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Gastrointestinal 1 > Clinical Presentation of the Diseases of the Stomach > Flashcards

Clinical Presentation of the Diseases of the Stomach Flashcards

1
Q

A 74 y.o. female, PMHx significant for longstanding diabetes for 23 years, presents with complaints of early satiety, bloating, and intermittent vomiting of undigested food. What is her most likely diagnosis?

A

gastroparesis (delayed gastric emptying)= disorder that slows or stops the movement of food from the stomach to the small intestine.

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2
Q

What are the symptoms of gastroparesis (delayed gastric emptying)?

A

epigastric pain, nausea, vomiting, bloating, and early satiety

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3
Q

What is the most recognized disorder of delayed gastric emptying?

A

DIABETIC gastroparesis

*bare in mind, gastroparesis can also often be seen in non-diabetic patients

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4
Q

What is the best test to confirm gastroparesis?

A

gastric scintigraphy (nuclear medicine test) after anatomic obstruction is ruled out. After about 90 mins if more than 50% of the nuclear tracing is still visible in the stomach, you can diagnose gastroparesis.

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5
Q

What specifically is impaired in diabetic gastroparesis?

A

both phase 3 of the interdigestive migrating motor complex (MMC), and phasic activities of the postprandial antral motility

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6
Q

How do you treat gastroparesis?

A
  • dietary modifications
  • prokinetic agents (be wary of tardive dyskinesia side effect).
  • G and/or J tubes
  • gastric electrical pacing for DM related
  • gastrectomy
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7
Q

What else can cause gastroparesis?

A

after gastric operations, progressive systemic sclerosis, or primary or secondary amyloidosis
*most common cause is idiopathic (we don’t know)

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8
Q

What are some acid peptic disorders?

A

gastritis, gastric ulcers, duodenal ulcers that occur due to a break in the mucosal lining.
*affects millions each year

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9
Q

Can peptic ulcers be caused by chronic NSAID use?

A

YES

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10
Q

What are the aggressive factors that can lead to acid peptic disorders?

A

Endogenous factors= acid and pepsin
Exogenous factors= H. pylori and NSAIDS
*Ischemia (in ICU settings especially)

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11
Q

What are the 2 largest risk factors for ulcer bleeding in the ICU?

A
  1. coagulopathy
  2. intubation
    * If a patient has either of these PUT THEM ON A PPI (NOT H2 blocker, because a patient will build a tolerance to H2 blockers after a few days).
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12
Q

Why would you put a patient on a PPI to help reduce the risk of an ulcer bleeding?

A

because elevating the pH helps a clot to stabilize :)

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13
Q

What is Helicobacter pylori?

A
  • spiral shaped, gram negative, flagellated bacterium that is able to live is gastric acidic environment.
  • causes chronic gastritis, most peptic ulcers, and gastric adenocarcinoma and lymphoma
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14
Q

How do we get H. pylori?

A

route of transmission remains unknown

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15
Q

Is reinfection after cure unusual?

A

YES

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16
Q

Could H. pylori be associated with nongastrointestinal disorders?

A

YES including chronic urticaria, CHD, HTN, migraine, raynaud…

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17
Q

How do you test for H. pylori?

A

Invasive techniques= urease test, histology, bacterial culture.
Noninvasive testing= urea breath test (used more for confirming eradication), stool antigen, serology, or PCR.

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18
Q

When should you test for H. pylori?

A
  • active peptic ulcer
  • PMHx of ulcer
  • Hastric MALT (mucoas-associated lymphoid tissue) lymphoma.
  • Testing should only be performed if treatment is intended.
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19
Q

Are DUODENAL ulcers often associated with H. pylori?

A

YES 95%

20
Q

Are GASTRIC ulcers often associated with H. pylori?

A

YES 75%

21
Q

Is dyspepsia (nausea, uncomfortable, queasiness) often associated with H. pylori?

A

YES 20-60%

22
Q

Is gastric cancer often associated with H. pylori?

A

YES 70-90%

23
Q

** What percentage of patients with H. pylori infection will develop ulcer disease? (TEST QUESTION)

A

only 10-15%

*Thus there must be other factors important in peptic ulcer disease.

24
Q

Does eradication of H. pylori reduce the risk of ulcer recurrence?

A

YES

25
Q

How do we treat H. pylori?

A

mono, dual, triple (PPI, clarithromycin, and amoxicillin), or quadruple therapy

26
Q

What is Zollinger-Ellison syndrome?

A
  • ulceration of the upper jejunum, hypersecretion of gastric acid, and non-beta islet cell tumors of the pancreas.
  • gastric tumor secreting gastrin (gastrinoma)
  • could be sporadic or associated with MEN1= 3 Ps: pituitary, parathyroid, and pancreas.
27
Q

Where are most gastrinomas found?

A

duodenum

*majority of pts develop peptic ulcer disease

28
Q

What are the 2 most common symptoms of gastrinoma?

A

abdominal pain and diarrhea

29
Q

** How do you test for gastrinoma if you suspect it? (TEST QUESTION)

A
  1. fasting serum gastrin level (first option)

2. secretin stimulation test (second option)

30
Q

How do we treat gastrinoma?

A
  • acid suppression (PPI) usually higher dose
  • surgery if not metastatic
  • prognosis is good for 15 years if not metastatic
31
Q

What test is a barium study called?

A

upper GI series. Ulcers will uptake barium!

32
Q

A 42 y.o. male, Hx of several days of abdominal pain, now presents with bright red hematemesis. He admits to ingesting Motrin 800 mg every 8 hours for headaches over the past 2 weeks. After checking blood work including H/H, Plts, PT/PTT, and type and crossing him for blood, you recommend what?

A

Upper endoscopy because anyone who vomits up blood, means you have an UPPER GI BLEED.
*never order upper GI series for an active bleed, because barium won’t show bleeding, and now you can’t do an upper endoscopy for a while until the barium has cleared.

33
Q

What is the difference between gastritis and gastropathy?

A
  • gastrITIS= inflammation of the stomach with epithelial damage and repair.
  • gastrOPATHY= epithelial damage and repair WITHOUT inflammation.
34
Q

What can cause gastritis?

A

infectious agents, drugs, and autoimmune and hypersensitivity reactions

35
Q

What can cause gastropathy?

A

drugs, bile reflux, stress, hypovolemia, and chronic vascular congestion

36
Q

What is watermelon stomach?

A

erythematous radial stripes resembling the rind of a watermelon

37
Q

What is the most common internal cancer worldwide?

A

gastric carcinoma (low in U.S., but high in Japan)

38
Q

How do early and late gastric cancers differ?

A

early does not invade the muscularis propria.
Type 1= polyp like
Type2= flat
Type 3= ulceration

39
Q

What is the prognosis for early gastric cancers?

A

GREAT

40
Q

What is important to remember about all gastric ulcers and healing?

A

you must follow them until they are completely healed!

41
Q

Must all gastric ulcers be biopsied?

A

YES

42
Q

What are bezoars?

A

persistent concretions of foreign matter that are unable to exit the stomach.
*most common are plant and vegetable fibers (phytobezoars), persimmons (disopyrobezoars), hair (trichobezoars)

43
Q

How do you diagnose bezoars?

A

UGI series and endoscopy

44
Q

Will most swallowed foreign bodies pass from the stomach naturally?

A

YES

45
Q

What is gastric volvulus?

A

abnormal degree of rotation of one part of the stomach around another

46
Q

What is organoaxial volvulus?

A

around a line joining the pylorus to the CEF

47
Q

What is mesenteroaxial volvulus?

A

around a horizontal line form the center of the greater curvature to the porta hepatis

Gastrointestinal 1 (21 decks)

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