Clinical-Stomach Disorders Flashcards by Michael Dennis

What is Portal hypertension gastropathy

Congestion of the capillaries and venules of the gastric mucosal and submucosal layers

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What can be given in the case of portal hypertensive gastropathy to reduce recurrent bleeding

Propranolol or nadolol

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What is the most common clinical manifestation of erosive gastritis

Upper GI bleeding, resulting in hematemesis, “coffee ground” emesis, or bloody aspirate during nasogastric suction
*Usually not hemodynamically significant bleeding

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During hemorrhagic gastritis, what is the method of diagnosis and what is the state of inflammation

Upper endoscopy, which will not show significant inflammation on histology

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What is the location of Type A gastritis

Body predominant

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In Type A gastritis, what are the autoimmune mechanisms associated with

achlorhydria
pernicious anemia
gastric cancer risk

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What antibodies are present in the majority of type A gastritis

Antibodies to parietal cells

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What is the process of Achlorhydria

Hypergastrinemia due to loss of regulation on G cells

- Hyperplasia of ECF cells (due to increased gastrin)

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What can achlorydia lead to

Small multi centric carcinoid tumors

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What population is more common for pernicious anemia gastritis

Females

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What are the effects of pernicious anemia gastritis

Megablastic anemia (due to decrease IF secretion and B12 absorption)
Autoimmune destruction of gastric fundic mucosa
Increased risk for gastric adenocarcinoma

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What is the cause of Type A gastritis

Rare autoimmune disorder involving the fundic glands

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What is the location and cause of type B gastritis

Antral dominated infection with H. Pylori

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H pylori is associated with an increased risk of which condition

Gastric cancer

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What is the characteristic morphology associated with Menetrier disease

Giant thickened gastric folds in the body of the stomach

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What are the symptoms of Menetrier disease

-Chronic protein loss, leading to anasarca (general swelling throughout the body)

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Where does peptic ulcer disease most commonly occur

Duodenal bulb and stomach

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What are the typical descriptions given by the patient for peptic ulcer disease

gnawing
dull
aching
“hunger like”

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What are the signs of peptic ulcer bleeding

“Coffee grounds” emesis

hematemesis
melena
hematochezia

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What is the rule of thumb for exclusion of nasogastric lavage fluid without blood with regards to active bleeding of a duodenal ulcer

Does not rule it out

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What is the prevalence of H pylori in duodenal bleeds, and what is the cause

70-90% and due to increased gastric acid secretion

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What is the prevalence of H. Pylori in gastric ulcers and what is the cause

Infection of the gastric body decreased acid secretion

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What are the factors that can cause ulcers and are not H pylor related

Study These Flashcards

NSAIDs, corticosteroids, anticoagulants, smoking

What are the tests that can be preformed to test for H. Pylori

Study These Flashcards

Urea breath test

Fecal antigen test

What is the protocol for being able to test for H. Pylori without a false negative

Stop the PPI for 14 days, as well as 4 weeks after completing antibiotic treatment

What is the stain used to see H pylori

Warthin-Starry silver stain

What is the complication with an ulcer in the posterior wall of the duodenum or stomach

Perforation into the pancreas, liver, or biliary tree

What is the treatment for an active GI bleed due to ulcer

-Continuous infusion with PPI via IV starting with a bolus

What are some complication of surgery for peptic ulcer disease

- Obstruction - Bile reflex gastritis - Bezoar (GI mass) - anemia - malabsorption - osteomalacia

How does H pylori cause a duodenal ulcer

-Causes the hyper secretion of gastric acid, which stimulated the antral G cells and increased activity of parietal cells

How does H pylori cause a gastric ulcer

In the lesser curvature of the antrum, but infects the cells celled, causing a decrease in the protective mechanisms

What is the clinical feature with regards to timing in duodenal ulcers

Gets better with food

What is the clinical feature with regards to timing in a gastric ulcer

Gets worse with food

What is the process of treatment for gastric ulcers

Eradication of H. Pylori | Followed up with EGD to rule out malignancy

What are the histological findings in gastric adenoma

Signet ring cells | Linitis plastica

What are the physical exam findings that are consistent with gastric adenocarcinomas

Virchow sentinel node (left supraclavicular node) | Krukenberg tumor

What are the clinical findings that may lead to the diagnosis of Zollinger-Ellison (ZE syndrome)

Ulcer disease is: - Severe - Refractory to therapy - diarrhea, yet NGT section stops it

What is the common location of a gastrinoma

Aka ZE tumor - Duodenum (45%) - Pancreas (Pancreatic)

Which condition is Zollinger Ellison associated with

MEN-1

What are the conditions commonly seen in MEN1

Gastrinoma, hyperPTH (and calcium), pituitary neoplasms

What finding on endoscopy would suggest diagnosis of Zollinger Ellison

Large mucosal folds

Which diagnosis can be made with a positive secretin test

Zollinger ellison, because it is the only gastrinoma that will respond

What is the level of gastrin that must present for the diagnosis of Zollinger-ellison

> 1000 ng/L

What are the levels in the blood that are checked for Zollinger ellison syndrome

- Serum PTH - Prolactin - LH-FSH - GH

In patients with MEN1, what is the usual prognosis of Zollinger Ellison

Not good, as they are usually multifocal and unresectable

What is the endocrine cause of gastroparesis

Diabetes mellitus

What are the 3 general conditions that can cause gastroparesis

Endocrine Neurological Postsurgical

What is the ideal method for assessing gastric emptying

Gastric scinigrapy with a low fat solid meal

What is the condition of gastric paresis

Chronic condition of intermittent, waxing and waning symptoms and signs of gastric obstruction in the absence of mechanical lesions

What is the treatment of gastroparesis

No specific therapy, but acute cases can be helped with NG suction and IV fluids

What is the recommended meal for those patients with gastroparesis

-Low in fiber, milk, gas forming, and fat

Which agents in gastroparesis should be avoided

-Opiods and others that reduce GI motility

In the treatment of gastroparesis with metocloparmide, what is the risk of tar dive dyskinesia

Less than 1% and defined as involuntary motions such as eye blinking and smacking of the lips

What is the characteristic of food or foreign body impaction

Inability to swallow liquids, including their own saliva

What is the condition of postvagotmy

Aka dumping syndrome -rapid food passage into the small intestine, leading to distention as a result of the osmotic flow into the lumen, resulting in reactive hypoglycemia

Clinical-Stomach Disorders Flashcards

(55 cards)