Acid Diseases of the Stomach

Question 1

what are the relative PPI potencies?

Answer 1

When measured as omeprazole equivalents, pantoprazole has the lowest potency, followed by lansoprazole, omeprazole and rabeprazole.

Question 2

in the setting of an acute bleed, when should aspirin be resumed?

Answer 2

w/n 7 days of adequate hemostasis

Question 3

any advantage in enteric coated or buffered aspirin in reducing the risk of recurrent bleeding?

Answer 3

No

Question 4

what does mechanical ventilation have anything to do with GI bleeds?

Answer 4

use of mechanical ventilation for >48hr is an independent risk factor for GI bleeding, and warrants ppx

Question 5

what is the primary risk factor for developing marginal ulcers in pts w/ rouxen-y gastric bypass?

Answer 5

relative ischemia to the gastroenterostomy

and long gastric pouch

and NSAID use, smokers, and DM

Question 6

what is a way to reduce healing time of marginal ulcers in roux-en-y pts?

Answer 6

open the omeprazole capsule

Question 7

what are risk factors that increase chance of fundic gland polyps developing dysplasia?

Answer 7

dysplasia of FGP’s is associated w/ large polyp size, presence of astral gastritis, and pts w/ FAP

Question 8

True or False.

Hemostatic powder TC325 (Hemospray) can be used for bleeding ulcers

Answer 8

False.

Hemostatic powder TC325 (Hemospray) is a treatment of choice for bleeding tumors or postendoscopic bleeding, but NOT for bleeding ulcers

Question 9

in pernicious anemia, what are the following values (high/low):

• gastric pH
• serum gastrin level
• secretin stimulation test
• parietal cell mass

Answer 9

in pernicious anemia, there is destruction of parietal cells –> atrophic gastritis –> high gastric pH –> high serum gastrin.

secretin stimulation test is negative.

secretin stimulation test is positive for Zollinger-Ellison Syndrome

Question 10

what are situations that increase gastrin level?

Answer 10

CAUSES OF HYPERGASTRINEMIA:
ACIDIC GASTRIC PH:
- gastrinoma (sporadic or associated w/ MEN-1)
- astral predominant Hp pylori gastritis
- pyloric obstruction
- renal failure and uremia
- post-gastric resection w/ intact antrum, especially Billroth II

ELEVATED GASTRIC PH:

• chronic atrophic gastritis a/w pernicious anemia (autoimmune CAG)
• chronic atrophic gastritis a/w chronic H pylori (H pylori-related CAG)
• PPI use
• H2RA use
• post-vagotomy

also, measuring serum gastrin level postprandially will cause elevated level

Question 11

what are two independent risk factors for stress ulcers?

Answer 11

mechanical ventilation 48hrs or more

coagulopathy (pat <50k or INR > 1.5)

secondary risk factors for stress ulcers:

• high dose steroids
• sepsis
• large surface area burns
• ARF
• ALF

Question 12

what kind of gastric ulcers can pts on immunosuppression get?

Answer 12

CMV gastric ulcers - multiple, shallow ulcers