Upper GI Tract Disorders Flashcards
Barrett esophagus is the replacement of _________ epithelium of the distal esophagus by __________ epithelium, also known as metaplasia
replacement of squamous by columnar epithelium
If EGD shows Barrett esophagus with severe dysplasia, what is the next step?
esophageal resection
What are treatments for H pylori?
1) omeprazole, metronidazole, clarithromycin (amoxicillin can be substituted for metronidazole)
2) bismuth, tetracycline, metronidazole, omeprazole
What surgery is performed for duodenal ulcers intractable to H pylori therapy?
highly selective vagotomy (leaves innervation to pyloric sphincter intact! less dumping syndrome, less mortality, but highest recurrence)
truncal vagotomy and pyloroplasty
vagotomy and antrectomy (w/ Bilroth I or II anastamosis)
If gastric ulcers have been treated medically with no resolution after ___ weeks, surgical resection is recommedned.
~18 weeks. with partial gastrectomy (antrectomy)
What is one notable difference between surgical treatment for type I and IV ulcers compared to type II and III (both of which involve partial gastrectomies?
Types II and III include truncal vagotomy to lower acid production
The anterior vagal trunk (made up primarily of fibers from the [[left/right]] vagal nerve) supplies the “crow’s feet” that innervate the anterior pyloric canal and pyloric antrum.
Left
Which subtype of gastric cancer has a worse prgonosis: diffuse or intestinal?
diffuse
What is the lymph node drainage of the stomach?
lesser curvature: superior gastric
fundus: superior gastric (inferior) and splenic (superior)
greater curvature: (superior) splenic and (inferior) inferior gastric
pylorus: hepatic (anterior) and inferior gastric (posterior)
What is linitis plastica? How is it treated?
diffusely infiltrating gastric carcinoma involving all layers and with a marked desmoplastic reaction. Treatment is total gastrectomy with splenectomy, but if the stomach is rigid and fixed throughout, cure is rare
If a duodenal ulcer perforated with no prior history of ulcer is treated with an omental patch, how is one treated if there IS a history of ulcers?
closure of hte perforation and highly selective vagotomy OR vagotomy and pyloroplasty
What is misoprostol?
A prostaglandin analogue that is used to treat gastric ulcers caused by NSAID use (and to induce labor, btw). It is a PGE1 analogue with gastric mucosal protective properties and it decreases acid secretion.
WHat is the treatment of a duodenal ulcer with a clean white base seen on endoscopy?
Nothing! This ulcer hasn’t bled for a while. Maintain pH over 5.
What are the indications for endoscopic hemostatic therapy of ulcers?
Active or recent bleeding, large initial blood loss, high risk of rebleeding or death ith the bleed.
If surgery is necessary for bleeding, how does the management for gastric vs duodenal ulcers differ?
gastric = excision (biopsy; could be gastric cancer!!) duodenal = oversew suture
Gastric varices may respond to injection with ________ if available, otherwise TIPS or splenectomy is necessary.
Cyanoacrylate glue
(Esophageal/gastric) varices are more difficult to treat than the other and may not respond to banding or sclerotherapy as often as the other.
Gastric are more difficult
What is a somatostatin analog used to treat bleeding from esophageal varices in a patient with cirrhosis?
Octreotide
(Sclerotherapy/band ligation) is preferred to control esophageal bleeding bcause it causes less injury to the esophagus.
Band ligation
Multiple linear erosions in the gastric mucosa at the gastroesophageal junction:
Mallory-Weiss syndrome (result from longitudinal tears through the mucosa and submucosa of the stomach near the GEJ due to forceful vomiting)
What should you remember about using IV vasopressin to control esophageal varices?
It is contraindicated in patients with cornary artery disease (and often in older patients) because it has coronary vasoconstriction as a side effect
Why is a careful examination of the oropharynx appropriate after diagnosing gastric lymphoma?
Make sure there aren’t abnormalities (additional lymphoma) in the Waldeyer ring (annular arrangement of lymphoid tissue in the pharynx)
Esophageal cancer can metastasize to the supraclavicular nodes, most usually on the (left/right).
RIGHT
Note: Virchow node, associated with colon cancer ,is on the left!
What are the types of paraesophageal hernias and when is the GEJ mobile?
Type 1: GEJ slides/herniates
Type 2; GEJ doesn’t move; fundus of stomach herniates
Type 3: GEJ AND stomach herniates
Type 4: GEJ AND other abdominal organ herniate
What do antimitochondrial antibodies represent?
PBC
What is treatment for H pylori?
amoxicillin, clarithromycin, omeprazole
(f patient allergic to penicillins, metronidazole can be substituted for amoxicillin)
if not working, can try quadruple therapy:
bismuth, metronidazole, tetracycline, omeprazole
What is normal urinary excretion of vit B12? What is it in patients with pernicious anemia?
normal: 10-40%
pernicious anemia: <10% (but will increase to normal with administration of oral intrinsic factor in Schilling test)
What is the Blumer shelf?
metastatic GI cancer found in pouch of Douglas and palpable on rectal exam
Gastric adenocarcinoma is confirmed by what study?
upper endoscopy
A “dense infiltrate of lymphocytes in the lamina propria with reactive B cell follicles” staining for CD 19 and CD20 is descriptive of
MALToma (most common extranodal lymphoma)
Related to H pylori and gastritis
