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Clin Med I- GI > Stomach > Flashcards

Stomach Flashcards

1
Q

GERD definition

A

Reflux of gastric content into esophagus- can be acidic or basic

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2
Q

Tx of GERD

A

PPI- makes the refluxate less acidic. Reglan- decreases episodes of reflux

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3
Q

What is LES comprised of and what is function?

A

LES- comprised of the circular esophageal muscles at the base of the esophagus- held in a state of tonic contraction until person swallows, and then open to allow contents to go from esophagus to stomach

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4
Q

Pathologic reflux is defined by…

A

SYMPTOMS- more than 2-3 episodes of heartburn requiring medicine a week, and DIAGNOSTIC TESTING- DeMeester score above 14.7 on pH probe testing

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5
Q

GERD often associated with…

A

hiatal hernia

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6
Q

Most common symptom of GERD

A

heartburn

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7
Q

Regurgitation of undigested food characteristic in..

A

Zenker’s or achalasia

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8
Q

Patient presents with heartburn, epigastric, substernal pain, a burning/stinging sensation. Regurgitation of digested food. Pain does not radiate to back. Patient describes symptoms as “water brash.” Other symptoms include coughing, aspiration, and occasionally wheezing. Likely diagnosis?

A

GERD

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9
Q

Water brash

A

Excessive salivation accompanying episodes of reflux

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10
Q

3 types of hiatal hernia

A

Type I (sliding), Type II (rolling or paraesophageal), Type III (mixed)

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11
Q

HH Type I

A

Ge junction is intrathoracic

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12
Q

HH Type II

A

GE junction is intra-abdominal, but viscera can herniate into the thorax

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13
Q

HH Type III

A

GE junction and viscera are displaced

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14
Q

Questions about dysphagia to ask to patient with GERD

A

Difficulty with swallowing solid vs. liquid. Often dysphagia to solid comes first, with mechanical obstruction.

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15
Q

Patient with GERD that has dysphagia to liquids and solids equally often associated with…

A

neuromuscular disorder

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16
Q

Cause of obstruction in patients with GERD

A

peptic stricture

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17
Q

GI disorder that is a common cause of asthma in adults

A

GERD

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18
Q

Test recommended to all patients over 40 with GERD or in anyone who does not respond to therapy

A

EGD

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19
Q

Tx for hiatal hernia and GERD

A

double dose PPI for 6 weeks, follow up, check for anemia, lifestyle modification

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20
Q

If GERD patient with no response to PPI, …

A

evaluate for other causes of pain- angina, cholelithiasis, PUD

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21
Q

Major cause of duodenal and gastric ulcers

A

H. pylori

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22
Q

How does H. pylori protect itself form acidic stomach environment

A

Lives in submucosa of stomach- protection from acid and antibiotics. Also, produces urease, which cleaves urea into bicarbonate and ammonia, producing an alkaline environment for itself.

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23
Q

Non invasive vs. invasive diagnostic tests for H. pylori

A

Noninvasive- Urea breath test, fecal antigen, H. pylori serology. Invasive- rapid urease assay and H. pylori histology

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24
Q

Gold standard for determining if H. pylori present

A

H. pylori histology- tissue biopsy during EGD

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25
Q

Effect of H. pylori

A

Damage to stomach- inflammation- increased gastrin levels, increased acid- ulceration or neoplasm

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26
Q

Tx for H. pylori infection

A

Prevpac- Prevacid, Biaxin, amoxicillin or alternate regimens- 4 agents taken Q1D

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27
Q

Common causes of gastritis

A

most common-NSAIDS, H. pylori, alcohol. less often- viral infection, auto immune disorder, bile reflux, cocaine, poisons

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28
Q

Chronic gastritis is a risk factor for ..

A

gastric cancer

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29
Q

Gastritis has strong association with…

A

ulcer disease

30
Q

Patient presents with nausea, loss of appetite, upper abdominal pain, melena, coffee ground emesis, fatigue. Dx?

A

Gastritis

31
Q

You suspect gastritis..what to order in workup?

A

CBC, EGD to examine and biopsy mucosa, H. pylori testing to see if that is the cause, hemoccult testing

32
Q

Gastritis tx

A

remove offending agent, treat infection, suppress the acid

33
Q

Tx of stress gastritis

A

fluid resuscitation, replacement of blood, treatment of underlying condition, NG placement, PPI

34
Q

Prophylaxis tx in stress gastritis

A

Double dose IV PPI’s, sucralfate 1 g q 6 hours per NG

35
Q

Hypertrophic gastritis aka

A

Menetrier’s disease

36
Q

hypertrophic gastritis associated with what other disorders

A

CMV infection in children and H. pylori infection in adults

37
Q

Tx in hypertrophic gastritis

A

anticholinergics, acid suppression, H. pylori eradication, octreotide

38
Q

Gastric ulcer and duodenal ulcer diagnosis

A

UGI, EGD, CBC

39
Q

Patient presents with upper abdominal pain, which is often RELIEVED by food. Also has nausea/anorexia. Fatigue. History of NSAID use, alcohol use, and H. Pylori infection.

A

Gastric ulcer

40
Q

Peptic ulcer disease can be either…

A

gastric or duodenal

41
Q

What are the 2 requirements of duodenal ulcers?

A

Secretion of acid and pepsin, and H. Pylori infection OR NSAID ingestion

42
Q

Tx of gastic ulcer and duodenal ulcer

A

Removal of offending agent, tx of infection, acid suppression, surgery if recurrent or complicated disease

43
Q

3 criteria of ZES

A

Gastric acid (HCl) hypersecretion by parietal cells, severe peptic ulcer disease, and non-beta islet cell tumor of pancreas (gastrinoma)

44
Q

Where are gastrinomas often located

A

Duodenal wall, pancrease, or regional lymph nodes

45
Q

Patient presents with steatorhea and diarrhea. Labs show increased gastrin levels and decreased secretin levels. Patient also has Multiple endocrine neoplasia. Diagnosis?

A

Zollinger-Ellison Syndrome

46
Q

Why do you see steatorhea and diarrhea in ZES?

A

Increased HCl in ZES which causes inactivation of lipase so breakdown of fat not occuring leading to fatty stools- steatorrhea. Increased HCL also causes hyperperistalisis–>diarrhea

47
Q

You have 2 patients with ZES. One has mass in duodenum, other does not. Tx in each case?

A

If mass, resect it. If no mass or metastatic disease, give ppi to reduce acid output to less than 10 mmol/hr. check acid suppression every 3 months.

48
Q

Name benign gastric polyps. Which is most severe?

A

Fundic gland polyp, hyperplastic polyp, adenomatous polyp- can develop into adenocarcinoma

49
Q

When should you remove adenomatous polyp

A

remove surgically when greater than 2 cm.

50
Q

Benign gastric neoplasms

A

Gastric polyps and ectopic pancreas

51
Q

95% of all MALIGNANT gastric neoplasms are…

A

adenocarcinomas

52
Q

Linitis plastica

A

Type IV gastric adenocarcinoma- involves entire stomach

53
Q

Boorman’s classification

A

Type I-5 gastric adenocarcinomas. Type I- polypoid. Type II- ulcerating with elevated borders. Type 3- ulcerating with infiltration. Type 4- diffusely infiltrating

54
Q

Virchow’s node

A

supraclavicular lymph node, indicative of gastric adenocarcinoma

55
Q

Sister Mary Joseph’s node

A

Periumbilical node, indicative of gastric adenocarcinoma

56
Q

Blumer’s shelf

A

peritoneal metastasis in the pelvis palpable on rectal exam

57
Q

Patient presents with weight loss, vomitting, indigestion, dysphagia. PE shows palpable abdominal mass, supraclavicular and preumbilical lymph nodes. Blumer’s shelf, hepatomegaly, jaundice, ascites, cachexia. Dx?

A

Gastric adenocarcinoma

58
Q

What is the problem with double contrast UGI in diagnosing gastric adenocarcinomas?

A

very accurate, but cannot separate benign from malignant ulcers

59
Q

Diagnosis of gastric adenocarcinoma made by…

A

biopsy taken during EGD

60
Q

gastric lymphoma tx

A

Chemo includes CHOP- cyclophosphamide, hydroxydaunomycin, oncovin, prednisone and radiation

61
Q

Where does gastric sarcoma arise from?

A

mesenchymal cells. a GIST.

62
Q

Dieulafoy’s lesion

A

large tortuous vessel in the submucosa

63
Q

In which disorder would you see Borchardt’s triad?

A

gastric volvulus

64
Q

Patient presents with sudden constant, severe pain, recurrent retching with little emesis, and inability to pass an NG tube. Dx?

A

Borchadt’s triad indicating gastric volvulus

65
Q

Patient has nausea, vomiting, upper abdominal pain, early satiety, bloating. Sx are worse with eating. There is slow gastric empyting due to denervation. What are you concerned about?

A

Gastroparesis

66
Q

Diagnosis of gastroparesis

A

EGD, UGI, gastric emptying study

67
Q

Tx of gastroparesis

A

prokinetics including Reglan and erythromycin and surgery (feeding tube)

68
Q

Types of bezoars

A

phytobezoar and trichobezoar

69
Q

Which bezoar has an underlying psychiatric disorder

A

trichobezoar

70
Q

Which bezoar usually has some underlying gastric motility disorder?

A

phytobezoar

Clin Med I- GI (10 decks)

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