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GI Exam 1 > Peptic Ulcer Disease > Flashcards

Peptic Ulcer Disease Flashcards

1
Q

What are the two biggest stimulants for Gastrin secretion?

A
  1. Luminal proteins in the stomach

2. Gastrin Releasing Peptide (GRP)

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2
Q

What are the 3 things that stimulate acid secretion from gastric parietal cells.

A
  1. Histamine
  2. Gastrin
  3. ACh
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3
Q

What is Zollinger-Ellison syndrome?

A

One of the Multiple Endocrine Neoplasms (MEN) Type 1 that involves a Gastrin secreting tumor in pancreatic islet cells

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4
Q

What are the 3 classifications of Gastritis and examples of each?

A
  1. Erosive Hemorrhagic: stress or ICU induced, NSAID induced, reflux injury
  2. Non-erosive Non-specific: H. pylori, autoimmune, cancer
  3. Specific: micro infections
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5
Q

What is the etiology, diagnosis, and treatment for Type A vs. Type B gastritis?

A

Type A:

  1. Autoimmune
  2. Achlorohydria
  3. Life-long IV Vit. B 12

Type B

  1. H. Pylori
  2. Urea breath test
  3. if required, PPI w/ antibiotics
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6
Q

What is the final clinical manifestation of Chronic Atrophic Gastritis?

A

Pernicious anemia, pts. need parenteral Vit. B12

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7
Q

What are the 3 main etiologies of Peptic Ulcers?

A
  1. H. Pylori
  2. NSAID abuse
  3. Stress
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8
Q

What are the 4 biggest risk factors for PUDs?

A
  1. Smoking
  2. Alcohol
  3. Adrenocorticosteroid use longer than 1 week
  4. NSAID use
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9
Q

Most sensitive test to detect PUD.

A

Endoscopy (95%)

-h&p along with upper GI radiology is also useful

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10
Q

What is the biggest contraindication for using PG analogs to treat PUD?

A

PGs cause smooth muscle contraction and could cause spontaneous abortion in pregnant patients.

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11
Q

What is the management strategy for peptic ulcers?

A

Duodenal ulcers: either PPI, sucralfate, or H2RAs for 4-8 weeks. Antibiotics if H. pylori is present.

Stomach ulcers: the same except for a repeat endoscopy is performed to check for malignancy.

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12
Q

What 3 things should be considered if a patient has a non-healing ulcer?

A
  1. ZE syndrome
  2. Smoker
  3. NSAID use
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13
Q

What is the treatment for a bleeding ulcer?

A

Contact thermal probe with endoscopy.

NO PHARM THERAPY CAN STOP AN ULCER BLEED!!!!
-some can only prevent it

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14
Q

What is the treatment for an ulcer caused by a gastric obstruction?

A

Continuous IV PPI with surgical pyloroplasty or endoscopic balloon.

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15
Q

Type of gastritis associated with H. pylori

A

Type B

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16
Q

Excluding NSAID abuse and ZE syndrome, what is 99.9% associated with duodenal ulcers?

A

H. pylori infection

-not all people with this infection develop duodenal ulcers

17
Q

What is dyspepsia?

A

Indigestion, recurrent pain in the upper abdomen.

18
Q

What are management recommendations for patients that have Non-Ulcer Dyspepsia?

A

Younger than 55: test and treat approach, PPI trial

Older than 55 or w/ alarming symptoms: endoscopic exam and treatment based on these findings

19
Q

What are the three best tests to diagnose and monitor H. pylori infection?

A
  1. Gastric Biopsy (gold standard)
  2. Carbon-urea breath test (most commonly used to test if treatment worked)
  3. Stool or Urine antigen test (good for documenting eradication 4 weeks post treatment)
20
Q

Which group of people infected with H. pylori is most crucial to treat?

A

Patients with a past history of gastric MALT lymphoma. (MOST IMPORTANT)

Patients with current stomach or duodenal ulcers or patients with past history of complications should also be treated.

21
Q

What is the standard treatment for H. pylori infection?

A

PPI/amoxicillin/clarithromycin

10-14 day

22
Q

What is Menetrier disease and how is it treated?

A

Hypertrophic gastric folds of unknown etiology.

Treat with PPI, H2RA, and prednisolone

23
Q

What is eosinophilic gastritis and how is it treated?

A

Inflammation of gastric mucosa most likely caused by an allergic reaction.

Treatment is prednisolone steroids to suppress the immune system.

24
Q

What are gastric bezoars?

A

A type of solid mass or concretion of foreign matter that becomes lodged in the stomach.

25
Q

What predisposes people to bezoars?

A

Any compromise of gastric motility; previous gastric surgery, PUD, crohn disease, cancer

MOST COMMON cause is gastric stasis due to diabetic neuropathy

26
Q

What is the main cause of volvulus and the two types?

A

Caused by laxity in suspensory ligaments.
1. Organo-axial: rotation around a line thru the pyloric sphincter and gastro-esophageal junction.

  1. Mesentro-axial: rotation around a horizontal line running thru the greater curvature and porta hepatis
27
Q

What is treatment for acute gastric volvulus?

A

Immediate surgical intervention to prevent ischemia and necrosis.

28
Q

What should be suspected when a patient presents with nausea, vomiting, ABDOMINAL PAIN, EARLY SATIETY, bloating, and weight loss?

A

Gastroparesis

29
Q

What is the number one etiology of gastroparesis?

A

Diabetes mellitus

30
Q

What is the best medication to treat gastroparesis?

A

Metoclopramide

MOA: unknown but seems to sensitize smooth muscle to ACh

GI Exam 1 (18 decks)

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