question 21

Appendicits presents with what type of pain?

Answer 21

periumbilical pain to rlq in children rectal pain

Question 22

If there is there perforation, abscess, obstruction or a mass what imaging should you consider?

Answer 22

CT

Question 23

______ is associated with alcohol, NSAID and stress

Answer 23

gastritis

Question 24

Almost all non-NSAID and alcohol related ulcers are due to this pathogen

Answer 24

Heliocobacter pylori

Question 25

In patients with suspected PUD and are not on NSAID’s what should you do to treat?

Answer 25

treat empirically for H. pylori with triple medication for 14 days with PPI, clarithromycin and amoxicillin

Question 26

Patients over 50 who present with dyspepsia or PUD symptoms should be get an ________

Answer 26

endoscopy due to higher risk for gastric cancer

Question 27

Patients over 50 who present with dyspepsia or PUD symptoms should be get an ________

Answer 27

endoscopy

Question 28

Patients with acute onset of intense pain, abnormal vitals and vomiting consider the diagnosis of ___________

Answer 28

perforated ulcer

Question 29

A patient with peritonitis and therefore will be very still and have generally __________ vitals

Answer 29

abnormal

Question 30

Any time there is free air in the abdomen, what do you need?

Answer 30

a surgeon

Question 31

If there is no free air on KUB (xray of kidneys, ureters, bladder) what should you do?

Answer 31

consult with GI instead surgery first

Question 32

The presence of free intra-abdominal gas usually indicates what? Is this emergent?

Answer 32

EMERGENT because could be due to a perforation from a peptic ulcer

Question 33

People who fail first line H. pylori tx should be treated with what three drugs?

Answer 33

Tetracycline, metronidazole, bismuth

Question 34

What is the preferred diagnostic to dx PUD?

Answer 34

endoscopy

Question 35

Zollinger Ellison syndrome is the excessive secretion of gastric acid by a gastrinoma. It can be located in what three places?

Answer 35

* Pancreas * Duodenal wall * Lymph nodes "gastrinoma triangle"

Question 36

How do we test for ZES?

Answer 36

fasting gastrin levels