Diseases of the Stomach and Duodenum

Question 1

Common complaint with disorders of the stomach

Answer 1

Dyspepsia

Question 2

inflammatory changes in the gastric mucosa

Answer 2

gastritis

Question 3

Common causes for erosive and hemorrhagic gastritis conditions

Answer 3

stress, NSAIDs, and alcohol, portal hypertension

Question 4

What are contributors for nonerosive, nonspecific gastritis?

Answer 4

H. pylori, pernicious anemia, eosinophilic gastritis

Question 5

Symptoms include: anorexia, epigastric pain, N/V, and upper GI bleeding

Answer 5

erosive or hemorrhagic gastritis

Question 6

What symptoms are associated with upper GI bleeding?

Answer 6

melena, coffee ground emesis, blood w/nasogastric suction

Question 7

What is included in the work-up of an upper GI bleed?

Answer 7

CBC, serum Fe, upper endoscopy

Question 8

How soon might stress gastritis occur in a critically ill patient?

Answer 8

within 72 hrs of admission

Question 9

Treatment for GI bleeding secondary to stress induced gastritis

Answer 9

IV PPI bolus followed by continuous infusion

Sucralfate suspension given orally

Question 10

What subtype of NSAIDs have a lower incidence of significant ulcer formation?

Answer 10

Cox-2 inhibitors

Question 11

What should be ordered if a patient presents with dyspepsia and any of the following symptoms: severe pain, weight loss, vomiting, GI bleeding, anemia?

Answer 11

upper endoscopy-these are red flags

Question 12

What is the treatment for a patient who presents with dyspepsia and no associated red flags?

Answer 12

discontinue NSAIDs, trial PPI 2-4wks. If no improvement, endoscopy referral

Question 13

Due to excessive ETOH consumption. Symptoms include dyspepsia, nausea, emesis, minor hematemesis

Answer 13

Alcoholic Gastritis

Question 14

Treatment for alcoholic gastrititis

Answer 14

H2 blockers or PPIs and sucralfate 2-4 weeks

Question 15

Treatment for portal hypertensive gastropathy

Answer 15

propranolol or nadolol

Question 16

Break in the gastric or duodenal mucosa >5mm in diameter and extend through muscularis mucosae. Can be caused by too much acid or pepsin

Answer 16

Peptic ulcer disease

Question 17

Most common location for gastric ulcers

Answer 17

antrum

Question 18

What is the difference between duodenal ulcers and gastric ulcers in terms of their age distribution at presentation?

Answer 18

duodenal ulcers more common btw 30-55yrs and gastric ulcers are more common btw 55-70 yrs

Question 19

What are the two most common etiologies of peptic ulcers?

Answer 19

NSAIDs and chronic H.pylori infection

Question 20

Clinical presentation includes: dyspepsia, periodic pain in epigastric region relieved w/food or antacids, sometimes nocturnal pain

Answer 20

peptic ulcers

Question 21

Physial exam is often normal. Might be epigastric tenderness w/deep palpation. FOBT or FIT may be positive

Answer 21

peptic ulcers

Question 22

Test of choice for the work-up of peptic ulcers

Answer 22

upper endoscopy

Question 23

What type of imaging is needed if ulcer perforation is suspected?

Answer 23

abdominal CT

Question 24

What are the primary pharmacological medications for peptic ulcer disease?

Answer 24

PPIs and H2 blockers

Question 25

What are the second line agents to enhance mucosal defenses in peptic ulcer disease?

Answer 25

bismuth, misoprostol, and antacids

Question 26

How soon are 90% of duodenal and gastric ulcers healed after PPI therapy has been initiated?

Answer 26

duodenal ulcers in 4 weeks. | gastric ulcers in 8 weeks.

Question 27

How soon are 85-90% of duodenal ulcers and gastric ulcers healed after initiation of H2 blocker therapy?

Answer 27

duodenal ulcers at 6 weeks. gastric ulcers at 8 weeks

Question 28

Drug that should be avoided with H2 blockers

Answer 28

Cimetidine

Question 29

Causes 75-90% of duodenal ulcers. Associated with increased gastric acid secretion. fecal-oral spread. Increases risk of gastric cancer

Answer 29

h. pylori infection

Question 30

Combination therapy for H.pylori eradiaction

Answer 30

2-3 antibiotics + PPI or bismuth (“Triple or Quadruple Therapy”)

Question 31

Treatment after triple or quadruple therapy for ulcers

Answer 31

``` Small ulcer (<1 cm) no further treatment. Large or complicated ulcer continue PPI for up to 6 weeks ```

Question 32

When should a patient be retested for H.pylori?

Answer 32

> 4 weeks post antibiotic therapy and > 2 weeks post discontinuation of PPI

Question 33

Gastrin secreting gut neuroendocrine tumor. Causes hypergastrinemia from increase acid secretion

Answer 33

Zollinger-Ellison Syndrome (Gastrinoma)

Question 34

Where are most tumors located in Zollinger-Ellison Syndrome (Gastrinoma)?

Answer 34

duodenal wall (45%)

Question 35

Cinical presentation includes: dyspepsia, peptic ulcers, diarrhea/steatorrhea/weight loss if pancreas affected

Answer 35

Zollinger-Ellison Syndrome (Gastrinoma)

Question 36

What is the best imaging study to find tumors associated with Zollinger-Ellison Syndrome (Gastrinoma)?

Answer 36

SPECT: Somatostatin receptor scintigraphy (SRS)

Question 37

Delayed gastric emptying in the absence of a mechanical obstruction

Answer 37

gastroparesis

Question 38

Common causes of gastroparesis

Answer 38

1-idiopathic (~50%), post-op, DM

Question 39

Which type of DM patient is more likely to experience gastroparesis?

Answer 39

type 1

Question 40

What are two viruses that may cause gastroparesis?

Answer 40

norwalk and rotavirus

Question 41

Symptoms include: N/V, early satiety, bloating, upper abdominal pain

Answer 41

gastroparesis

Question 42

What are the dietary modifications to help treat gastroparesis?

Answer 42

small meals 4-5x, low fat, avoid insoluble fiber/ETOH/carbonation/tobacco

Question 43

Name the prokinetics used to treat gastroparesis

Answer 43

Metaclopramide and Macrolide antibiotics

Question 44

Prokinetic that is used as a liquid formulation 15 min prior to eating. serious drug interactions that can lead to irreversible tardive dyskinesia. 12 week prescription with 2 week holiday

Answer 44

Metoclopramide

Question 45

Prokinetic that induces gastric contraction and stimulates fundic contractility. Liquid formulation 40-250mg TID. Use no longer than 4 weeks

Answer 45

Erythromycin

Question 46

First line antiemetic for persistant N/V caused by gastroparesis

Answer 46

Diphenhydramine 12.5mg po q 6-8 hrs

Question 47

Surgical treatment for refractory cases of gastroparesis

Answer 47

Gastrostomy tube for decompression and jejunostomy for feeding